Is the Obama administration bleeding Florida's health-care system, or offering lifesaving infusions of funds? The diagnosis depends on political perspective, and for now, the state's Republicans are taking a pass on the cash.
Last month, a legislative panel rejected federal money to help move nursing home patients back to their own homes. The "Money Follows the Person" program would have provided $2 million to cover administrative costs and opened the door to $35.7 million in additional Medicaid funding.
Voting as a bloc, House Republicans turned down the grant.
Rep. Robert Schenck, R-Spring Hill, and chairman of the House Health and Human Services Committee, said the federal program duplicates Florida's existing nursing home diversion efforts.
Not all Republicans said no. Two GOP senators -- J.D. Alexander and Joe Negron -- voted to take the money and even Gov. Rick Scott, who turned down $2.4 billion in federal high-speed rail funds, recommended the program.
But, citing a blend of philosophical and fiscal rationales, the GOP line held again in the House. Previously, lawmakers turned away or refused to apply for $54 million in other health-related grants from Washington.
Erwin Bodo of the Florida Association of Homes and Services for the Aging, said he was sorry to see the Legislature reject "Money Follows the Person," a program launched by the George W. Bush administration.
"Without any doubt, there would be some [federal] requirements. The state would not have total latitude," Bodo said. "But for every 45 cents Florida pays into Medicaid, we get 55 cents from the federal government. It doesn't make sense to turn down money when we're not getting our fair share."
FAHSA, which Bodo calls "a proponent of diverting people to the least restrictive environment," said nursing homes need the help.
"Nursing homes got a $200 million budget cut this year. Now we're just giving up a little more," he said.
But voicing concerns about Obamacare and further federal controls, Republican leaders have refused several other Washington-based funding initiatives. A list compiled by the Orlando Sentinel included:
- Part of a $40 million federal program to promote wellness, including helping those with chronic diseases, such as diabetes, manage their health;
- $8 million for construction of community-health centers;
- $3.4 million for in-home visitations with at-risk families;
- $2.1 million to set up a consumer-assistance office to educate Floridians about health insurance and assist them in appeals when insurers deny treatment;
- $2 million for hospice care for children;
- $2 million to $650,000 to help low-income seniors pay their Medicare premiums and buy prescription drugs;
- A $1 million grant to help the state plan a health-care-exchange system that would let consumers compare insurance plans;
- $1 million to help the state insurance agency monitor rising health-insurance rates.
Bruce Rueben, head of the Florida Hospital Association, said turning down such grants could cost the state's taxpayers in the long run.
"The federal government is trying to spend a little money up front to save more money downstream," Rueben told Sunshine State News.
"Community health centers and chronic disease management allow people to stay healthy or to be treated at the earliest moment and keeps them out of the hospital. It's an investment that saves taxpayer money," he said.
Rueben said the program on health insurance lays the foundation for the Affordable Care Act.
"Most states are preparing for ACA. Sooner or later, we are going to have to be able to provide people with the information they need to seek insurance through exchanges. I hate to think we're going to do it anyway without financial assistance," Rueben said.
Florida is leading 25 other states in challenging Obamacare, and won its initial courtroom test when U.S. District Judge Roger Vinson struck down the law's individual mandate requiring the purchase of health insurance. The Obama administration's appeal is pending at the 11th Circuit Court of Appeals in Atlanta.
Last week, ruling on a separate case, a panel of the 6th Circuit Court of Appeals declared the law constitutional.
In the debate to accept or deny Washington's largess, state Rep. Denise Grimsley, R-Sebring, suggested that fiscal restraint has to start somewhere.
"I realize that they are federal dollars, but they are also taxpayer dollars," said Grimsley, who chairs the Legislative Budget Commission and also heads the House Appropriations Committee.
The state Agency for Health Care Administration, asked about the programmatic costs and overhead attached to federal funds, said each grant has its own limitations and requirements.
ACHA said the "Money Follows the Person" program offers 100 percent federal funding for associated administrative costs, with strings attached.
However, the federal Centers for Medicare and Medicaid Services require states to provide the necessary matching funds to complement the money from Washington.
"Enhanced federal financial participation is available under the grant for medical services, and therefore the state would have been responsible for approximately 22 percent, for the current fiscal year, of the cost of expenditures for medical services under the program," ACHA said.
Because Florida intended to use special proviso funds approved by the Legislature for nursing-home transition as general revenue for the MFP program, "no additional general revenue would have been requested," ACHA explained.
The Florida Medical Association declined to comment for this article. Negron, who chairs the Senate Subcommittee on Health and Human Services Appropriations, did not reply to Sunshine State News' message.
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Contact Kenric Ward at kward@sunshinestatenews.com or (772) 801-5341.
