'Healthy Florida' Medicaid alternative ready to be heard

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  • | 12:00 p.m. March 20, 2013
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Moving quickly on an alternative to expanding Medicaid, the Senate Appropriations Committee is slated Thursday to take up a proposal that could lead to hundreds of thousands of uninsured adults receiving coverage through private health plans.

The Senate posted details of the proposal, SPB 7038, Monday on its website after Appropriations Chairman Joe Negron (R-Stuart) gave a broad outline last week.

The bill would create a program called "Healthy Florida" that would be administered by the Florida Healthy Kids Corp., which has long provided subsidized insurance for children in low- and moderate-income families.

If approved by the Legislature and signed by Gov. Rick Scott, the bill calls for speedily moving to try to put Healthy Florida in place.

State officials would have to seek federal approval by June 14, with enrollment expected to start as soon as Oct. 1 and coverage taking effect as early as Jan. 1.

The bill would require Healthy Florida to be evaluated after three years, with the Legislature deciding whether to renew it. Also, the program would rely heavily on federal funding to pay for the coverage — and would end if federal funding dropped below 90 percent.

Negron proposed the plan after a Senate select committee last week rejected expanding Medicaid eligibility under the federal Affordable Care Act, the massive health overhaul proposed by President Barack Obama.

Healthy Florida would serve the same population targeted in the Medicaid expansion and rely on federal funding, but Negron and others say a critical distinction is that it would do so through private insurers instead of Medicaid.

Meanwhile, the Senate Health Policy Committee is expected to take up another possible alternative today backed by the committee's chairman, Fernandina Beach Republican Aaron Bean.

That approach would use the Florida Health Choices program — a type of insurance marketplace that is on the drawing board — to offer coverage to people whose incomes are below 100 percent of the federal poverty level.

Though the Negron and Bean proposals greatly differ, Senate President Don Gaetz (R-Niceville) said Tuesday he thinks both need to be discussed.

"I don't have to reconcile them,'' Gaetz said. "That's the job of the Senate."

Scott last month made national headlines when he supported the Medicaid expansion, which would allow people with incomes up to 138 percent of the federal poverty level to get coverage. But Republican-controlled House and Senate select committees voted down the expansion, amid opposition from conservatives.

Scott proposed re-evaluating the Medicaid expansion after three years, a position that appears to be echoed in Negron's Healthy Florida proposal.

Under the Affordable Care Act, the federal government is expected to pay 100 percent of the expansion costs for those three years, with the federal share tapering off to 90 percent in 2020.

The Healthy Florida plan also would allow the governor to appoint the chairman and board members of the Florida Healthy Kids Corp. board, subject to Senate confirmation. Currently, the board includes appointees from a variety of sources, and the chairman is the state's chief financial officer or a designee.

Florida Healthy Kids offers subsidized insurance to children whose families pay $15 or $20 a month. It covers about 240,000 children, who are enrolled in private health plans.

The proposed Healthy Florida program would operate in much the same way, offering what the bill describes as "benchmark" benefits that would be similar to those in Florida Healthy Kids. One exception would be that the Healthy Florida program would not offer preventive dental coverage, according to the bill.

Healthy Florida could require enrollees to pay premiums and co-payments for services, with the amounts set each year in the state budget. Enrollees would have a choice of health plans, which could receive contracts on a statewide or regional basis.

Like in the current Florida Healthy Kids program, insurers would be required to spend at least 85 percent of the money they receive on providing health services to enrollees, a concept known in the industry as a medical-loss ratio.

It remains unclear how much support the Healthy Florida proposal will receive in the Senate and whether the House and Scott would agree with it.

While saying they want to look at alternatives to Medicaid expansion, House Republican leaders have repeatedly raised concerns about relying heavily on future federal money to offer expanded health coverage.

Another question is whether the Obama administration would approve the Healthy Florida approach and, if so, how soon that could happen.

The bill would give leeway to the Florida Healthy Kids Corp. to make changes, if necessary, to gain federal approval of the Healthy Florida program.



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