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U.S. Sen. Bill Nelson (D-FL) and Rep. Kathy Castor (D-FL) led a group of Florida lawmakers today in calling on the Centers for Medicare & Medicaid Services (CMS) to reject a State of Florida proposal to cut nearly $100 million from the state’s Medicaid program.

“I rise here today because the State of Florida has again proposed to harm thousands of seniors and folks with disabilities who rely on Medicaid for their health care,” Nelson said on the Senate floor Thursday.

Nelson’s remarks come just hours after he, Castor and 10 other members of Florida’s Congressional delegation sent a letter to the head of CMS urging the agency to reject the State of Florida’s request to allow it to stop providing three months of retroactive coverage for Florida’s Medicaid beneficiaries.

“This proposal will directly hurt Floridians with disabilities and seniors in nursing homes,” the lawmakers wrote. “If approved, this decision could jeopardize the financial security of at least 39,000 of the most vulnerable Floridians and countless providers who treat them.”

Under the existing Medicaid framework, Medicaid beneficiaries can get up to three months of retroactive coverage from the date they apply to enroll in the Medicaid program, as long as they were eligible for Medicaid when they received care. In March, the State of Florida proposed eliminating this policy of providing retroactive coverage – a proposal Nelson, Castor and others are now urging the agency to reject.

“It is our duty to ensure eligible individuals have access to care without going into debt to obtain it, which is why retroactive eligibility is so vital,” the lawmakers wrote. “This proposal would not only wipe out many families’ pocketbooks, but it would also place a financial burden on health care providers, the state and indeed all Florida taxpayers through increased uncompensated care costs.”

The federal lawmakers dismissed the state’s claim that the proposal was an attempt to “enhance fiscal predictability” of the state’s Medicaid program.

“If the state were serious about securing greater financial security,” the lawmakers wrote to CMS, “they should expand Medicaid and accept the $66 billion in federal funds that Floridians have already paid for with their tax dollars and provide health care to about 700,000 Floridians.”

In addition to Nelson and Castor, the letter was signed by Reps. Charlie Crist (D-FL), Val Demings (D-FL), Ted Deutch (D-FL), Lois Frankel (D-FL), Alcee Hastings (D-FL), Al Lawson, Jr. (D-FL), Stephanie Murphy (D-FL), Debbie Wasserman Schultz (D-FL), Darren Soto (D-FL) and Frederica Wilson (D-FL).

Below is text of the letter, followed by a transcript of Nelson’s speech. A .pdf copy of the lawmakers’ letter can be found here.

May 10, 2018

The Honorable Seema Verma
Administrator
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244

RE: Oppose Florida’s 1115 Medicaid Waiver Amendment to Eliminate Retroactive Eligibility Due to Potential Extreme Harm to Older and Disabled Floridians

Dear Administrator Verma,

As members of the Florida Congressional Delegation, we write to urge you to oppose provisions of the State of Florida’s 1115 Medicaid MMA Waiver Amendment that would directly harm thousands of seniors and neighbors with disabilities in Florida.

Today, critical protections in Medicaid mean beneficiaries can get up to three months of retroactive coverage from the date they apply to enroll in the program as long as these individuals were eligible for Medicaid when they received care. In March, the state proposed eliminating this policy of retroactive eligibility by amending its ongoing Section 1115 demonstration. If approved, this decision could jeopardize the financial security of at least 39,000 of the most vulnerable Floridians and countless providers who treat them. It will also cut at least $100 million from an already underfunded Medicaid program that is suffering from the state’s continued choice to pass up more than $66 billion in federal funds by refusing to expand its Medicaid program.

Retroactive eligibility is designed to protect Medicaid beneficiaries—including seniors, pregnant women, individuals with disabilities, and parents—and their families from the steep costs of medical services and long-term care. Importantly, this protection was also designed to minimize uncompensated care costs faced by hospitals and other health care providers who take care of our neighbors and are already challenged by the state’s low reimbursement rates. Also important to remember is, even though retroactive, folks who end up covered are unquestionably eligible for Medicaid and this existing policy and time frame protects those who are unaware – through no fault of their own – that they qualify.

