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House offers $200 million to Senate to get budget negotiations rolling

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With just one week left in the legislative session, the House on Thursday offered to spend $200 million in general revenue to help fund hospitals in the absence of the federal Low Income Pool.

“It is a proposal that is on their desk right now,” House Speaker Steve Crisafulli told reporters announcing the proposal.

There was no substantive healthcare policy offered with the money, Crisafulli said. The $200 million could draw down another $305 million in federal Medicaid dollars, which would not need to be approved by the federal government in advance, unlike the Low Income Pool.

Crisafulli said that the $200 million comes from a variety of sources, including money set aside to increase public education as well as money targeted for tax reductions, both of which are priorities for Florida Gov. Rick Scott.

The $200 million amount is about one third of what Senate President Andy Gardiner said the Senate would commit in general revenue to help offset cuts to Florida hospitals if the Low Income Pool were to be eliminated.

Gardiner’s spokesperson, Katie Betta, said Gardiner had not had an opportunity to review the proposal but he is “looking forward to working together” with Crisafulli.

Crisafulli the $200 million was offered to get the conversations and negotiations between the two chambers back on track. The speaker said that he has been willing to compromise.

“We’ve come up with the $200 (million), maybe they start somewhere, and eventually that’s the compromise, that’s the conversation starter,” Crisafulli said. “We are willing to have that conversation if they are willing to have it without waiting back from CMS.”

Medicaid financing for hospitals and Medicaid expansion have derailed the 2015 legislative session. The Low Income Pool is made possible by a Medicaid 1115 waiver, which requires federal approval. The federal government told Florida last year that the LIP program would not be extended beyond this summer.

The Agency for Health Care Administration has been negotiating with the federal government since February to maintain the funding but the negotiations have soured and the federal government advised Deputy Medicaid Director Justin Senior in a letter that insurance — not pools for uncompensated care like LIP — is a better use of taxpayers’ dollars.

The federal government’s letter caused a firestorm of reaction. Gov. Rick Scott has threatened to sue the federal government for trying to “coerce” the state into expanding Medicaid under Obamacare. Congressional Republicans have written the Department of Health and Human Services and congressional Democrats have written the governor advising him not to sue the federal government.

Meanwhile, the agency posted the proposed amendment on its website and announced three meetings whether it can take public comment on the proposed amendment. The agency must hold the record open for 30 days before it submits the waiver to the federal government.

The federal government, too, must take public comment for 30 days. After the federal public comment period expires the federal government must wait 15 days before it can officially act on the waiver.

The timeline means that Florida’s waiver cannot be acted on until July 4, after the start of the 2015-16 fiscal year, unless the federal government agrees in principle to notify how much it can expect to receive in LIP dollars.

“We all live in a realistic world, and the reality is, we probably won’t  be hearing from (the Centers for Medicare and Medicaid Services) for a little while,” Crisafulli said. “We figured we’d go ahead and act on the offers we’ve been putting out there.”

Even if the offer made Thursday by the House is approved by the Senate, the chambers won’t be able to have a budget negotiated and agreed to and ready to vote out before the scheduled May 1 end of the 2015 session.

“We can’t get out on time just because of the process. That would take miracles at this point,” he said. But Crisafulli added that if the budget conversations begin now and work gets underway the session could be extended “and potentially come to some resolution on the budget.”

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