Counties, AHCA hash out Medicaid billings

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With hundreds of millions of dollars at stake, local officials from across Florida sought changes Friday as the state moves forward with new plans for collecting Medicaid payments from counties, reports Jim Saunders of the News Service of Florida.

The issue has become highly controversial, after lawmakers in March required that the Agency for Health Care Administration recoup disputed Medicaid charges to the counties going back more than a decade. As of this week, 53 counties had joined a pending lawsuit that challenges the constitutionality of the Legislature’s move.

AHCA held a hearing Friday on draft rules that offer details about how the state would seek payments from past years and make billing changes for the future. Karen Lloyd, an assistant county attorney from Brevard County, said the draft rules are a “start” but need to include more critical information about issues such as the proof counties would need to dispute state billings.

“It’s a skeleton, if you will, in great need of some meat, some muscle, ligaments and tendons,” Lloyd said.

The controversy stems from a longstanding requirement that counties reimburse the state for certain hospital and nursing-home costs for residents who are Medicaid beneficiaries. Arguing that up to $325 million has gone unpaid in the past, lawmakers approved a budget-related bill that calls for gradually recovering the money.

As a sign of the concerns about the issue, representatives of Alachua, Brevard, Broward, Hillsborough, Manatee, Orange, Pinellas, St. Johns, St. Lucie and Sarasota counties spoke during Friday’s hearing. Also, the Florida Association of Counties made presentations and has spearheaded the lawsuit challenging the constitutionality of the Legislature’s decision.

County officials repeatedly raised concerns about part of the law that would require AHCA to tally unpaid county billings since Nov. 1, 2001. They said the state should only go back to 2008 and that at least some counties don’t have records from the earlier years – the counties argue the law doesn’t require them to retain records going back any farther.

In a related issue, county officials also said Medicaid billing guidelines have changed through the years. They said AHCA should take into account the guidelines that were in effect at the time in determining whether counties owe money from past years.

Another concern centered on how the state determines where Medicaid beneficiaries live, which is important because it affects which counties should pay the bills.

Officials said they run into residency issues related to people who have been in prison or who have lived in multiple nursing homes. Also, people sometimes list addresses as post-office boxes, attorneys’ offices or businesses.

“So many times, those addresses are just incorrect,” said Beth Ryder, housing and community-services director in St. Lucie County.

AHCA officials have traveled throughout the state during the past two months to talk about the Medicaid billing issues with counties. Karen Zeiler, the agency’s chief of staff, said officials have gone to 64 counties and will finish the final three next week.

The agency will continue taking written comments about the draft rules through next Friday. It then will determine whether changes need to be made before finalizing the proposals.

Peter Schorsch is the President of Extensive Enterprises and is the publisher of some of Florida’s most influential new media websites, including,,, and Sunburn, the morning read of what’s hot in Florida politics. SaintPetersBlog has for three years running been ranked by the Washington Post as the best state-based blog in Florida. In addition to his publishing efforts, Peter is a political consultant to several of the state’s largest governmental affairs and public relations firms. Peter lives in St. Petersburg with his wife, Michelle, and their daughter, Ella.