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Florida Facing Huge Medicaid, 'Obamacare' Decisions in 2013

TALLAHASSEE - Dealing with issues that affect the health care of millions of poor and uninsured residents, Florida leaders in 2013 could move forward with a long-awaited overhaul of the Medicaid system and likely will decide how to carry out the federal Affordable Care Act.

Both issues are highly complex and politically controversial.

Gov. Rick Scott and Republican legislative leaders want to require almost all Medicaid beneficiaries statewide to enroll in managed-care plans, an effort that has drawn opposition from Democratic lawmakers and some patient advocates. Meanwhile, after waging a legal and political battle, Scott and his GOP colleagues face the reality that the Affordable Care Act --- better known as Obamacare --- is here to stay.

Lawmakers in 2011 approved the Medicaid overhaul, but it requires approval from the federal government. State Medicaid director Justin Senior told lawmakers this month that he expects a decision from federal officials in February about the first part of the overhaul.

That part would lead to managed-care enrollment for seniors who need long-term care. If approved by federal officials, those changes would start taking effect by Oct. 1. Broadly, the idea is that HMOs and other types of managed-care plans could provide services that would allow seniors to stay in their homes and communities instead of having to live in costly nursing facilities.

The state Agency for Health Care Administration has been seeking approval from the federal Centers for Medicare & Medicaid Services for more than a year and also has started the contracting process for managed-care plans that want to take part in the long-term care system. The state would be split into 11 regions, with a limited number of plans receiving contracts in each region.

Senior said much of the state's negotiations with federal officials have focused on safeguards to make sure that the program would be based on providing services in people's homes and communities and would not be a "nursing home light" system.

'We Will Really Start To Negotiate With The Federal Government'

The state also is seeking approval to require the broader Medicaid population, such as low-income women and children, to enroll in managed-care plans. Those changes would start to take effect by October 2014, though Senior said the state has focused first on getting approval for the long-term care portion of the overhaul.

"As we get that approval, I think our guns will turn, if you will, onto the (proposal dealing with the broader Medicaid population), and we will really start to negotiate with the federal government to get to the best possible product there as well and do it in a timely fashion,'' Senior told the House Health & Human Services Committee.

Supporters of the overhaul contend that it will help hold down costs in the Medicaid program and better coordinate care for beneficiaries. Medicaid serves more than 3.2 million people in Florida, and is expected to spend about $20.8 billion this fiscal year.

But critics of the overhaul have long raised concerns that for-profit HMOs will scrimp on care for the beneficiaries. Rep. Elaine Schwartz, D-Hollywood, pointedly asked Senior about whether the state will have enough oversight of the managed-care organizations.

"I don't hear from you that there is a beefing up in these programs to oversee these managed-care companies who could easily be diverting that money to the wrong purposes,'' Schwartz said.

Senior said AHCA is aware it will have to be a "watchdog" over managed-care organizations, looking at such things as the health plans' finances and medical data. But while Schwartz is concerned about the overhaul, other state officials want to get federal approval of what are known as "waivers" and move forward quickly with the changes.

"I'm very concerned about the length of time it's taken us to get the waiver,'' said Rep. Gayle Harrell, a Republican who has long been involved in health issues.

Health Insurance Exchange Decisions Looming

As AHCA works to get approval, lawmakers this spring also will debate whether the state should play an active role in carrying out the Affordable Care Act.

Scott and Republican legislative leaders largely refused over the past two years to move forward with the law, which President Obama and congressional Democrats approved in 2010. But after a U.S. Supreme Court ruling in June and Obama's re-election in November, it became clear that the Affordable Care Act will not be tossed out or repealed.

The House and Senate have formed select committees that will study issues such as whether the state should create what is known as a health-insurance exchange, which is a key part of the law's attempt to expand coverage to millions of more Americans. Also, the committees will study issues such as a potential expansion of Medicaid eligibility in Florida.

Scott, whose opposition to the Affordable Care Act helped propel his political career, is scheduled to meet Jan. 7 with U.S. Health and Human Services Secretary Kathleen Sebelius.

He and other Republican leaders say they need more information about issues such as the insurance exchanges, which are designed to be online marketplaces where people can shop for coverage. Depending on income levels, many people will be able to receive subsidies to buy the coverage.

