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CMS taking harder line on Medicaid expansion

Expiration of funding for Florida's Low Income Pool gives federal agency leverage

The Centers for Medicare & Medicaid Services (CMS) appears ready to abandon its conciliatory approach to Medicaid expansion in favor of a harder line, the National Journal reported.

The issue is coming to a head in Florida, where $1 billion in federal funding for a separate Medicaid program known as the Low Income Pool (LIP) is set to expire this summer.

CMS has said the funding won't be renewed as it is. In fact, the Journal said, the agency's one-year approval of that money last year came with the condition that an independent group study the LIP program's effectiveness. The unstated message from CMS, according to the article: Automatic LIP funding isn't guaranteed when Medicaid expansion under the Affordable Care Act remains an option.

That pressure seems to have spurred a call to action in the Sunshine State, where the Republican-led Senate introduced a Medicaid expansion bill in the first week of the new legislative session. "We don't know how this ends, but we want to be prepared for whatever is going to come down the pipe," Florida Senate President Andy Gardiner (R-Orlando) told the Journal.

Expansion would cover about 1 million Floridians and bring about $50 billion in federal money to the state in the next decade, acording to the St. Augustine Record. The bill also seeks $2 billion in federal funds to continue the LIP program, which primarily benefits the state's safety net hospitals.

The bill admittedly faces an uphill battle. Florida has been wary to expand Medicaid, despite the support of Gov. Rick Scott (R), and the Florida House has blocked similar legislation the past two years. However, it will also see quick action--the bill is tied to the Senate's budget proposal, and Florida requires a balanced budget to be approved before its legislative session closes May 1, the Record said.

Florida is hardly the first state to draft its own proposal for Medicaid expansion. Notably, CMS approved a private Medicaid expansion option in Arkansas, while Indiana's Medicaid expansion includes premiums and co-pays, FierceHealthPayer previously reported.

However, CMS seems to have leverage in Florida, the Journal noted, and that has put pressure on the state to act.

For more:
- here's the National Journal article
- read the St. Augustine Record article

Related Articles:
Indiana latest state to expand Medicaid
Texas and Florida remain wary to expand Medicaid
Medicaid expansion roundup: Where are all the states now?
States pursue tailored Medicaid expansion approaches
Arkansas first to use private Medicaid expansion