A mandate to buy? Proposed rule would require some Medicaid patients to buy health insurance

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The Legislature set an anti-Medicaid expansion tone in the Capitol Tuesday but regulators at the state’s biggest health agency have proposed a rule that, like Obamacare, mandates the purchase of insurance.

The Agency for Health Care Administration is proposing a rule that, if cost effective, would require any Medicaid beneficiary with access to employer-sponsored insurance to enroll in the commercial plan. It would not apply to pregnant adults.

The insurance mandate also would not apply to Medicaid patients who don’t have access to employer-sponsored insurance even though their spouse or other family member  can purchase insurance through an employer.

Patients are deemed cost effective if the premium, co-payments, co-insurance and other cost obligations–combined with an administrative cost–are less than what the state would pay for the patient in the new Medicaid managed-care program.

What they currently spend in the managed medical care program depends on where the Medicaid patient lives and what plan they enroll in, among other things.

The federal government would need to sign off on the employer-sponsored insurance mandate before it could be implemented.

Under terms of the proposed rule the Medicaid patient would be reimbursed costs after submitting the proper documentation to the agency.

Agency spokesperson Shelisha Coleman said the mandate is not on the individual but, rather, on the Medicaid program. “Recipients will have access to the same service package and there is no cost to the recipient,” she said in an email.

There is no SERC analysis on the proposed rule. The analyses are required if proposed rules or proposed changes to existing rules have a $200,000 impact in the aggregate on businesses.

The proposed rule cites chapter 409.977(4), which authorizes the agency to develop a plan for Medicaid patients to “opt out” of the mandatory managed-care program and into employer-sponsored coverage or products authorized pursuant to state law that provide access to health-care services sold through the Florida Health Choices Program or any health exchange.

The Florida Health Choices Program was created in 2008 by then-Speaker Marco Rubio.

The agency will discuss the  proposed rule at a public hearing November 24.