Florida has already missed a deadline for states that plan to operate exchanges starting in January 2014. That means, at least initially, the federal government will run an exchange in the state.

But lawmakers during the spring session will look at the possibility of operating an exchange in the future or entering into a partnership with the federal government.

The House and Senate also will discuss a series of other issues stemming from the Affordable Care Act, including whether to expand Medicaid eligibility to offer coverage to more people. The federal government would pay for the eligibility expansion from 2014 to 2016, with the state gradually picking up some of the costs after that.

In grappling with the Affordable Care Act, Scott and Republican lawmakers likely will face pressure from conservatives to avoid taking part in an exchange and the Medicaid expansion. That political pressure was evident early this month when a meeting of the Senate select committee turned raucous after a group of activists pleaded with lawmakers to not carry out the law.

But Sen. Eleanor Sobel, a Hollywood Democrat who is vice chairwoman of the select committee, said the state has to abide by the law and pointed out that Florida has one of the largest uninsured populations in the country.

"I think that needs to be reckoned with, and we need to adjust our attitudes so we make sure that everybody has health insurance and a health care policy that's affordable and accessible,'' Sobel said.

9 Responses
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649848 tn?1534633700
I read the whole article, but my disgust with Rick Scott won't let me comment further.......
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Avatar universal
Our lawmakers have expended so much time, energy and money trying to defeat this law.  Can they now settle down, do their jobs and make it work?  I wonder.
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163305 tn?1333668571
True, true, welcome to the CE.
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Avatar universal
Rick Scott is nothing but scum to me and the sooner this state rids itself of him the better off we will be. Has something like a 38 percent approval rate I think?

He is simply another obstructionist, self serving, politician and we all know it.
If he succeeds in his antics, I will be moving out of state.
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1530342 tn?1405016490
I will never understand opposing this law....It's just crazy that any lawmaker would...
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Avatar universal
I posted it with you in mind...and a couple of others.
It's a strange world we find ourselves living in - yes?

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Avatar universal
It's a strange world we find ourselves living in - yes?
Yes, it is.
I often wonder if I have been living in Wonderland with my perpetual optimism about people and have just woke up in a much darker world.
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Avatar universal
Since Rick Scott has built a career on opposition to the Affordable Care Act, and has failed to get rid of the Act, may we please now pronounce him a complete failure and send the man home to do something he is qualified to do?  Pulling the wings of flies, for instance.
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649848 tn?1534633700
"It's a strange world we find ourselves living in - yes?"   Yes..

Every since Rick Scott's 2010 election, I've been trying to figure out where the heck are all the people who voted him in, because I have yet to run across just one, who likes him...   IMO, he is, without a doubt one of the biggest crooks that ever walked.  

I'm sure ya'll remember when he wanted to have welfare recipients drug tested?  I really had no problem with the drug testing - what I had a problem with was that Rick Scott's wife owned the chain of labs that was contracted to do the testing.   Maybe just a little conflict of interest, there?

I agree that the ACA is here to stay, whether we like it or not, so we might as well get with the program and work on getting the best care, for the most people, at a decent price.  

I, personally, am totally against the managed care plans that Scott is promoting, for Medicaid beneficiaries, because I don't think those people will get adequate care.  I believe that corners will be cut and that people will be denied testing/treatments based solely on "minimum standards of care", rather than individual needs.  I wouldn't be a bit surprised if, somewhere down the line, we find out that Rick Scott, his wife or some other family member either owns or stands to gain a lot of money with the managed care plans. I see way too  much room for abuse with that type of plan.

teko is right -- I heard on the radio today that Scott's approval rating is the lowest it's ever been in the low 30%.  And he's already campaigning for his 2014 re-election bid.

All of that said, since the ACA is here to stay, when is somebody going to start talking about actually lowering the cost of care and/or insurance, rather than ONLY focusing on how many are insured?  

I'm not totally clear on this "waiver" they're waiting for, but things that have to be pushed through, often turn out to be bad for the people.

Personally, I have insurance and while it's very expensive, I'll keep it as long as I can, so other than increased taxes, etc I don't really see the health care plan affecting me all that much, until I qualify for Medicare. Unless, of course, I'm forced to give up my private insurance and go on some government sponsored plan.
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