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Federal Government Calls Gov. Scott’s Lawsuit Over Medicaid Expansion “Baseless”

| June 2, 2015

medicaid florida

She just heard about Gov. Scott’s lawsuit. (Zoriah)

Describing the state’s arguments as “baseless,” federal officials this week fired back in court against Gov. Rick Scott’s contention that the Obama administration has unconstitutionally tried to link expanding Medicaid with the continuation of a key health-care funding program.

In documents filed late Monday in federal court in Pensacola, the U.S. Department of Health and Human Services gave its first detailed accounting of talks with Scott and other state officials about the Medicaid issue and the continuation of the Low Income Pool funding program. The filings deny Scott’s argument that the Obama administration has tried to coerce Florida into expanding Medicaid.

Top federal Medicaid official Vikki Wachino said in one of the documents that she attended a May 6 meeting between Scott and U.S. Department of Health and Human Services Secretary Sylvia Burwell. She said the federal government took issue with details of a state proposal for continuing the so-called LIP program after June 30 — but decisions about the program were not tied to expanding Medicaid.

“At that meeting, Secretary Burwell stated expressly that Medicaid expansion is a state decision and that whether or not a state receives federal funding for an uncompensated care pool (LIP) does not depend on whether that state expands,” Wachino said in the document. “She also said that HHS was not saying there would not be a LIP program but instead that it needed to be altered.”

A day after the May 6 meeting, the state filed a motion in court seeking a preliminary injunction to block federal officials from linking the issues, contending that Washington was trying to “hold LIP funding hostage to Medicaid expansion.” LIP, which totals nearly $2.2 billion this year, provides additional Medicaid funds to hospitals and other health-care providers that serve large numbers of low-income patients.

“By refusing to continue funding a multibillion-dollar Medicaid program that offsets the costs of uncompensated health care provided by safety-net hospitals and trauma centers, children’s hospitals, medical schools, and other providers statewide unless and until Florida agrees to opt into the Affordable Care Act’s Medicaid expansion program, the federal government has engaged in unconstitutional coercion,” attorneys for the state wrote in the May 7 motion for a preliminary injunction.

Scott filed the lawsuit April 28 amid a state budget impasse that has stemmed from questions about the future of the LIP program and a dispute between the House and Senate about whether to offer private health-insurance coverage to hundreds of thousands of low-income people. The Senate has pushed the expansion plan, which would use federal Medicaid money available under the Affordable Care Act, better known as Obamacare — though Senate leaders contend the plan wouldn’t be an expansion of Medicaid.

The documents filed Monday by the federal government responded to the state’s motion for a preliminary injunction in the case. But the documents also noted that federal officials notified Florida on May 21 that it could expect to receive about $1 billion for the LIP program in the fiscal year that starts July 1, without the money depending on Medicaid expansion.

State lawmakers started a special legislative session Monday and are expected to use the $1 billion figure as they negotiate a budget for the upcoming year. The Senate has continued pushing the health-care expansion plan, which continues to be adamantly opposed by Scott and the House.

“CMS’ (the federal Centers for Medicare & Medicaid Services’) letter to Florida of May 21, 2015 further confirms defendants’ continued openness to consider approval of a LIP program in Florida with reasonable reforms, regardless of Medicaid expansion,” federal attorneys wrote in one of the documents.

The documents also give a glimpse of sometimes-strained relations between federal and state officials. As an example, the documents pointed to a statement issued April 1 by Florida Agency for Health Care Administration Secretary Liz Dudek, who said the state had been notified the day before that top federal Medicaid official Eliot Fishman would not be available for further LIP negotiations for two weeks.

“This was sudden and disappointing news,” Dudek said in the April 1 statement. “AHCA’s conversations with CMS had been productive and positive until this point. For CMS to discontinue LIP negotiations now is troubling and could signal the abrupt end of this federal health-care program in Florida.”

But in one of the court documents, Fishman said he had notified the state beforehand that he would be unavailable because of a “long-scheduled vacation to Europe and then to Israel for Passover.” He also said he had told state officials they could talk with his senior policy adviser “who was intimately familiar with the Florida discussions.”

Wachino recounted in another document that she made an “unscheduled call” April 2 to state Medicaid director Justin Senior because of the Dudek statement. She said she told Senior federal officials were considering LIP information submitted by the state.

