March 25, 2014

Nobody wants to talk about Medicaid expansion

The debate that dominated last year’s legislative session hasn’t gone away.

Hospitals, powerful business alliances and grassroots advocacy groups still believe Florida should access the billions of federal dollars available for Medicaid expansion.

The difference between this year and last: Nobody wants to talk about it.

House Republicans, who blocked a similar move in 2013, say there is no point in having the contentious conversation again.

“The federal government has parameters that are too constrictive,” said Rep. Richard Corcoran, R-Land O’Lakes, of the guidelines for accepting the money. “Until the feds say they will give us flexibility, there is no reason to move forward.”

But critics say election-year politics are at play. Polls show that some registered Republicans in Florida oppose Medicaid expansion. And in an election year, Republican lawmakers are particularly wary of supporting policies associated with Obamacare.

“Ideology is the only thing stopping House Republicans from moving forward on this issue,” House Democratic Leader Perry Thurston said. “Not expanding healthcare is the wrong thing for Florida.”

Last year, the Senate unanimously approved a bill that would allow the use of federal Medicaid expansion dollars to buy private insurance policies for poor Floridians.

Read more here.

March 17, 2014

Senate Democrats say Medicaid expansion would free up $470M state dollars


What could Florida do with $470 million extra dollars to spend?

That is the question Senate Democrats are asking now that they've calculated the state would have that money to spend if it accepted $51 billion federal Medicaid expansion dollars. They have answers, too, outlining this morning how they would spend the money.

A plan to use Medicaid expansion dollars to buy private insurance for poor Floridians was rejected by House Republicans last year. Two bills intended to reignite the issue during the 2014 session aren't going anywhere.

Lately, proponents of Medicaid expansion have tried to make a business case. They say reducing the number of uninsured Floridians creates jobs and helps small businesses save money they would otherwise have to spend insuring low-wage workers. But House Republicans still haven't budged, and Gov. Rick Scott is now avoiding the topic.

Senate Democrats said the $470 million is a "conservative estimate" based on various studies of the impact of Medicaid expansion by the state Agency for Health Care Administration, Georgetown University's Health Policy Institute, Florida Center for Fiscal and Economic Policy and state budget analysts.

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March 13, 2014

Proposal would limit Medicare coverage for some Florida drug testing

Attorney General Pam Bondi is fighting a plan that would limit Medicare coverage for some drug testing in Florida and could allow accidental deadly drug combinations.

The proposal, by the Jacksonville-based Medicare contractor First Coast Service Options, would restrict reimbursement for confirmatory tests, which are used to check the accuracy of drug screenings.

In a Tuesday letter to Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner, Bondi cited Florida’s “protracted battle against prescription and illicit drug use,” and said the new guidelines would “restrict access to one of the most critical tools for identifying drug abuse and misuse.”

“Our fear is if Medicare goes down this road, Medicaid will soon follow suit,” Bondi said.

Read more here.

March 09, 2014

How HCA turned trauma into a money-maker as regulators, legislators look away

From the Tampa Bay Times:

Last year in western Pasco County, 16-year-old Mason Jwanouskos was in the backseat of a convertible when his friend lost control and crashed into a stone pillar. He couldn't have picked a more expensive place to get hurt.

If he had crashed 30 miles to the south, he would have gone to one of three trauma centers in Tampa or St. Petersburg. They likely would have charged him about $30,000, their typical charge for patients with a concussion.

But Mason was closer to the trauma center at Regional Medical Center Bayonet Point.

His bill: $99,000.

Mason's uninsured parents were not billed three times more because their son got vastly better treatment. Bayonet Point offers the same kind of care as any state-certified trauma center.

The family's bill was so high because Mason, through no choice of his own, wound up at a trauma center run by Hospital Corporation of America.

An unprecedented analysis of state records by the Tampa Bay Times has found that HCA trauma centers, as a group, are charging injured patients tens of thousands of dollars more than Florida's other trauma centers.

The difference has nothing to do with the level of care provided.

Instead, HCA is capitalizing on a marketplace that is unchecked by politicians or regulators. That has allowed one of the nation's largest for-profit hospital chains to bill injured patients record fees, the Times has found. More here.

March 05, 2014

Sen. Garcia says House GOP should get on board with Medicaid expansion


 There is a large, bipartisan coalition that supports using federal Medicaid expansion dollars to provide insurance coverage to poor, working-class Floridians. But their efforts were blocked last year by House Republicans.

That hasn't stopped Sen. Rene Garcia, R-Miami, and Rep. Amanda Murphy, D-New Port Richey, from trying again by filing identical bills asking for reconsideration of the failed plan. Both joined the League of Women Voters of Florida for a rally today where they implored the House GOP to "take the money."

Both SB 710 and HB 869 have been referred to committees but have yet to be slotted for a hearing. Garcia feels confident he will get one in the Senate, but Murphy may have a tougher road. She spoke to House leaders before filing the bill but there is no indication the Republican majority is willing to budge.

Business and civic groups that support Medicaid expansion have to work to change that, Garcia said.

"We just need to get the message out, educate the House members and put the pressure on the leaderhsip in the House to accept these dollars and move forward," Garcia said.

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March 04, 2014

Florida Health Choices state-based marketplace now live


After years of delay -- and some last-minute website concerns that slowed things down a few more weeks --- Florida's state-based health exchange has finally launched at

Florida Health Choices was the vision of then-House Speaker now U.S. Sen. Marco Rubio. But it has changed in scope over the years, partially because the federal insurance marketplace tied to the Affordable Care Act stole lots of thunder from Rubio's pet project when it launched last year.

