Florida is headed toward a legislative showdown over Medicaid expansion. Republicans in the Florida House late Thursday passed a budget that does not include expanded coverage provisions. The state Senate had unanimously passed a budget calling for expansion a day earlier.
The two sides must somehow reconcile the measures to pass the state budget. No reconciliation talks are currently scheduled, said Katie Betta, a spokeswoman for GOP Senate President Andy Gardiner.
When talks do begin, they'll be overshadowed by questions regarding what the CMS will do about the state's low-income pool waiver.
The chambers have until May 1, the last day of the legislative session, to reach a compromise. If they can't, they will need to hold a special session. Florida's next fiscal year starts July 1. A special session to pass a budget hasn't occurred in recent memory, according to Rep. Mark Pafford, the House minority leader.
If the Senate gets its way, as many as 800,000 lower-income adults could gain healthcare coverage. This is the second time the Senate has backed expansion. Instead of a bill focused on expansion this time around, however, the Senate put Medicaid expansion into the budget, the one piece of legislation that has to be enacted each year, Pafford said.
"This means (expansion) will require a discussion," he said. "I think there's an absolute possibility something can happen."
The conservative advocacy group Americans for Prosperity, financed by the billionaire Republican heavyweights Charles and David Koch, has mounted an aggressive campaign against the Senate expansion proposal.
Florida's Republican House leaders have said they don't intend to address Medicaid expansion this year. But they face pressure to close a big budget deficit, which the Senate does by including $5 billion in federal funds for Medicaid expansion and the low-income pool.
The House's budget, which passed 86-29, outlines total spending of $76.2 billion compared to $80.4 billion suggested by the Senate. The difference is the Senate's version includes federal funds for Medicaid expansion and a low-income pool now used to help safety net hospitals cover uncompensated-care costs.
The Senate's bill would establish a new form of the low-income pool. The state's current pool, funded by the CMS, expires in June. The CMS announced in February it would not renew its waiver for the pool in its current form.
Since 2005, the state had been receiving $1 billion to $2 billion annually to support safety net providers. The Senate bill would restructure the low-income pool to distribute funds more broadly so more hospitals benefit, Gardiner said.
Elizabeth Dudek, secretary of Florida's Agency for Health Care Administration, Thursday said the CMS has halted talks on the low-income pool waiver and said it hasn't announced any plans to resume talks.
The CMS' suspending negotiations has raised doubts about if the agency will renew it in any form if the state does not also expand Medicaid, Gardiner said.
The CMS countered with a statement of its own Thursday, disagreeing with Dudek's claims, saying talks are continuing on the waiver.
House Republicans feel that the CMS will renew the low-income pool without expansion, said Rep. Richard Corcoran, chair of Florida's House Appropriations Committee. Any other scenario is “absolute fantasy," he said.