The proposal (SPB 7044) would establish a state-run private insurance exchange available to Florida residents who earn less than $16,000 in annual income, or $33,000 for a family of four.

Beneficiaries would be required to work or attend school, and pay monthly premiums.

It won’t be the first time Florida lawmakers debate the issue. The Republican-led Legislature refused to expand Medicaid in 2013 as part of the Affordable Care Act.

But the question of federal funding has resurfaced in the Senate, because the state now risks losing a separate pot of federal money that helps hospitals pay the costs of treating uninsured, under-insured and Medicaid patients.

Senate President Andy Gardiner, R-Orlando, has said expanding Medicaid could help the hospitals that would be affected by covering some of the health care costs for low-income Floridians.

“Some say Florida should not expand the existing Medicaid program and I agree,” Gardiner wrote in a memo to the Senate. “But we have the obligation to make coverage affordable and the opportunity to develop a consumer-driven approach — one that provides access to high-quality, affordable health care coverage while promoting personal responsibility. We should develop options that uniquely suit the needs of Floridians.”

A spokesperson for House Speaker Steve Crisafulli, R-Merritt Island, declined to comment on the Senate proposal. But last week Crisafulli said House Republicans were “not interested in expanding Medicaid as we know it.”

The federal government has said it will not renew a $2 billion program called the Low Income Pool — or LIP — that helps hospitals pay the costs of treating uninsured, under-insured and Medicaid patients.

The state is working with the federal government to negotiate a successor program. But there is no definitive time line for an agreement to be reached.

Late last week, Senate Budget Chairman Tom Lee said the uncertainty surrounding the LIP program had brought the budget process to a “standstill.”

“Everything is on the table, including... being here in May,” Lee said, suggesting lawmakers might need to have a special or extended legislative session to finish the budget.

Senate leaders say accepting federal Medicaid expansion funds would ease the burden on hospitals like Jackson Health System that treat uninsured patients.

“Extra federal funds will enable more of our friends and neighbors to obtain health coverage,” Gardiner wrote in his memo.

But House Budget Chairman Richard Corcoran says he believes the Low Income Pool money will come through — and that Medicaid expansion is unnecessary.

“We were in this exact situation last year,” Corcoran told reporters last week. “It wasn’t until the second week of April that we knew we were getting the LIP money, and we were fine.”

The proposal in the Senate is likely to win the approval of the Senate Health Policy Committee Tuesday.

The bill would create a new health insurance marketplace known as the Florida Health Insurance Affordability Exchange. It would be run by Florida Health Choices, which operates the state’s existing insurance exchange.

The income-based eligibility requirements are the same as those outlined in the federal Medicaid expansion proposal. The work requirement, however, is specific to Florida.

The Florida plan also requires participants to pay monthly premiums and incur $25 fines for “inappropriate” trips to the emergency room.

“Skin in the game is very important,” Senate Health Policy Chairman Aaron Bean said. “When I go to the doctor, I have to pay a little bit. It is important that people do that as we’re going forward.”

Because the plan is different from Medicaid expansion as envisioned under the Affordable Care Act, Florida would need a waiver to receive the $51 billion available for Medicaid expansion in the state.

Bean pointed out that the Centers for Medicare and Medicaid Services, a federal regulatory agency, had recently approved a Medicaid expansion proposal in Indiana with some similar components. But CMS would not approve Indiana’s request for a work referral as a condition of eligibility.

Some local elected officials are urging Florida lawmakers to move forward.

At a Monday press conference, Miami Mayor Tomás Regalado pointed out that hundreds of thousands of Floridians earn too much to qualify for Medicaid — but not enough to qualify for a premium subsidy to help cover the cost of private insurance on the federal exchange.

“This is a real crisis, but it’s been under the radar,” Regalado said. “I really think Miami has a problem with this gap.”

The mayor was joined by Harry Melo, 28, who recently moved to Miami-Dade County to pursue a master’s degree in higher education administration. He learned he no longer qualified for Medicaid when he attended an Florida International University enrollment fair.

“I considered driving back to New York, where I wouldn’t have to pay for out-of-state tuition [or] on-campus housing, I can accept student loans and have insurance,” he said.

Melo said he would likely remain uninsured — and hope the Florida Legislature expands Medicaid.

Julio Fuentes, president of the Florida State Hispanic Chamber of Commerce, made another argument for expansion during Monday’s press conference: It could create as many as 100,000 new jobs in Florida.

“From a business perspective, it’s absolutely a no-brainer,” Fuentes said. “From a moral perspective, it’s imperative.”
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