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By Gray Rohrer, Orlando Sentinel (TNS)

TALLAHASSEE, Fla. — The fight over expanding Medicaid to cover 800,000 more people in Florida took another twist Monday, as a statement released by Gov. Rick Scott hinting at his opposition to expansion set off a ripple through the state government and health care circles.
Scott has previously stated he wants to focus on his priorities of cutting taxes, keeping tuition low, and boosting K-12 education funding instead of making a push for Medicaid expansion, something he came out in favor of in 2013.

But with the federal Center for Medicare and Medicaid Services, or CMS, threatening to end funding for the Low Income Pool, a Medicaid program paying hospitals for care for low-income and uninsured patients, Scott raised doubts about expanding the underlying Medicaid program.

“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,” Scott said in a statement first released to The Associated Press.

Asked if the statement meant Scott was now opposing Medicaid expansion, a spokeswoman for the governor declined to elaborate.

LIP, funded mostly through county and federal funds, is a $2.2 billion program set to end June 30.

Should Scott ultimately oppose Medicaid expansion, it would be a reversal of his previous position.

“While the federal government is committed to pay 100 percent of the cost, I cannot, in good conscience, deny Floridians the needed access to health care,” Scott said during a February 2013 news conference.

Original Medicaid expansion plans under the Affordable Care Act would offer coverage to those making up to 138 percent of the federal poverty level, or $33,000 for a family of four. The expansion plan would cost $52 billion in federal funds over 10 years, with the federal government paying the full cost for two years before phasing down to 90 percent, with the state covering the rest.

Because the Florida House refused to expand Medicaid two years ago, the cost would now be $47 billion over eight years.

“The law is clear: Federal funding for Florida’s Medicaid expansion covers 100 percent of the costs of newly eligible individuals through 2016 and will never fall below 90 percent. HHS has proven itself willing to work with any state interested in expanding Medicaid, and we have consistently said that a Florida solution would reduce costs for hospitals that are typically passed on to taxpayers and expand access to quality health care for more Floridians,” said Ben Wakana, spokesman for the federal Department of Health and Human Services.

Florida Senate President Andy Gardiner, R-Orlando, has pushed an alternative Medicaid expansion play known as Florida Health Insurance Affordability Exchange, or FHIX. It requires newly eligible Medicaid recipients to pay co-pays, premiums, and be employed or looking for work. It would also end if the state didn’t receive approval or financial support from the federal government to pay for it.

Gardiner isn’t budging from his support of the expansion plan, despite Scott’s hints and a weeks-long period of standoff budget negotiations with the House, which has refused to take up expansion. He said the federal government won’t likely extend funding for an alternative LIP program if the state doesn’t expand Medicaid.

He also suggested Scott’s tax cut and other priorities could take a hit given the uncertainty over LIP and the state health care budget, which takes up about 30 percent of the overall budget.

“The Senate also shares the Governor’s commitment to tax relief and record funding for education; however, if our state is forced to make up the difference of $2.2 billion in hospital funding, every area of our budget will be impacted,” Gardiner said.

Mainly because the Senate has built both the expansion plans and an alternative LIP plan into its budget and the House includes neither in its spending plan, the two chambers are $4.2 billion apart. And since House leaders are so staunchly opposed to expansion, the budget talks are at an impasse before they’ve even begun.

Meanwhile, Scott and state lawmakers are hoping to negotiate a deal with the federal government to provide an alternative to LIP. Those talks are bogged down as well, however.

Florida Agency for Health Care Administration secretary Liz Dudek released a statement last week saying CMS had cut off LIP negotiations; CMS retorted that was incorrect, they were still in touch with state officials.

(c)2015 The Orlando Sentinel (Orlando, Fla.), Distributed by Tribune Content Agency, LLC

Photo: Gage Skidmore via Flickr

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