States may expand Medicaid under the Patient Protection and Affordable Care Act to those with income up to 138% of the federal poverty threshold, but last June's Supreme Court decision on the law removed any penalty for states that refuse to expand the program, which is jointly financed by state and federal tax dollars.
Medicaid rolls could expand by 7 million to 13 million in 2014, largely low-income adults without children, under the new eligibility rules, federal officials estimate. Roughly 3.8 million Floridians lacked insurance in 2011, according to the most-recent figures from the U.S. Census Bureau, or about 20% of the total population.
Scott called for a state law to expand Medicaid that would expire in three years, when federal financing for the expansion declines to 95% from 100%. He also called for the law to expire should federal officials fail to cover 100% of costs through 2016, as required under the ACA. With total federal financing, Scott said he could not “in good conscience” reject expansion.
At the end of three years, Scott said the state would not “simply deny” insurance to the newly enrolled, but did not specify how coverage would continue. “We will evaluate whether services are best provided through the Medicaid program, if the program needs more flexibility, or if some services are better provided in the private market,” he said.
Scott also said the state would not establish a health insurance exchange, another major pillar of the law's push to reduce the number of uninsured. Under the law, federal officials must instead operate the exchange, which serves as an insurance marketplace. Low-income households may receive subsidies to buy insurance in the exchange.
Scott, a vocal critic of the law who previously rejected Medicaid expansion, said he continued to disagree with the law. “It's not an easy choice,” he said, at times sounding defensive. “It is not a white flag of surrender to government-run healthcare.”
Scott praised federal health officials for recent waivers that will allow the state to shift those covered under Medicaid into managed-care plans.
HHS recently notified the state that it would grant its request for a medical assistance waiver—a decision that comes just weeks after the department granted Florida's first request for a waiver for its long-term-care program.
The waivers allow the state to enroll virtually all Medicaid beneficiaries into the managed-care program, including elderly and disabled beneficiaries currently in nursing homes.
However, HHS noted in a letter that the agency will work with the state's Agency for Health Care Administration to ensure a “robust independent consumer support program” to help address beneficiary concerns.
Scott in a news release called the waiver decision “a great win for Florida” that will give the Medicaid program increased flexibility to improve care coordination, manage chronic conditions and boost preventive care.
Scott added in the release that the goals of the managed-care program include encouraging patient-centered care and personal responsibility, providing fully integrated care and allowing new reimbursement models with an increased focus on outcomes.