Friday was a good day for Florida’s kids. The federal government indicated that the state would not be allowed to proceed with a proposal, passed by the legislature last spring, to charge all Medicaid beneficiaries enrolled in managed care plans $10 a month regardless of income or age. It is important to note that much of the state’s waiver request to move most of the Medicaid program into managed care remains under discussion with the federal government and is largely unaffected by its decision on this particular issue. In fact, the premium proposal received little attention when debated by the legislature last spring.
As we found in our recent study, this proposal was likely to result in approximately 807,000 fewer children and parents enrolling in Florida’s Medicaid program. Most of these children and parents would have become uninsured and lost access to health coverage they need. Children were expected to bear the brunt of the losses, largely because there are far more children than adults enrolled in Florida’s Medicaid program. More than 80 percent of those dropping coverage – about 663,000 – would have been children, and the vast majority would have had incomes below the poverty line. Imposing premiums of this magnitude on families with very low incomes would have had dramatic consequences.
In turning down this aspect of Florida’s request, the federal Centers for Medicare and Medicaid Services (CMS) cited a number of statutory provisions including the cost-sharing provisions of the Medicaid law and the Affordable Care Act’s maintenance-of-effort provisions. Cost-sharing protections in Medicaid are essential to ensure that very low-income persons are able to access needed services as research is clear that copays create barriers to needed care. CMS also turned down the state’s request to charge a $100 copay for non-emergency use of the ER on Friday. This area will remain under discussion as CMS works with the state to find other ways to achieve this worthwhile objective.
This decision was probably not a surprise to state officials or other seasoned waiver watchers. In fact, the heart of the state’s proposal to move most of the program into managed care – both on the acute care and the long term care side – is still under active consideration by CMS. Many complex issues need to be addressed and many questions remain. But on the premium issue the Obama Administration made a sound decision that both comports with federal law and, more importantly, protects the health of Florida’s children and families.