The Senate Ethics and Elections Committee voted 8-1 to approve Liz Dudek‘s appointment as head of the state Agency for Health Care Administration but only after she answered more than an hour’s worth of questions regarding Low Income Pool funding, Medicaid expansion and how negotiations are evolving with the federal Centers for Medicare and Medicaid Services.
Senators asked some pointed questions and Dudek–a longtime state healthcare planner who is held in high regard by the Florida Legislature–gave senators the answers they were looking for.
She acknowledged that there is a chance that Florida could get no supplemental Medicaid funding — known as LIP — though she couldn’t tell the Senate how likely that would be to occur.
She acknowledged that the agency and the Governor’s Office do not have a “plan B” if the federal government were to cut off the LIP dollars, now set at $2.1 billion, more than $1 billion of which is federal money.
When Sen. Joe Negron asked Dudek what amount Florida could expect to receive in LIP funding, Dudek hesitated. “We know what number we believe is correct,” she said, adding that at one point the federal government countered Florida’s request for $2.1 billion with “half of that amount.”
When Negron pressed for a dollar figure with a follow-up question, Dudek replied: “Unfortunately, given that I can’t guarantee what they would approve, I don’t know if i can give you a figure. I wish I could.”
She also told the Senate that she didn’t think a trip to Baltimore made by state Sens. Rene Garcia and Garrett Richter interfered with negotiations between the state and federal government. The House of Representatives and Gov. Rick Scott‘s office have repeatedly suggested that the senators’ unexpected trip to Baltimore may have derailed the negotiations.
A growing controversy surrounding the expiration of the LIP program surrounds when the agency began to prepare for the impending loss of federal dollars and what did it do to prepare.
Those series of questions came from former Senate President Don Gaetz.
“We knew a year ago that LIP was ending or being radically changed; we knew a year ago it was a multibillion impact on our budget. When we dealt with issues like this in the past we submitted a 235-page proposal to the federal government,” Gaetz said. “Did we submit a formal proposal with narrative and explanations to the government anytime before late February or early March of this year?”
Dudek said the agency didn’t submit anything but that it was advised by the federal government that it didn’t need to because CMS would be “flexible” and would work with the state.
Dudek said the state had submitted three Low Income Pool proposals to the federal government in early March but Gaetz interrupted her testimony noting that in previous testimony, Deputy Medicaid Director Justin Senior described the documents as “scenarios.”
Gaetz added that to him the documents appeared to be “spreadsheets, vague concepts.”
As Gaetz continued to press, Dudek said that the agency submitted a formal proposal to CMS on Wednesday and that it was the modified LIP proposal compiled by the Florida Senate.
To which Gaetz countered: “Well, I’m glad the Senate was not the impediment then. Apparently, we were the only life raft available.”
Gaetz also questioned Dudek whether the Governor’s Office or agency had been debating the merits of submitting a request for what is called a 1332 innovation waiver, named after the section of the federal healthcare law–known as Obamacare– that creates them. Essentially the “innovation waivers” are block grants that would allow the state freedom from the federal healthcare law. Dudek said there had been no discussions about the waivers.
Gaetz asked Dudek whether the governor supports the Senate plan. Dudek replied, “The governor supports our submission of the amendment which is the Senate LIP plan. Yes.”
When asked if she were satisfied with the approach Florida has taken to renegotiating the LIP dollars, Dudek acknowledged that she has been “disappointed” but quickly added that the federal government is “100 percent in control.”
When asked whether it was ever the governor or AHCA’s plan to not go forward with LIP dollars, Dudek replied, “It has never been within our realm of thought that we wouldn’t continue moving forward with the LIP.”
Throughout her testimony Dudek maintained–as does her boss–that Medicaid expansion and the continuation of the Low Income Pool dollars are separate issues and not linked. Dudek said she did not realize the two were linked until the Department of Health and Human Services sent the letter to AHCA on April 14.
Unlike Department of Health Secretary John Armstrong, who awkwardly avoided answering questions about Medicaid expansion and whether he supported it, Dudek artfully answered the questions when they came her way. Armstrong’s confirmation process has been temporarily deferred by the Senate and has not been taken back up.
She said that no one has complained to her agency about lack of access to health care when asked whether accepting federal Medicaid dollars would improve Floridians’ access to health.
Dudek did offer that she did not think the Senate’s proposed plan to expand Medicaid access–called FHIX–would pass muster because of the requirements that many of the Republicans in the Senate are most proud, such as a work requirement and co-payments.