May 08, 2015

Miami Democrats, Jackson hospital workers rally for Medicaid expansion

via @dchangmiami

Democratic state representatives and Jackson Health System nurses and doctors on Friday called for Republicans, including Gov. Rick Scott and House leaders, to expand Medicaid healthcare coverage for more low-income Floridians and also preserve a federal program that funds hospitals that treat large numbers of uninsured patients.

The rally — hosted by Jackson’s labor union for doctors and nurses, SEIU 1991, in front of the state’s busiest public hospital, Jackson Memorial — drew several hundred hospital employees and at least three House Democrats who support a plan approved by the Republican-controlled Florida Senate but rejected by House leaders.

The plan would expand Florida’s restrictive eligibility criteria for Medicaid, the federal-state health program for the poor and disabled, and renew a hospital funding program called the Low-Income Pool, or LIP, that provides about $1.3 billion for hospitals but is set to expire on June 30.

The healthcare issue is at the center of a stalemate between the two chambers that led House leaders to abruptly end the legislative session without adopting a budget — the one job they are constitutionally required to complete.

More here.

Kansas, Texas say Florida lawsuit is 'more than an isolated dispute'

For those of you following Republican Gov. Rick Scott's lawsuit against the Obama Administration, here's a copy of the amicus brief filed by Texas and Kansas.

The two states announced their plans to join the suit earlier this week.

The opening line of their brief: "This lawsuit is more than an isolated dispute between Florida and a federal agency."

Download Amicus

May 07, 2015

Gov. Rick Scott seeks immediate action in healthcare lawsuit

ScottGov. Rick Scott took another jab at the Obama Administration Thursday, asking the court to take immediate action in his lawsuit against federal healthcare officials.

The lawsuit, filed last week in federal court, alleges that the U.S. Department of Health and Human Services is trying to coerce Florida into expanding Medicaid by threatening to end a $2.2 billion program that helps hospitals pay for uncompensated care.

The Republican governor now wants a court-ordered injunction to stop federal health officials from tying the two programs.

"Unless this unconstitutional coercion is redressed, it will have immediate and devastating consequences for Florida, its healthcare providers, and its residents," Scott's attorneys wrote Thursday.

HHS has long maintained that Medicaid expansion is a state decision.

The agency says it is willing to work with Florida to address uncompensated care, regardless of the state's Medicaid expansion status. But top federal health officials have also said they want Florida to expand health insurance coverage, which would reduce the need for the so-called Low Income Pool, or LIP.

Florida has yet to learn if LIP will be renewed next year. The program is scheduled to end on June 30 unless the federal government approves a proposed successor program.

If no deal is reached, Jackson Health System in Miami and Tampa General could face $200 million and $86 million in cuts, respectively.

Scott made an appeal for the money to HHS Secretary Sylvia Burwell on Wednesday, but left Washington empty handed. The agency later published a statement saying the Florida proposal fell short of the federal guidelines for funding uncompensated care pools, and that Florida seemed to be asking for too much money.

May 06, 2015

Gov. Rick Scott meets with feds, but still no healthcare funding resolution

via @learyreports

WASHINGTON - Gov. Rick Scott's trip here in search of a way to plug Florida's hospital funding shortfall didn't pay off.

Scott met with U.S. Health and Human Services Secretary this morning to talk about renewing a $2.2 billion hospital funding program for Florida. HHS has told Florida the program is being phased out. Afterward, Scott told reporters "we don't have a resolution" to the funding dispute.

Florida lawmakers have been unable to agree on how to plug the gap left by ending the Low Income Pool (LIP) program or whether to endorse a Medicaid expansion, a conflict that led to the abrupt end of the Legislature's regular session a week ago. The state has not yet approved a budget for its fiscal year beginning July 1.

"Now we're in a time crunch," Scott said. "If we don't have an answer our only solution is a base budget. That's what I'm working on now, is to make sure that we keep government working. Let's remember, this started with a federal government program for low-income families. Low income families deserve to have an answer."


--ALEX LEARY, Tampa Bay Times

May 05, 2015

Gov. Rick Scott to meet with top HHS official

Republican Gov. Rick Scott will meet with U.S. Department of Health and Human Services Secretary Sylvia Burwell on Wednesday to discuss the future of an important hospital funding program, his office said.

Uncertainty over the $2.2 billion Low Income Pool, which reimburses safety-net hospitals and county health departments for uncompensated care, has paralyzed state lawmakers tasked with building the state budget.

The program is scheduled to end June 30, unless the federal government approves a proposed successor program.

