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265 posts from May 2015

May 29, 2015

Feds say they're not quite ready to approve governor's LIP plan

The federal Centers for Medicare and Medicaid Services said Friday that it has not signed off on the proposal by Gov. Rick Scott to rely on local governments and safety net hospitals to draw down money for the uninsured and raised concerns about the impact of the change on communities -- like Miami -- that provide the bulk of the funding for the Low Income Pool.

"CMS continues to be engaged with Florida regarding the state's LIP proposal and the May 26 letter but has not communicated approval,'' said Ben Wakana, press secretary for the U.S. Department of Health and Human Services said in response to a question by the Herald/Times. "CMS is reviewing the proposal and public comments, and working to understand the implications of the letter as well as the viability and sustainability of the proposed funding mechanism."

Under the governor's plan, announced by the Agency for Health Care Administration in a letter to the federal government on Wednesday, the state would offset the loss of $1 billion into the Low Income Pool by relying on local hospitals and local governments to raise $900 million in financing to draw down $1.2 billion in federal funds. The financing arrangements are known as intergovernmental transfers. 

As a return on their investment, hospitals would be rewarded a 10 percent profit -- a cost to the program of about $100 million. The state would then use the $1 billion promised by the federal government in Low Income Pool funding to reimburse teaching hospitals and increase patient reimbursement rates.

Continue reading "Feds say they're not quite ready to approve governor's LIP plan" »

UPDATED Jeb Bush calls lifting Cuba terror designation a 'mistake,' Marco Rubio says it's a 'giveaway'


Jeb Bush, who last week basked in the hometown embrace of Miami Cuban-American hard-liners, stayed loyal to their cause Friday when he again denounced the Obama administration for removing Cuba from a list of terrorism sponsors.

"Neither continued repression at home nor Cuba's destabilizing activities abroad appear sufficient to stop President Obama from making further concessions to the Communist regime in Havana," Bush said in a statement. "Today's news is further evidence that President Obama seems more interested in capitulating to our adversaries than in confronting them. Iran's leaders are surely taking note."

He went further, referring to the action as a "mistake":

"The removal of Cuba from the State Sponsors of Terrorism List and the unilateral concessions to Havana, before it changes its authoritarian ways and stops denying the Cuban people their basic human rights, is a mistake," Bush said. "I call on Congress to keep pressure on Cuba and hold the Administration accountable."

Bush had taken a similar stance when lifting the designation was first announced. Congress had 45 days to try to block it but didn't try to do so. The change is effective as of Friday.

Sen. Marco Rubio, the other 2016 Republican presidential hopeful from Miami, has called the decision "terrible."

UPDATE: Here's video of Rubio from Friday criticizing the decision as a "giveaway":


Miami's three Cuban-American Republicans in Congress -- Carlos Curbelo, Mario Diaz-Balart and Ileana Ros-Lehtinen -- also slammed the change in statements Friday. Diaz-Balart and Ros-Lehtinen have endorsed Bush, and Curbelo also seems likely to do so once Bush formalizes his candidacy.

Continue reading "UPDATED Jeb Bush calls lifting Cuba terror designation a 'mistake,' Marco Rubio says it's a 'giveaway'" »

Safety net hospitals blast governor's proposal -- say it helps for-profits at their expense

Florida hospitals that provide the bulk of the charity care in Florida said Friday that Gov. Rick Scott's plan to draw down federal health care money by relying on them to raise funds will slash revenue to the state's teaching, public and children's hospitals by $302 million and "could put some out of business."

The governor's proposal attempts to address the concerns of the federal government -- which wants federal money to follow the patients who seek health care, instead of following the hospitals that serve them. But, the so-called "safety net" hospitals say, that set-up now rewards for-profit hospitals that often intentionally avoid serving the uninsured.

The Herald/Times first reported that the governor's formula resulted in a net reduction in federal revenues of $214 million to hospitals in Florida, most of it from Jackson Memorial in Miami and North and South Broward hospitals.

Since offering the plan to the federal Center for Medicare and Medicaid Services earlier this week, the governor's office has started telling lawmakers that the governor is willing to spend as much as $200 million in general revenue to offset those cuts and keep hospitals whole, sources have told the Herald/Times.

But the Safety Net Hospitals warn it could have a devastating impact -- for example, cutting revenue to Jackson Memorial in Miami by as much as $84.7 million in the first year and $135 million in the second year.  Download Spreadsheet of Governor's Proposal, 5.29.15

Under the plan, Miami Dade County would put up $320 million of its tax money to draw down $490 million in federal matching funds -- based on the 40/60 formula -- and receive only $100 million in return. 

