Reform Update: Is Medicaid deal out of reach in Florida?

Florida is one of a growing number of states where time is running out for lawmakers to make a deal on expanding Medicaid.

The Florida Legislature has worked furiously on legislation to raise Medicaid eligibility. But the Senate's passage of a bill Tuesday belied concerns that approval by the overall Legislature appears out of reach.

“It's very uncertain whether anything is going to happen this year,” said Bruce Rueben, president of the Florida Hospital Association.

The Senate's approval of a plan came just four days after the state House passed a very different alternative, which would extend coverage to a more limited population than envisioned in the Patient Protection and Affordable Care Act and would forgo additional federal funding.

The Senate version—backed by Republicans and Democrats, as well as Republican Gov. Rick Scott—would use more than $50 billion in federal funding over 10 years to buy private insurance coverage for about 1.1 million state residents.

But House Republicans rejected that approach over fears that the federal government would renege on its promises to cover much of the cost—leaving the state to cover the difference. Instead, they passed a plan to use state funding to provide health coverage for about 115,000 residents.

Such concerns over rising state costs may have been bolstered by the Government Accountability Office's projections this week that state and local governments will face increasing disparities between their revenue and costs. The nonpartisan GAO projected the worsening budget situation (PDF) was “primarily driven by the rising health-related costs of state and local expenditures on Medicaid and the cost of healthcare compensation for state and local government employees and retirees.”

The divergent bills in Florida followed failed compromise talks between leaders of the two legislative chambers.

In the face of the apparent impasse and the impending end of the legislative session this week, hospitals geared up an advocacy push to get House members behind the Senate plan. That has included television advertising and a social media campaign, Rueben said. He would not specify the budget for the legislative push, but said it included efforts to mobilize members of communities most likely to benefit from the Senate's larger expansion of coverage.

“We're doing everything we can at this point,” Rueben said.

The faceoff also led House Democrats to push Scott on Tuesday to veto the state's $74.5 billion budget if the House refuses to accept the Senate plan.

Florida's tight timeframe for approval echoed recent action in other states, which narrowly passed or rejected Medicaid expansions in the final hours of their annual legislative sessions. For example, the Arkansas passed an April 17 Medicaid expansion—the model for the Florida Senate plan—in the final days of its session. Other states, including Arizona and Nevada, are approaching the scheduled ends of their legislative sessions with the Medicaid dilemma unresolved.

As state lawmakers make up their minds, their plans will still need the approval of the CMS, which has issued some general guidelines on the variations it's willing to accept on expansions of the standard Medicaid program.

The Republican-majority Iowa House approved Gov. Terry Branstad's healthcare proposal for low-income Iowa residents Tuesday, setting up a tough negotiation with the Democratic-controlled Senate, which favors a Medicaid expansion, the Associated Press reported.

In a 51-49 vote split mostly along party lines, the House approved legislation for the "Healthy Iowa" plan. The plan revamps an existing program for low-income residents and would provide coverage to an estimated 89,000 people with incomes at or below the poverty line using state and federal dollars. The state would need a federal waiver to put the plan in place. Meanwhile, the Democrat-majority Senate has passed a bill that would expand the Medicaid program in the state.

Maine Gov. Paul LePage, a Republican, renewed calls for the Democratic-led legislature to vote on his plan to repay a $484 million debt to the state's hospitals. Democratic leaders have insisted on tying the debt repayment to an expansion of Medicaid to at least 55,000 people. LePage has viewed Medicaid expansion and repaying the hospitals as separate issues.

Negotiations also continue between Democrats on expanding Medicaid in California, the Associated Press reported. Gov. Jerry Brown, a Democrat, is pushing to limit future state liabilities as part negotiations with legislative leaders on a plan to add 1.2 million new enrollees to the state's Medicaid program by 2017. Democratic lawmakers say the benefits of expanding outweigh the costs, which include covering up to 10% of new enrollees' costs by 2020.

Follow Rich Daly on Twitter: @MHrdaly