"I look forward to meeting with HHS Secretary Sylvia Burwell tomorrow to discuss the importance of funding the federal Low Income Pool program in Florida," Scott said in a statement. "We hope HHS will reconsider LIP funding in Florida, and it's critical for us to get that information immediately so the Legislature can construct a budget that best meets the needs of low income families during a special session."

Will the feds welcome Scott with open arms? Maybe not.

Last week, the governor filed a lawsuit accusing Burwell's agency of trying to coerce Florida into expanding Medicaid by threatening to cut off LIP funding. Kansas and Texas joined the legal challenge Monday.

And don't forget about the Scott Administration's bizarre back and forth with the U.S. Centers for Medicare and Medicaid Services (CMS). In early April, Scott's top healthcare administrator sent out a press release saying CMS had suddenly suspended the negotiations over LIP. But federal health care officials essentially said the release was untrue. 

May 04, 2015

Kansas, Texas to support Gov. Rick Scott's lawsuit against the feds

ScottKansas and Texas are joining in Gov. Rick Scott's lawsuit against the federal government over health care funding, Scott's office announced Monday.

The legal challenge alleges that federal health officials are trying to coerce Florida into expanding Medicaid by threatening to end the $2.2 billion Low Income Pool program, which reimburses hospitals for uncompensated care.

Scott has said the two health care issues should be kept separate.

His lawsuit will now have the support of Kansas Governor Sam Brownback and Texas Governor Greg Abbott, both of whom are Republicans.

"I am glad Kansas and Texas are joining our fight against the Obama Administration for attempting to coerce Florida into Obamacare expansion by ending an existing federal healthcare program and telling us to expand Medicaid instead," Scott said in a statement. "The U.S. Supreme Court has already called this sort of coercion tactic illegal. Making sure all of our families have access to affordable, high quality health care is incredibly important and we will continue to fight to protect the health care of all of our families."

Kansas and Texas are in a similar situation when it comes to healthcare funding.

The Republican-led Legislatures in both states have rejected federal Medicaid expansion money. But each receives supplemental federal funding for hospitals that treat large numbers of uninsured and Medicaid patients. The program in Texas is scheduled to end in September 2016. The program in Kansas runs through 2017.

In a statement, Brownback characterized the Florida lawsuit as an "effort to stop the Obama administration from cutting off health care dollars for the Low Income Pool in an effort to force Obamacare upon the states."

"In joining with Florida and Texas, Kansas is protecting the states' right to make their own determinations about these issues," he said.

April 29, 2015

Could Medicaid Expansion debacle be an opening for House Democrats?


Robocalls. Rallies. Snarky social media comments that are on message.

It's good to be a Florida House Democrat these days.

Just six months ago, they were in the doldrums. They had lost six seats in the November elections and were facing an 81-39 disadvantage in the lower chamber. 

But on Wednesday, the Democrats were in a more celebratory mood. The day before, House Speaker Steve Crisafulli, R-Merritt Island, told members to go home. The budget impasse was too broad to bridge because of the House's disagreement with the Senate on Medicaid expansion.

The House Democrats have been pushing for Medicaid expansion for three years now. The stalemate between the House Republicans and the Senate on the budget guaranteed exactly what House Democrats couldn't do: force a meaningful debate.

"We've been the adult in the room this year," said Minority Leader Mark Pafford of West Palm Beach, to Democrats during a Wednesday caucus meeting. "We were willing to listen and consider alternatives and then everything got dropped."

Although the caucus didn't remain unified on a House budget that was crafted by Republicans and didn't include Medicaid expansion (only 29 of the 39 voted against it), they've been pretty much unified behind Pafford and Rep. Mia Jones, D-Jacksonville, who has been the lead policy adviser on the issue.

"We stand in stronger position because of this issue," Pafford told members. "The one issue that they don't want to talk about, we've forced them to talk about. We've been disciplined. Give yourself a hand. We kicked some ass."

Continue reading "Could Medicaid Expansion debacle be an opening for House Democrats?" »

Florida House says it is ready to build a budget

CrisafulliOne day after abruptly ending the legislative session, the House announced it is ready to begin the budget process.

The announcement from House Speaker Steve Crisafulli, R-Orlando, came in response to a late statement issued by the Centers for Medicare and Medicaid Services, or CMS.