 “While we appreciated Governor Scott’s recent unsuccessful efforts to retain current levels of LIP funding, we are disappointed to see that his proposal targets safety net hospitals and could literally put some out of business,” said Tony Carvalho, Safety Net Hospitals of Florida president in a statement. “We are urging the governor and his team to re-evaluate the harmful impacts of this proposed redistribution.”

Scott's spokeswoman, Jackie Schutz responded: 

“AHCA has spent days with HHS officials trying to be responsive to the parameters they sent us last week and they have worked through a formula that would keep record hospital profits almost entirely whole,'' she said in a statement. "In fact, only a handful of hospitals would lose money as a result of reducing the funding that their record profit margins show they could not afford.  This group totals only around $60 million in losses. Without HHS finalizing an agreement in principal on this federal healthcare funding for the poor, we will fail to have a budget that keeps Florida’s economy growing.”

Here's their press release:  Download SNHAF press release on Gov's LIP proposal 5.29.15

Continue reading "Safety net hospitals blast governor's proposal -- say it helps for-profits at their expense" »

Conservative Americans for Prosperity takes to TV to blast Florida lawmakers over Medicaid expansion


Americans for Prosperity, a conservative group backed by the industrialist Koch brothers, is continuing to campaign against Medicaid expansion under Obamacare in Florida.

The group plans to launch a new television ad timed with the start of the special Florida legislative session, which begins Monday (a longer web version of the spot is below). AFP has also sent fliers to voters to targeting Republicans in the state Senate who back Medicaid expansion.

"The Florida Senate's Medicaid expansion plan is wrong for Florida," AFP state director Chris Hudson said in a statement. "The only thing that is certain is that Florida families who depend on this already bloated program will have an even harder time getting care and, like other states' expansions, it could cost billions more than expected, ultimately forcing legislators to raise taxes or make cuts from other essential services."

Hudson's father is state Rep. Matt Hudson of Naples.

A Healthy Florida Works Coalition, which supports Medicaid expansion as proposed by the Senate, has been airing its own ad in support of those lawmakers.


Revisiting the Legislature's budget showdown

With the Legislature starting a special session June 1 to settle on a budget, the elephant in the room is still the debate over what to do about Medicaid expansion.

Gov. Rick Scott and the House refuse to budge on the issue, arguing that expanding the federal health coverage program for the poor is bad for the state. The Senate has proposed -- and since modified -- a private solution that aims to use federal money guaranteed through the Affordable Care Act.

The sides were so intractable on the $4 billion difference between their proposed budgets, the House adjourned three days early in April, a move the Florida Supreme Court ruled unconstitutional. Scott has issued dire warnings of a "government shutdown" and ordered state agencies to draw up lists of critical services that must continue if the Florida Legislature cannot pass a budget by July 1.

Tied up into the debate is a joint state and federal program called the Low Income Pool, a discretionary program started in 2005 that helps pay hospitals for uncompensated care expenses from low income patients that are uninsured or underinsured (including Medicaid patients).

Despite telling Florida in April 2014 that the $2.2 billion LIP program was going to lose about $1.3 billion in matching funds, Scott included the program’s federal money in his proposed budget. When Washington stuck to its timeline of ending the program’s federal match, budget talks were thrown into chaos.

Washington has since backed off its yearlong warning telegraphing LIP’s demise, suggesting instead the program could be gradually phased out. But questions that still remain about what to do with the budget, even with federal money coming back.

There have been plenty of arguments about both the LIP and Medicaid expansion, with PolitiFact Florida working hard to cover all the bases. Turn to PolitiFact Florida for a look back at our fact-checks related to Medicaid expansion.

Rallies planned for Everglades land purchase in advance of special Florida session

via @jenstaletovich

Conservationists who want Florida to preserve more land are holding rallies across the state Saturday in advance of the special legislative session that starts Monday.

The push follows a bitter fight during the regular session that included protests and a rally headlined by Jimmy Buffett to persuade lawmakers to buy U.S. Sugar land before a deal expired. Backers of Amendment 1, the constitutional amendment overwhelmingly supported in November, say the state needs to buy land for water storage south of Lake Okeechobee and order the South Florida Water Management District to lay out a plan for designing and building a reservoir they say is part of the original restoration plans for the wilting wetlands.

A South Miami rally, including Mayor Philip Stoddard, Miami-Dade County Commissioners Rebecca Sosa and Daniella Levine Cava and Audubon Florida, will be held at 11 a.m. Saturday at South Miami's City Hall, 6130 Sunset Drive.


Florida GOP rolls out finance committee


The Republican Party of Florida has assembled a team to kick off fund-raising for the 2016 election.