The state-based exchange has taken a new direction. It offers discount cards and prepaid plans for services like dental and vision. There are even virtual doctor visits and access to a 24-hour nurse hotline that can be purchased. Unlike the federal site, Florida Health Choices does not offer insurance or provide financial assistance to help customers afford its options.

The Florida Health Choices board decided to target the uninsured who don't qualify for subsidies to afford policies on the Obamacare site, as well as people who may be looking for plans to supplement the insurance they already have.

The site's was delayed because news coverage of its pending launch caused web traffic to skyrocket, creating concerns about whether it could handle the demand. The site's administrators are planning for a soft launch and won't actively market Florida Health Choices initially to make sure everything runs smoothly.

March 02, 2014

New Medicaid law to sting Jackson

Jackson Memorial Hospital is bracing again for big cuts — this time, the result of a new law that will send millions of federal dollars that used to go to Miami-Dade hospitals elsewhere in the state.

When the provision takes effect in July, healthcare systems across Miami-Dade County stand to lose $218 million in Medicaid matching funds, also known as Low Income Pool funds.

Jackson alone will shoulder a $140 million hit. “That would be fairly catastrophic,” Chief Executive Officer Carlos Migoya said. “We’re at a point right now where we are fairly efficient. It’s not like we have a whole lot of extra fat to cut.”

Tony Carvalho, president of the Safety Net Hospital Alliance of Florida, says the new funding system should be repealed. “We believe that it’s an arbitrary methodology without a lot of basis in policy,” he said. “And we believe the state is best served by deleting the whole section of law.”

Miami-Dade lawmakers say they will do what they can to help.

“That is arguably the most important Miami-Dade delegation priority,” said Rep. Jose Felix Diaz, R-Miami. “This is the opposite of Robin Hood. It is stealing from the poor to give to the rich.”

Read more here.

February 28, 2014

Rep. Castor highlights 'irony' of Medicaid cash grab months after rejection of expansion dollars


This issue has received scant attention, likely because Florida's Republican leaders would rather not talk much about their decision to ask the federal government for more Medicaid dollars even as they rejected Medicaid expansion.

But U.S. Rep. Kathy Castor, D-Tampa, brought up the state's cash grab in a letter to House Speaker Will Weatherford and Senate President Don Gaetz today where she implores them to support Medicaid expansion.

Florida is waiting to hear back from the federal government on its request to expand a pool of money funded by state, local and federal Medicaid dollars to provide health services to the poor and uninsured. The $1 billion "Low Income Pool" (LIP) program would be combined with other Medicaid funding streams and be renamed the "System Access and Transformation Incentive Fund."

The state plan calls for that new fund to be increased to roughly $4.5 billion annually, or $45 billion over 10 years. Remember, Flroida rejected $51 billion over 10 years in Medicaid expansion funding tied to President Barack Obama's federal reforms.

"This is ironic to say the least," Castor wrote. "It is ironic because the LIP was established to ensure continued government support for the provision of health care services to Medicaid, underinsured and uninsured populations.  So on one hand, the State is blocking Medicaid funds, but on the other, the State has its hand out for billions of dollars of Medicaid funds."

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February 26, 2014

Scott's finance chair is recipient of millions in Medicaid contracts

Mike Fernandez

By Dan Christensen @BrowardBulldog

Before the Legislature convenes in Tallahassee next Tuesday, Coral Gables healthcare tycoon Miguel B. “Mike” Fernandez will host a Sunday afternoon BBQ with Gov. Rick Scott, his wife Ann, and key members of the governor’s campaign finance team.

Fernandez, dubbed “Florida’s newest billionaire” last year by Florida Trend, was named finance co-chair for Scott’s campaign in January. In the announcement, the governor called Fernandez a “close friend.”

But Fernandez, chairman of MBF Healthcare Partners, is more than Scott’s friend. He’s also a huge contributor to his re-election campaign and the owner or co-owner of fast-growing healthcare companies that under Scott’s administration have been awarded multiple, multi-year state contracts potentially worth hundreds of millions of dollars.

Most of those lucrative contracts involve Florida Medicaid, which is implementing managed care changes, including the Managed Medical Assistance program. The program is expected to begin in May.

Better Health Plan, which does business as Simply Better Health and is an affiliate of Fernandez’s $450 million Simply Healthcare Plans, won contracts from Florida’s Agency for Health Care Administration (AHCA) last year to provide general services in three of Florida’s 11 Medicaid managed care regions, including Broward County.

Clear Health Alliance, a Medicaid plan offered by Simply Healthcare Plans, was awarded AHCA contracts to provide “specialty” services to Medicaid patients who are HIV positive or have been diagnosed with AIDS. Story here. 



February 18, 2014

Expanded scope of practice for highly trained nurses gets first committee approval


A proposal that has been described as one of the most sweeping changes in history to Florida law regulating medical providers received bipartisan support today it its first committee vote.

The House Select Committee on Health Care Workforce Innovation agreed to officially introduce the proposed committee bill after another three-hour long meeting filled with testimony from workers on both sides of the issue. Highly trained nurses argued they have they skills to work independently to address the state's growing health care demands while medical doctors lobbied for the status quote.

In the end, all but two members of the committee approved the bill with a one person from each party casting "no" votes. Rep. Gayle Harrell, R-Stuart, has been one of the most vocal members on the committee asking questions and casting doubt on giving nurses more independence and prescribing authority. Rep. Elaine Schwartz, D-Hollywood, indicated that she voted against the bill out of protest. If the House Republican leadership was truly worried about addressing the state's health care needs, they would support Medicaid expansion, she said. 

The bill now will receive a number and be referred to other House committees. Members of the committee who voted "yes" said they did so hoping there will be changes along the way, such as additional training and background checks for highly trained nurses before they are allowed to practice without a doctor's supervision.