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Florida, Arkansas looking at hybrid approaches to Medicaid expansion

insurance-healthcare_webAs deadlines near for state legislatures to either accept or reject the Obama administration’s offer of billions of dollars to expand Medicaid, the governors of Arkansas and Florida are working to convince their legislatures to accept alternatives routes to expansion.

Florida Republican Gov. Rick Scott and Democratic Gov. Mike Beebe of Arkansas have presented their respective legislatures hybrid forms of Medicaid expansion that have received tentative nods from federal health care officials. Now their task is to convince their lawmakers to go along.

Scott could have the rockiest road, having spent the year and a half since taking office harshly criticizing Obama’s Affordable Care Act. He reversed himself earlier this month with a proposal to give Medicaid expansion a three-year tryout with private managed health care organizations, HMOs, providing treatment to about one million of Florida’s working poor who would be added to Medicaid rolls.

State analysts have estimated that Florida could get up to $55 billion in federal funds for the first 10 years while paying out about $3 billion for Medicaid expansion.

Scott’s plan got off to shaky start in the Legislature last Monday with the Senate Select Committee on the Affordable Care Act voting 7 to 4, along party lines, not to expand the Medicaid program.

Republican Sen. Joe Negron, committee chair, said he has a plan to use both federal and state funds to subsidize private health coverage for the population group that the Affordable Care Act made eligible for Medicaid, the Associated Press reported last Tuesday.

In Arkansas, meanwhile, Gov. Beebe is pushing for approval of a plan that would expand coverage to about 250,000 of the state’s working poor by using the federal Medicaid expansion to buy insurance on the state’s health care exchange, a private sector marketplace. Beebe must win over a super majority of the Arkansas House, one controlled by Republicans by a two-vote margin, with 51 GOP members, 48 Democrats and a Green Party member who votes with the Democrats.

Beebe began his push after hearing that Florida had received a waiver to put the new Medicaid enrollees into private HMOs, said Matt DeCample, Beebe‘s communications director.

Florida, he said, “showed there was potential flexibility we never knew was there.”

Also, the option Florida received for repealing Medicaid expansion after three years is looked on favorably in Arkansas, DeCample said.

“That’s an idea obviously appealing to a lot of Republicans here,“ he said, and noted the three years should provide ample data for deciding whether to continue in the expansion.

A study from the Arkansas Hospital Association says expanding Medicaid’s eligibility would result in a $664 million net savings to the state over the next several years and create 8,600 new jobs in 2014 and 10,600 new jobs by 2020.

By contrast, the main speaker at a Mississippi Hospital Association press conference last Monday said rejecting Medicaid expansion would put 9,000 Mississippi health care jobs at risk. The jobs would be lost through either steep reductions or elimination of $152 million in federal money the state’s hospitals receive annually for treating uninsured patients.

The speaker, Singing River Health Systems CEO Chris Anderson, said he is encouraged that Gov. Phil Bryant has agreed to explore alternative approaches that would expand health care to more of the state’s uninsured and preserve the federal dollars the state’s hospitals receive.

Alternatives under consideration in Florida and Arkansas will likely be considered in the Hospital Association’s discussions with Bryant, who had been adamant that he will not accept expansion of Medicaid as currently set forth by the Obama administration.


Hospital execs strike urgent note on alternatives to Medicaid expansion


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