“I also told Mr. Senior that it was highly unusual for a state official to issue a press release when a CMS employee was taking a scheduled vacation,” Wachino said in the document. “Mr. Senior responded that the length of Mr. Fishman’s vacation came as a surprise to him. I assured Mr. Senior that CMS was considering the general approaches (about LIP) that Florida had given to CMS and would get back to Florida with general feedback on the approaches Florida was suggesting.”

–Jim Saunders, News Service of Florida

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8 Responses for “Federal Government Calls Gov. Scott’s Lawsuit Over Medicaid Expansion “Baseless””

  1. Anonymous says:

    What we need is some lawmakers with a pair that would go with single payer health insurance. Problems solved… oh maybe those people who have been very fortunate to have some nice paychecks would have to fork over a few more dollars to do so but hey aren’t they supposed to be christian caring individuals? Or perhaps not. When does the greed end???

    • djsii says:

      “maybe those people who have been very fortunate to have some nice paychecks would have to fork over a few more dollars………………..When does the greed end???”

      I’m sorry but it is a bit unclear to me as to where the “greed” exists. Is it really with the rich who pay the taxes that are required of them? Is it with the middle class of this country who pay the majority of the taxes in this country? Is the greed with the socialists who have never seen a tax they couldn’t support or a pocket they were unable to pick?

      Here is just an example of how we are currently burdened with “a few more dollars”

      How Much Tax Do We Really Pay:

      Federal personal income tax 17%
      State & local income taxes 10.1%
      Sales tax 9.7%
      Social security & Medicare 7.65%
      Federal and state corporate income tax share 2.5%
      Property tax 2.5%
      Fuel/gasoline tax 0.5%
      Other 6%

      Total tax percentage potentially paid by the well above average US citizen, 2005 – 53.2%
      Total tax percentage potentially paid by the well above average US citizen, 2013 est. – 58.5%

      I doubt that these numbers include charities or other donations that so many people willingly give to each year.

      I guess the question could be “When is enough enough?” For me, if I am paying over 50% of my income to support this country…………………….. that’s enough.

  2. groot says:

    State Medicaid offices always have to run their state plans by the feds for approval. Sounds like the feds have decided to fund the LIP program but it still has to conform to federal regulations. The hospitals in Florida were no doubt raising holy heck at the federal level.

  3. My thoughts says:

    What the Fed has been trying to do for some time, and it’s in the Affordable Care Act, is transition away from using hospital emergency rooms as the primary point of service. It’s expensive (paid for out of the Low Income Pool) and with limited positive results because there wasn’t any patient follow up or continuing care that you would ideally get with a primary doctor. So what are the solutions? How about private insurance and transition away from funding the ER? The LIP money isn’t going away, it’s funneling through different channels that are less expensive. How Republican.

    I suspect Governor Scott did a “180” on this because someone is looking at him to run as a Vice Presidential candidate on their Presidential ticket.

    You and I right now pay for this twice. Once through taxes and again through “overcharges” at the hospital.

  4. Anonymous says:

    It’s not baseless. It’s based on political opportunism, supported by the force of utter prejudice.

  5. Sherry E says:

    Just for a point of accuracy to all. . . Florida does not have “state or local income taxes”, but many other states do.

  6. groot says:

    The state portion of the program is about $1.1 billion. This is not public tax dollars. The state, AHCA, taxes the hospitals based on their gross business and then redistributes the money back to the hospitals based on uncompensated care and medicaid business. So, the big ticket hospitals like Mayo and the Cleveland Clinic, pay a lot but the money goes back to those hospitals that treat the uninsured and under insured. In the state up north where I did this, we funded not only the DSH (LIP) program itself but also our bureau and a portion of the state legislature. It’s big money and it’s very important to the hospitals. By standing up to CMS, Scott is trying to make a teabagger point.

  7. Sherry E says:

    Right On “My Thought Says”. . . this is all political posturing by horrific Rick Scott. . . a man who would throw anyone under the bus for his own political gain!! He’s suppose to be a “Tea Party” leader, who says they want “less wasteful government”. . . yet, if the idea of efficiency comes from President Obama or the Federal administration, he is dead set against it!!! Hypocracy and obstructionist game playing at it’s worst!!!! Meanwhile, the tax payers pay more for a lower quality of health care for those who suffer the most!!!

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