Florida Proposing New Medicaid Fees

July 12, 2011
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The state of Florida wants to impose $10 monthly premiums on Medicaid recipients who are not in nursing homes. Additionally, the state is proposing a $100 fee for Medicaid patients who use emergency rooms for routine care, according to Kaiser Health News.

The state of Florida wants to impose $10 monthly premiums on Medicaid recipients who are not in nursing homes. Additionally, the state is proposing a $100 fee for Medicaid patients who use emergency rooms for routine care, according to Kaiser Health News.

State officials and consumer advocates say they do not expect the administration to approve Florida’s proposals because they allegedly violate the Affordable Care Act. While the 2010 law gives states more flexibility, it does not allow them to enact new fees and premiums for existing beneficiaries.

While a dozen states charge Medicaid co-pays for ER visits, none charges more than $20 for those earning less than the federal poverty level. Medicaid recipients use the ER about three times as much as people with private insurance, according to recent studies. And that is often because they do not have a primary care physician.
Opponents of the ER fee argue it would be potentially lethal for impoverished Florida residents.

“You can imagine a host of examples, such as chest pains, false labor, children having problems breathing, where a very low-income person would have to make the decision not to go to the ER or risk being fined $100,” Laura Goodhue, the executive director of the patient advocacy group Florida CHAIN, told Kaiser.

This is just a sign of the times.

Legislators are seriously considering cuts in Medicare payments to hospitals for uncollectible patient debt and the training of doctors; steps to eliminate Medicare “overpayments” to nursing homes; a reduction in the federal share of some Medicaid spending; and new restrictions on states’ ability to finance Medicaid by imposing taxes on hospitals and other health care providers.

Medicare skilled nursing facility cuts (SNFs) of 11.3 percent are currently being proposed effective October 1. And the Centers for Medicare and Medicaid Services (CMS) must issue a final ruling by August 1. The Medicare Payment Advisory Committee has called for greater cuts of up to 30 percent. At the minimum, $100 billion in cuts can be foreseen.

The government is also trying to reduce their percentage of payment to states on the Medicaid side. States in turn are grappling with shortfalls. And that is leading to discussions around block grants, global spending caps and blended rates.

Needless to say more than just long-term care providers are in a panic. Hospital lobbyists are in full swing and even the AARP is concerned.

So you may want to brush up on your legislative and advocacy skills because you may be asked by your local health organizations to get involved.