But it marks the end of a lengthy and protracted set of negotiations. Florida lawmakers passed sweeping bills in 2011 allowing them to expand a program that allows for-profit providers to determine the healthcare of 3 million of the state's poorest.
Scott and other GOP lawmakers have repeatedly warned that Medicaid's annual costs were consuming Florida's budget and they pushed for a waiver from federal rules on Medicaid in order to carry out the overhaul.
The privatization plan expands on a five-county pilot program begun under former Gov. Jeb Bush that has been rife with problems.
Critics worry for-profit providers are scrimping on patient care and denying medical services to increase profits. Some doctors have dropped out of the pilot program, complaining of red tape and that the insurers deny the tests and medicine they prescribe. Patients have complained they struggled to get doctor's appointments.
Several health plans also dropped out of the pilot program, saying they couldn't make enough money. Patients complained they were bounced from plan to plan with lapses in care. Nearly half the 200,000 patients enrolled in the pilot have been dropped from at least one plan, federal health officials noted at one point during negotiations.
Lawmakers say they have fixed the pilot program's shortcomings, with provisions including increased oversight and more stringent penalties, including fining providers up to $500,000 if they drop out. The measures also increase doctors' reimbursement rates and limits malpractice lawsuits for Medicaid patients in hopes of increasing doctor participation in the program.
Still even those who had been skeptical about the plan said that the program as now designed has some of the strongest patient protections in the nation.
"The final agreement between federal officials and Florida allowing the statewide Medicaid managed care initiative to move forward gives patients reason both to hope and to be vigilant," said the health care advocacy group Florida CHAIN. But the group cautioned that advocates will need to monitor the program to make sure that providers do not take advantage of the changes to deny care to patients.
The approval of Florida's Medicaid waiver comes just weeks after state legislators refused to draw down billions in federal aid to expand the program to roughly 1 million additional Floridians. House Republicans regularly bashed the Medicaid program during debate and said it made no sense to expand what they called a broken program.