Without Medicaid expansion, Floridians could really be S.O.L. come July, group says

On the heels of Florida House Speaker Steve Crisafulli's Wednesday announcement that state lawmakers probably won't consider accepting federal Medicaid dollars available under the Affordable Care Act (sigh, Obamacare), a coalition of health care advocates stressed how dire things would be if lawmakers reject the money yet again.

This year, they said, accepting the money would be more important than ever.

In a conference call to reporters Thursday morning, advocates from the Florida League of Women Voters and other organizations highlighted a cache of studies showing how much money Florida would lose if Medicaid expansion dollars weren't available to fill in the gaps that will open when two federal money streams that currently fund low-income health care in Florida dry up this summer.

Hospitals that use that money to treat poor and low-income patients would be hit particularly hard.

The panel urged lawmakers to expand Medicaid so that tens of thousands of people can have low-cost health insurance without an interruption in their coverage. 

“We have to find a way to get to yes and accept the funding to expand coverage,” said Charlotte Cassel, Equal Justice Works Fellow with Florida Legal Services and a coauthor of the report.

They said because of the likely June 30 sunsetting of two federal health care Medicaid funding sources, the Low-Income Pool Program (LIP) and the Medicaid Disproportionate Hospital Program (DSH), many low-income Floridians would be screwed, as would the hospitals that receive LIP money to treat poor patients who can't afford medical treatment they receive.

The state receives $2 billion annually under LIP and $151 million in DSH money.

Even though this money will likely go away, Governor Rick Scott still incorporated it into the Department of Health and Human Services' share of the budget he proposed earlier this week.

The Miami Herald reported earlier this month on a study showing the problems that would be caused for LIP by the loss of federal funding.

The report by Navigant Consulting Inc., a financial and healthcare advisory firm, concludes that without an extension of the LIP program, Florida’s large public hospitals — the primary beneficiaries of the LIP program — would be hard-pressed to provide services to the poor and uninsured.

“These funds are critical for maintaining access to essential hospital services for the state’s large Medicaid and uninsured population,’’ the report noted in its conclusion. “Not having these funds available for payment to Florida’s hospitals may exacerbate an already tenuous situation.’’

Without LIP payments, the report notes, the average reimbursement for hospitals to treat Medicaid patients would be about 62 percent of the actual cost.

Payments below cost generally lead hospitals to cover those expenses by raising prices on other payers, a practice commonly known as “cost shifting.”

One study released Thursday says Hillsborough County, whose indigent care program is funded in part by a half-cent sales tax, could be impacted. The 24-year-old program covers 12,000 of the 230,000 uninsured adults. The cut in funding would place a heavy burden on he system and others like it without Medicaid expansion money, Cassel said.

With the scheduled cuts to LIP and DSH, Hillsborough County is at risk of losing more than $151 million in funding currently used to help cover the cost of the county’s uninsured. The loss of that funding will be offset by approximately $200 million if Florida devises a plan that would draw down federal funding for covering uninsured county residents. 

The panel insisted that it's no longer a matter of R vs. D now that Obamacare's positive impacts are plain to see.

“We are now hearing loudly the drumbeat of the business community,” said Deirdre Macnab, a spokeswoman for the Florida League of Women Voters. 

While most Democrats and an increasing number of Republicans are warming up to the idea of taking the $51 billion the feds are offering, especially when it's framed in a business-friendly way, there are still a few Republicans holding out for ideological reasons.

Asked about Crisafulli's unwillingness to discuss Medicaid expansion, Macnab said she's holding out hope. After all, she said, the House Speaker didn't completely shoot the possibility down.

"I am a never-say-never kind of guy, and certainly anything can come about that provides opportunity, but at this time we do not plan to hear Medicaid expansion," Crisafulli told reporters and editors at the annual Associated Press Legislative Planning Day at the Capitol, according to a News Service of Florida report Wednesday. 

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