Florida's Republican Gov. Rick Scott said he no longer supports expanding Medicaid to low-income adults under the Affordable Care Act because he does not believe the federal government will keep its promise to provide funding for the new group of beneficiaries.
That could scuttle legislative moves to expand Medicaid in a state that has one of the nation's largest populations of uninsured people. The state's Republican-controlled Senate unanimously passed a budget bill that includes expansion, while the more conservative Republican-controlled House passed its own budget rejecting expansion. A group supported by the billionaire Koch brothers has lobbied hard against Medicaid expansion in the state.
Scott indicated a number of times during his first term that he supported Medicaid expansion but never did much to make it happen. Now the former CEO of the Columbia/HCA hospital chain has changed his tune after the CMS has played hardball about renewing federal funding for the low-income pool the state uses to help hospitals with uncompensated-care costs. Florida Democratic Sen. Bill Nelson said HHS is reluctant to renew the pool funding if Florida doesn't expand Medicaid, because many of the same low-income people who benefit from the pool would benefit from Medicaid expansion. He said it's paying twice for the same population.
"Given that the federal government said they would not fund the federal LIP program to the level it is funded today, it would be hard to understand how the state could take on even more federal programs that CMS could scale back or walk away from," said Scott, who was re-elected in November.
The low-income pool funding expires in June. The CMS announced in February it would not renew the waiver in its current form. State officials have been working on a way to alter the program to convince the CMS to renew it. Since 2005, the state has been receiving $1 billion to $2 billion annually to support safety net providers.
Some observers say CMS officials have tied the future of the pool to coverage expansion. Scott argued that if the CMS stops funding the low-income pool, it also could stop funding Medicaid expansion, leaving the state on the hook.
Experts note that there's no history of the federal government ever discontinuing funding for Medicaid.
If Florida expanded coverage, an additional 800,000 low-income adults would gain coverage. Hospital and business groups in the state strongly support the Senate expansion bill, which would rely on private health plans, includes work requirements for beneficiaries, and imposes a six-month cutoff of benefits for those who do not pay their premiums.
The Senate and House have until May 1, the last day of the legislative session, to reach a compromise. If they can't reach a deal, they will have to hold a special session. Florida's next fiscal year starts July 1. Even if the Senate could get the House to agree to expansion, Scott's new position suggests he would veto any budget bill that includes expansion.
Senior House Republicans say they have no intention of backing down in their opposition to Medicaid expansion. They have blasted the CMS for allegedly tying renewal of the low-income pool to the expansion.
“In my opinion, it's blackmail,” Rep. John Wood, chair of the House's Insurance & Banking subcommittee, said in an interview. “At the end of the day, if the federal government doesn't honor its commitment hospitals won't receive those funds. We don't have the money.”
Scott had announced his support for Medicaid expansion in 2013 in an emotional speech in which he talked about his loss of his mother a few months earlier. He said extending Medicaid was just a matter of doing right.
"While the federal government is committed to paying 100% of the cost of new people in Medicaid, I cannot in good conscience deny the uninsured access to care," he said at the time.
His Democratic opponent in last year's gubernatorial race made Scott's failure to push Medicaid expansion a major campaign theme, and Scott tried to dodge the issue.