"Last night, after Gov. [Rick] Scott and Attorney General [Pam] Bondi filed a lawsuit on behalf of Florida, CMS issued a statement reversing their earlier position that [Low Income Pool] funding and Medicaid Expansion are linked," Criasfulli wrote in a Wednesday morning memo to members. "We applaud CMS for their statement, and agree that the policy preference of the Obama administration should not be used as leverage for the Low Income Pool. The House stands ready to secure allocations and get into budget conference in order to finish our constitutional duty to pass a balanced budget."

But that wasn't the only interpretation of the CMS statement.

During a meeting of the House Democrats Wednesday, Rep. Mia Jones insisted that CMS had not backed off of its earlier position, noting that the agency would still rather expand coverage than provide additional dollars for uncompensated care.

"Don't get caught up in the interpretation from the other side," she warned her colleagues.

Senate Health and Human Services Subcommittee Chairman René García, R-Hialeah, said he, too believed the two programs were still linked, both in the eyes of the Florida Senate and federal health officials.

"The linkage is the population of people that [the programs] cover," he said.

García said the Senate would not shift its position based on the statements from CMS or Crisafulli.

"We have to find a solution to the uninsured problem in the state of Florida," he said.

Former Senate President Gaetz takes jabs at House leaders after early sine die

The day after House Republicans unexpectedly ended session early, Sen. Don Gaetz said lawmakers need to start working together or risk looking like they can’t get anything done.

“We ought to wave a copy of the Constitution under everybody’s nose and say we have a constitutional obligation to pass a budget and we’ve got to pass it by June 30,” Gaetz, R-Niceville, said. “If not, we’re Washington. We look like Washington.”

Coming from a Florida Republican, that’s like saying lawmakers look completely incompetent.

Yet he is confident state lawmakers will get to a point of compromise. It just may take a little bit of a cooling-down period.

Republicans in the two chambers and Gov. Rick Scott have been at the heart of the budget stalemate that has roiled the Legislature this year. And as arguments have escalated, Gaetz said his party — which controls both legislative chambers and all four statewide elected offices — doesn’t come off looking particularly strong.

“Circular firing squads never help win elections,” he said.

But Gaetz, who said he had a very positive relationship with House Speaker Will Weatherford when he was president of the Senate, took pointed jabs at leadership in the House.

“Kind of like an old married couple, we never let the sun go down on bitterness or anger or disagreement,” Gaetz said. “I’m sorry that President (Andy) Gardiner hasn’t had that kind of a partnership with whoever is in charge over in the House.”

That phrase — “whoever is in charge” — undoubtedly refers to the House leadership power couple of Speaker Steve Crisafulli and Appropriations Chair Richard Corcoran. The designated speaker for the 2017-18 sessions, Corcoran has taken a hard stand against Medicaid expansion, arguing passionately against it on the floor.

Last weekend, he took his debate to Twitter:

Gaetz, not a Twitter user himself, said now is not the time for such things, but he does have some confidence in the House.

“There’s a shortage, right now, of leadership, but I think it’ll arise,” he said. “Now’s a good time for our friends in the House of Representatives to go home and calm down and think about their constitutional responsibilities.”

April 28, 2015

CMS to Florida: LIP is not linked to Medicaid expansion

Hours after Gov. Rick Scott announced he's filed a lawsuit suing the federal government for linking the Low Income Pool to Medicaid expansion, CMS released a statement saying that LIP funding is "not dependent on whether it expands Medicaid." Here's the lawsuit. 

Here's the statement from Aaron Albright, spokesman for CMS:

“The decision to expand Medicaid, or not, is a state decision. We will work with Florida and each state that has an uncompensated care pool regardless of its Medicaid expansion status, to support access to health care for low-income residents that works for individuals, hospitals and taxpayers, taking into account the state’s specific circumstances. CMS will review proposals regarding uncompensated care pools based on the same principles whether or not a state has expanded Medicaid.” 

Additional background information from CMS:

·         We do not comment on pending legal action.

·         Uncompensated care pools, such as the Low Income Pool in Florida, are optional demonstration programs that CMS has approved for a limited time period to enable states to help offset the costs borne by health care providers in providing care to uninsured residents. 

·         The LIP is authorized as part of a broader optional, time limited demonstration program, and that authority has long been scheduled to expire June 30.

·         Whether or not a state receives federal funding for an uncompensated care pool is not dependent on whether it expands Medicaid.   However, as we said in our April 14 letter, pool funding should not pay for costs that would be covered in a Medicaid expansion. 

·         In addition, we said that Medicaid payments should support services provided to beneficiaries and low-income uninsured individuals; and provider payment rates must be sufficient to promote provider participation and access, and support plans in managing and coordinating care.