Democrats’ Medicaid expansion bill in Florida may be trumped by last-minute waiver extension

(The Center Square) – With Florida’s pandemic-swollen Medicaid rolls projected to result in a $1.25 billion shortfall in the state’s budget, Florida Democrats are hoping their annual pitch to expand the program finds some traction among Republicans in 2021.

Sen. Shevrin Jones, D-Miami Gardens, and Rep. Nicholas Duran, D-Miami, filed companion bills Friday that call for Florida to join 38 other states in expanding Medicaid under the Affordable Care Act (ACA).

Jones and Duran said Senate Bill 698 and House Bill 341 would expand health care access for nearly 850,000 Floridians, draw $14.3 billion in new federal dollars to the state by 2024 and save taxpayers $199 million to $385 million over the next five years.

According to the Florida Agency for Health Care Administration (AHCA), 4.44 million people were enrolled in the state’s $30 billion Medicaid program in December, an increase of 450,000 people since July 1.

State economists project Medicaid enrollment could swell by another 700,000 by 2022, increasing costs by 19% and presenting lawmakers with a $1.25 billion health care funding hole within an estimated $2.1 billion shortfall in next year’s budget.

Under the ACA, if a state expands Medicaid eligibility to single adults who earn less than 138% of the federal poverty level, the federal government initially foots all additional costs before its share declines to 90%, where it remains.

SB 698 and HB 341, as well as Senate Bill 556, sponsored by Sen. Perry Thurston, D-Fort Lauderdale, are “smart investments in our people because it’s the fiscally, and morally, responsible thing to do,” Jones said.

“Drawing down new federal Medicaid funds will be one of the fastest, proven-effective ways to deliver fiscal relief to Florida’s economy during this economic downturn,” Duran said. “The new federal dollars will directly impact the healthcare community, its vendors and its employees, but its economic ripples will go beyond the healthcare sector indirectly impacting small businesses, restaurants, gyms, personal and business services, and state and local governments.”

Florida Republicans have balked at paying the 10% state cost-share under ACA Medicaid expansion. The pandemic is unlikely to diminish that reticence in 2021.

Not only has Sen. Manny Diaz, R-Hialeah Gardens, filed Senate Joint Resolution 340, calling for a 2022 ballot measure to require a two-thirds majority of the Florida Legislature to approve a single-payer system, but the Trump administration may have boxed-out Medicaid expansion in Florida.

In the waning moments of the administration, now-former Department of Health & Human Services Secretary Alex Azar approved a 10-year extension of Florida’s Medicaid Section 1115 waiver, granting its Low Income Pool (LIP) program $1.5 billion in supplemental funding annually through 2030. Florida’s AHCA had requested a two-year extension.

According to Medicaid.gov, Medicaid 1115 waivers initially are approved for five years. Afterward, states “commonly receive” three-year waiver extensions. Florida’s 10-year extension, as well as one Azar approved for Texas, are the two longest ever granted.

“Continuing this essential program means Floridians will have access to quality health care when they need it,” Gov. Ron DeSantis said Friday.

The Obama administration eliminated Medicaid’s LIP supplemental payment program in 2015, rescinding $2.1 billion in federal funding in Florida’s budget. Former governor and now U.S. Sen. Rick Scott sued in federal court, alleging the administration was pressuring the state into expanding Medicaid.

Florida retained its LIP program under a Section 1115 waiver. The Trump administration increased Florida’s LIP funding in 2018, primarily allocated to hospitals and care centers to offset uncompensated care costs.

The extension is a “blatant attempt to reward political allies and block Medicaid expansion,” Center for Children & Families Executive Director Joan Alker told The News Service of Florida.

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