Florida Story Shows Risk of Conflating Medicaid Waivers With “Block Grants”
Earlier this week I was asked by the Kansas City Star for my thoughts on a Medicaid expansion proposal being marketed as a “block grant” that’s currently circulating in the Missouri Senate. The problem? It’s not a block grant but rather a waiver, and I noted that as structured, the proposal could “guarantee Obamacare’s expansion but would not guarantee key reforms.”
The concern with waivers (Medicaid and otherwise) is their time limitations. When a waiver’s term expires, it’s up to the Federal government to determine whether that waiver will continue — and if the waiver continues, under what conditions.
The CMS will not renew a Medicaid waiver in Florida expiring at the end of June that provides more than $1 billion a year to help the state’s hospitals with uncompensated-care costs for low-income and uninsured patients. That may put additional pressure on Florida Republican leaders to consider expanding Medicaid to low-income adults under the Affordable Care Act.
Since 2005, Florida has had a Section 1115 Medicaid waiver establishing a low-income funding pool to aid the state’s hospitals. The state has received between $1 billion and $2 billion annually to support safety net providers.
To have genuine block grant Medicaid reform at the state level, the Medicaid laws would first have to change at the Federal level. Short of that, states and their Medicaid programs will always be subject to having the policy rug pulled out from under them. Florida is seeing this firsthand with a waiver that existed long before Obamacare passed but whose continued existence may hinge on implementation of Obamacare’s Medicaid expansion.
It’s good to hear politicians at least give lip service to a substantive change to Medicaid, but if little more than lip service is all that can be guaranteed in the Medicaid reform discussion, then Missouri taxpayer: beware. A waiver may look like a carrot, but it can easily be used like a stick. Just ask Florida.
Until flexibility in state reform is enshrined in Federal law with unambiguous block granting language, enduring and dynamic Medicaid reforms will be little more than a policy mirage. Unfortunately, a request for a waiver under Obamacare simply doesn’t cut it if long-term, state-based and patient-centered Medicaid reform is going to ever be a reality in the Show-Me State.