Florida governor confronts HHS in ObamaCare fight

Florida Gov. Rick Scott (R) on Wednesday demanded an answer from the Obama administration “right now” on the renewal of federal funds for hospitals in his state, amid a showdown over ObamaCare’s Medicaid expansion.

“I've let them know our timeline and we need an answer right now,” Scott told reporters outside the Department of Health and Human Services headquarters in Washington after meeting with Health and Human Services (HHS) Secretary Sylvia Mathews Burwell. 

According to HHS, Burwell gave Scott the “preliminary view” that the state’s current proposal falls short of the administration’s requirements.

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At issue are federal funds to reimburse hospitals in Florida for treating uninsured people, known as the Low Income Pool (LIP). Scott is suing the Obama administration, alleging that the administration is withholding the funds in an effort to force the state to expand Medicaid under ObamaCare. 

The administration counters that Florida is free to expand Medicaid or not, and that the decision on LIP funding will be made “regardless” of whether the state expands Medicaid. 

There is also the condition, though, expressed in an April 14 letter to Florida, that the LIP funding should be tailored so as to not cover costs that would be covered if Medicaid was expanded. The administration says giving people Medicaid is a better system than reimbursing hospitals for uninsured care.

Questions remain about the timing of the letter, which Scott says was timed to raise pressure on the state after months of negotiations with HHS. 

Burwell told Scott Wednesday that the state’s LIP proposal, submitted on April 20, does not appear to meet the administration’s standards. The proposal, at $2.2 billion, is for about the same level of funding, with no plan to transition it down, an indication that it is not tailored to avoid covering costs that would otherwise be covered by Medicaid expansion.

“The size of the proposed LIP appears larger than what matches the principles,” HHS said in a readout of the meeting.

HHS pointed out that the proposal is still in the middle of a 30-day public comment period in Florida, a step before its final decision on the proposal.

“HHS is continuing to engage with Florida on the state’s LIP proposal, even as the period for public comment in Florida is underway,” the readout said. “HHS heard the Governor’s request for a timely response to help the state meet its budget timeline. HHS believes completion of the public comment period, on-going discussions with the state, and the state’s submission of its proposal to CMS are the next steps in the process.”

Scott did not mention this message from Burwell when he spoke after the meeting. “We had a good conversation, I want to thank her again for the opportunity, but we don't have a resolution,” he said.

“If they are going to take action, they're going to need to take action in the next few weeks because if they don't, again, that's the same as a ‘no,’ ” Scott said. 

The Republican Florida Senate president, Andy Gardiner, has been critical of Scott for waiting until April 20 to submit the application, pointing out that the state has known for a year that the LIP funds were expiring. 

Scott, asked about the delay Wednesday, said historically the process was done informally before the formal proposal was submitted. But “we were not getting an answer from HHS,” he said. 

“We went ahead and made the final [proposal] to see if we could get an answer in the time frame that worked for our state budget,” he said.

Asked about Scott's claim, an HHS spokesman referred back to a statement from early April, when Florida argued that the administration had walked away from negotiations. "Indications that the Center for Medicare and Medicaid Services discontinued conversations with the state of Florida are categorically false," HHS said then.

Florida's government is deadlocked in budget negotiations over questions of whether the LIP and Medicaid funds will be available. The Senate wants to expand Medicaid, while the House is strongly opposed. Scott was initially open to the idea but has pulled his support. 

The administration has pushed Scott to expand Medicaid.

“Secretary Burwell urged Governor Scott to consider Medicaid expansion, saying it is an important element to providing access to quality health care and reducing hospital costs that are typically passed on to taxpayers,” the HHS readout said.

Scott defended his opposition to Medicaid expansion on Wednesday. He said that when he came into office, Medicaid was “sucking out all the money in the budget.” After reforming the state’s program, he said, “we have a program that works.”

— This story was last updated at 4:22 p.m.