The Florida House has unveiled plans to overhaul the state’s Medicaid program. The proposal includes new premiums and work requirements. But longtime observers say the program is stingy as-is, and they’re questioning whether the House plan is even feasible.
Florida spends a third of its $82 billion budget on Medicaid. It’s now the largest share of the state’s spending. But most of that spend isn’t coming straight out of state coffers. The federal government kicks in about 80 percent of the funding. There are more than four million people who use the low-income healthcare program. And Georgetown University Professor Joan Alker is blunt with her assessment of the proposed changes.
“This bill…is one of the worst pieces of legislation I’ve seen in a long time," she says.
She’s worried children, which make up the majority of Medicaid enrollees will begin to lose coverage under a plan by the Florida House's health and human services committee. At issue: plans to impose work requirements, and charge premiums.
And Democratic Representative Lori Berman has a question about that.
“We already have pretty low eligibility levels in Medicaid. So who exactly will the new work requirements apply to?” She asks.
Sixty percent of Florida’s Medicaid recipients are children. The state also covers seniors who have exhausted their retirement funds, people with certain disabilities, and pregnant women.
“It would apply to working parents which obviously our eligibility for working families, we estimate to be maybe a few thousand. There aren’t a lot covered under our traditional safety net," says Committee Chairman Republican Rep. Travis Cummings.
The measure would also begin charging monthly premiums. $10 a month may not sound like a lot, but Karen Woodall with the Florida Center for fiscal and economic policy argues the people most affected by the provision are seniors, people with disabilities, and children.
“If you’re taking a senior citizen, 50 percent of FPL is $502 a month. And I understand for many paying $10-$5 a month for your healthcare doesn’t seem like too much to ask. But someone living on $502 a month, or a little over $1000 a month for a couple, every little bit matters.”
Georgetown’s Alker agrees, and says the premiums in particular will end up costing the state more money than lawmakers think they might save. That’s backed up in a staff analysis of the bill that Democratic Representative Daisy Baiez reads aloud.
“It says formal enrollees who require Medical care may seek such care in the emergency rooms, and without the ability to pay, may lead to an increase in charity care or uncompensated care by hospitals.”
Emergency rooms are among the most expensive places to get healthcare. And such costs for uninsured patients are born by the state and federal government. But Cummings isn’t worried. He says premium collections are already done in Florida’s Healthy Kids program, and he argues his proposal is no different. Failure to pay would result in a year-long lockout. Cummings admits it’s an arbitrary timeframe. The moves comes after U.S Secretary of Health and Human Services Tom Price announced in March that his agency would grant states more flexibility in their waiver programs. Alker says the federal government has historically resisted work requirements and co-pays, but that may be changing.
"Of course, we have the Trump administration saying ‘we’re open for business, come to us with proposals.' So I think state lawmakers, especially as this moves forward to the Senate, to take a much more careful look at this. It could result children, people with disability, children and seniors losing their vital Medicaid coverage.”
No similar measure has emerged in the Florida Senate.