The list so far includes well-known former statehouse leaders, as well as prominent GOP fund-raisers, according to a news release in which Chairman Blaise Ingoglia touted members from "the many geographic areas" of the state. Unmentioned: the party's tense relationship with Republican Gov. Rick Scott, who has his own fund-raising committee, and with the state Senate.

"Our fundraising efforts will be vital as we prepare for Hillary Clinton and the Democrats," Ingoglia said in the release.

Here's the list:

Continue reading "Florida GOP rolls out finance committee" »

May 28, 2015

Scott's LIP plan would cut $214 million from hospitals, most in South Florida

Gov. Rick Scott released details of his latest proposal to draw down $2.3 billion in federal Low Income Pool funds on Thursday. While the formula is higher than previously announced, it does not use any state dollars to backfill the loss but it cuts reimbursements to hospitals by $214 million.

Hardest hit are hospitals that do the bulk of the state's charity care. Among those facing the deepest cuts are: Jackson Memorial (-$34.5 million), Broward General (-$22.3 million), Shands in Gainesville (-$34.5 million), Shands in Jacksonville (-$36.5 million) and All Children's Hospital in St. Petersburg (-$12.9 million.)

Under the plan, announced by the Agency for Health Care Administration in a letter to the federal government on Tuesday, the state would not lose $1 billion in federal health care money as previously suggested but the money would be offset by local hospitals and local governments, which would raise $900 million in financing to draw down $1.2 billion in federal Low Income Pool funds. The financing arrangements are known as intergovernmental transfers. 

As a return on their investment, hospitals would be rewarded a 10 percent profit -- a cost to the program of about $100 million. The state would then use the $1 billion promised by the federal government in Low Income Pool funding to reimburse teaching hospitals and increase patient reimbursement rates.

Continue reading "Scott's LIP plan would cut $214 million from hospitals, most in South Florida" »

Mayor Gimenez promotes from within for department chiefs


Tara Smith, a deputy in Miami-Dade's procurement department, will take on the top job there, Mayor Carlos Gimenez announced Thursday.

Smith's appointment as Internal Services director puts her in charge of an 880-person department that manages county facilities, runs its auto fleet and -- of great importance to County Hall's lobbyist corps -- oversees purchasing for a $6 billion budget. It was also the department at the center of the recent parking-services scandal, when Internal Services officials stumbled onto an alleged embezzlement scam.

Smith is a relative newcomer to Internal Services, having joined the department in 2013 after nine years in county government. An assistant director at ISD, she succeeds Lester Sola, who was tapped earlier this year as director of the Water and Sewer department.

Also on Thursday, Gimenez named  long-time aide Inson Kim to the county's Community Information and Outreach Department (often known as CIAO).

The 202-person department includes the 311 Answer Center, oversees the county's website and runs a 12-person television channel. Kim worked for Gimenez when he was a county commissioner, and continued as a top  aide when he was elected mayor in 2011. She recently left the mayor's office to run external affairs for the Regulatory and Economic Resources Department. 

CIAO faced its own scandal last summer when Henry Sori, then the department head, was suspended over an internal "team-building" video that featured employees air humping  and performing other antics. Sori, who left his post earlier this year, was suspended for five days after Channel 10 revealed the video's existence. 

Smith's yearly compensation will rise from $150,000 to $180,000 a year, and Kim's will go from $128,000 to $155,000, said Gimenez spokesman Michael Hernández.

The announcement said the appointments were effective immediately. County commissioners don't need to approve mayoral appointments, but can veto them with a 2/3 vote. 

Miami groups petition for Medicaid expansion at state Rep. Jose Oliva's office

via @chabelih

At a busy corner in the ZIP code with the highest number of Obamacare enrollments in the nation — 33012 in Hialeah —demonstrators armed with 30,000 signatures knocked on the door of state Rep. Jose Oliva’s office Thursday hoping to gain his support on the issue that has polarized Florida’s lawmakers: Medicaid expansion.

About 30 people showed up for the rally led by SEIU Local 1991, a union representing 5,000 healthcare workers in the Jackson Health System. They sought to convince Oliva — who was not in his office — and other House Republicans opposing expansion to change their minds before the start of the legislative special session next week.

The Affordable Care Act, also known as Obamacare, includes a provision to expand Medicaid. Florida is among the 18 states that have not chosen to expand and a bitter dispute between Republicans in the House and Senate over the issue forced an early end to the regular session.

The groups delivered the signatures, collected over several months from around the state, to Oliva’s second-floor office at a shopping center, urging him to listen to his constituents.

“His constituents are telling him: ‘We want healthcare. We are buying healthcare under the Affordable Care Act,’” said Martha Baker, president of the local SEIU, before leaving the petition with Oliva’s secretary.

More here.