After saying no to feds on Medicaid expansion, Florida may ask for more money

TALLAHASSEE — Months after Florida lawmakers rejected $51 billion from the federal government to expand Medicaid, state officials are prepared to request billions in new federal aid for a different program to improve care for the poor, uninsured and underinsured.

State officials want to grow Florida's Low Income Pool (LIP) program from $1 billion a year to possibly $3 billion a year, said Justin Senior, deputy secretary for Medicaid at the Agency for Health Care Administration. The additional money could help hospitals cover charity care, provide premium support for low-income Floridians or expand health care programs.

"Our feeling at the agency is that there are opportunities here to make the LIP program larger," Senior told lawmakers, who didn't object. "We have talked with the federal government about that, and the federal government, by and large, they seem generally receptive to the possibility of it."

Even contemplating accepting additional federal LIP dollars seems at odds with the Legislature's stone-cold rejection of additional Medicaid funding tied to health care reform. But it highlights how intertwined Tallahassee and Washington are — whether Republican lawmakers in the state Capitol like it or not.

Rep. Matt Hudson, a Naples Republican and chairman of the House's health care budget committee, said it's best to keep the two discussions separate.

"While opponents would love to water down the House's opposition to Medicaid expansion to a single sound bite, it's not that simple," he said in an email. "We will evaluate these decisions based on the long term physical and fiscal well-being of Florida."

For years, the Legislature has signed off on leveraging local tax dollars to qualify for additional health care funding from the federal government. But it's hardly enough, health care officials say, and less than what states like Texas and California receive.

"Florida is embarrassingly low in the amount of money it gets from the federal government in supplemental payments," Tony Carvalho, president of the Safety Net Hospital Alliance of Florida, told the panel.

Florida receives roughly $1.4 billion a year in supplemental Medicaid funding, according to a report commissioned by Carvalho's organization. California collects about $5 billion a year for similar programs and Texas expects $7.5 billion each year, the same study said.

Texas uses the money to help pay hospitals that treat large numbers of uninsured patients and to fund innovative health programs.

Florida officials say the state will tie the request for more funding to Florida's application for an extension of the federal waiver that privatized Medicaid. The waiver application will be submitted in about a month. Most likely, the federal government will insist on new quality improvement benchmarks as a trade-off for any new money.

Linda Quick, president of the South Florida Hospital and Healthcare Association, said the need for more funding became even more pronounced after House Republicans blocked a plan to expand Medicaid to 1 million low-income Floridians earlier this year. The federal health care law also reduces some supplemental funding hospitals now receive.

Even if that weren't true, Florida will always have people who are uninsured or don't have enough insurance coverage, Quick said. And that means hospitals and health centers will always need this supplemental money, she said.

"Unfortunately, those people are not going anywhere, and they're not getting insurance," she said. "And therefore we need to continue to put money into the Low Income Pool."

The state is hoping the federal government will give at least conditional approval to its Medicaid waiver renewal and funding increase by early 2014. That will allow the Legislature time to pass any laws needed to implement it for the 2014-15 fiscal year.

House Republicans rejected Medicaid expansion largely because it relied on federal funding to reduce the number of uninsured. Now, they may be needed to sign off on how any new dollars are allocated.

"I suppose there is some sense of irony if not hypocrisy there," Quick said, "that we'll take money with a different title and tag on it."