The Florida Senate prescribed an overhaul for Medicaid as part of a unanimously passed $68.6 billion budget Wednesday.
Along party lines, senators passed an amendment that would allow residents with higher incomes to pay deductibles or supplement Medicaid with private insurance and allow the Legislature to change eligibility requirements for certain optional programs.
Its a measure that the amendments powerful Republican sponsors say will allow the state to control the terms of Medicaid spending as Florida faces roughly $19 billion in Medicaid costs.
"Im operating under the assumption that our current Medicaid program is broken, said Sen. Joe Negron, R-Palm City, who led the charge on the floor. We have 2.77 million people on Medicaid, and were spending about $19 billion. And, it's the only program Ive seen where you're spending $19 billion, and no one's happy."
The 16-line proviso, sponsored by Sens. Negron, Don Gaetz, R-Destin, and Mike Haridopolos, R-Melbourne, is part of a budget proposal that uses $3 billion in federal stimulus money and about $800 million in Medicaid funds to resolve a $3.2 billion deficit. The proviso tells the Agency for Health Care Administration, the state's chief health policy agency, to prepare a federal Medicaid waiver that will allow the state to limit its Medicaid spending to the amount specified in the state budget.
The waiver would require higher-income recipients to pay a deductible or coinsurance payment for the programs services. The waiver also authorizes the Legislature to change Medicaid eligibility for certain groups and services and revise the benefit structure and delivery system to steer Medicaid recipients toward the private insurance market.
The recently approved federal health-care reform would raise Medicaid eligibility, said Negron, thus giving access to residents with higher levels of income. If a recipient can pay $5 or $10, he or she should be required to do so, Negron said.
The waiver would allow the state to decide on a firm budget for Medicaid expenditures and hold the state to the budget. This would prevent the federal government from dictating how much the state spends.
Gaetz said he and his co-sponsors did not intend to make the program smaller or less accessible. They only wanted to make it more manageable.
Theres no program targeted for elimination, he said.
The waiver drew criticism from Democrats, who lambasted Negron for not bringing the bill before committee and rushing a vote. The bill would put many without health insurance at risk, they said.
This is a huge appropriations issue," said Sen. Nan Rich, D-Weston. "It does not belong, passed or defeated, on the floor today," said the incoming minority leader.
But, the president of Florida TaxWatch, an independent government watchdog, said that changes to Medicaid cant come soon enough.
We think this is just what the doctor of fiscal sanity and good stewardship called for, President Dominic Calabro said.
The waivers will allow Florida to better negotiate its Medicaid expenditures, Calabro said. Laying out the terms of Medicaid means the state will not have to scramble to find money it doesnt have.
Theyre saying, 'Let's do the opposite of what weve been doing for the past 20 years. Weve been taking it on the chin.'
TaxWatch met with the senators a few times on the matter, and the group supports the proviso, Calabro said.
The proviso would have to pass the full Legislature to be enacted into law. It will go to the House with the rest of the budget. A House council is also crafting a Medicaid reform bill to be addressed later this session, according to the House Majority Office.
In a statement, the AHCA said it had not assessed the impact of the amendment, but the Legislature has the authority to require it to craft a waiver.
Today, the Florida Senate adopted an amendment containing such direction," the statement read. If the language is adopted by the full Legislature and signed into law by the governor, the Agency will work with its federal partners to explore potential waiver options as directed.