Applying for Medicaid coverage can be a complicated and sometimes burdensome process, particularly when an individual or family member is dealing with securing admission to a nursing home, addressing a medical emergency, or seeking care for a worsening illness or injury. Leaving Medicaid-eligible applicants without financial protection simply because they have not enrolled is cruel and in direct conflict with the goals of the Medicaid program. This proposal will directly hurt Floridians with disabilities and seniors in nursing homes. If CMS approves this proposal in its current form, it would likely prevent vulnerable populations, especially seniors in nursing homes, from getting the care they need.

It is our duty to ensure eligible individuals have access to care without going into debt to obtain it, which is why retroactive eligibility is so vital. This proposal would not only wipe out many families’ pocketbooks, but it would also place a financial burden on health care providers, the state and indeed all Florida taxpayers through increased uncompensated care costs. We fail to see how this proposal will “enhance fiscal predictability” as the state claims when it will increase costs across the board. If the state were serious about securing greater financial security, they should expand Medicaid and accept the $66 billion in federal funds that Floridians have already paid for with their tax dollars and provide health care to about 700,000 Floridians.

Instead of building barriers to coverage, we need to focus on getting our uninsured and underinsured neighbors quality and affordable health coverage and reducing uncompensated care costs that hurt health care providers’ ability to provide needed care and strain Florida’s economy. That is why we urge you to reject the State of Florida’s proposal to eliminate retroactive eligibility.

Thank you for considering our request.

Sincerely,

U.S. Sen. Bill Nelson
Remarks on the Senate floor
May 10, 2018

Sen. Nelson: Mr. President, I appreciate the remarks made by the senator from Texas. Indeed, I think we have a career intelligence officer that has done a commendable over three decades, commendable service, service to this country. I will be meeting with her next week. I have a number of questions, and upon meeting with her, then I will make my decision. And I thank the senator from Texas, as I have thanked many on the intelligence committee that I have sought their opinion as well as reading all the relevant documents.

Mr. President, I rise here today because the state of Florida has again proposed to harm thousands of seniors and folks with disabilities who rely on Medicaid for their health care as well as their financial security. Under current law, critical protections in Medicaid allow those who rely on program for their health care, they can get up to three months of retroactive coverage after they apply for Medicaid after the time that they have enrolled in the program.

To put that another way, a person who has had health care problems and that is eligible under Medicaid, once they apply, under current law there’s a lookback period of three months that those health care expenses that they incurred would be reimbursed to their health care providers — the doctors, the nurses, whatever the service is — and paid by Medicaid because they have been deemed to be eligible. Certain people with disabilities and certain people because of their income level and their status. Now, what the state of Florida is proposing — and this is what is so damaging — is to cut that three months of reimbursement for Medicaid down to one month.

Well, the current law is three months, so why should the state of Florida penalize its citizens that are getting their health care — they’re eligible — under Florida’s law for health care through Medicaid? Why should you penalize them by saying we’re only going to make you eligible for 30 days instead of three months? It defies understanding.

The state proposed to C.M.S. Just a week or so ago to eliminate this critical protection, and in the process it jeopardizes how many people in Florida right now? 39,000 of the most vulnerable Floridians and the countless medical providers who treat them. So if they constrict this period, that means a lot of people are not getting compensated by Medicaid, such as a hospital. The hospital can’t eat all of those uncompensated expenses. And so what happens? Ultimately that finds its way into all the rest of us, all of the rest of us taxpayers who also have private health insurance, and it runs the price of the health insurance up.

And if this is not enough of an outrage that the state of Florida is doing to these 39,000 people, this maneuver will also cut up to $100 million from an already underfunded Medicaid program that is suffering because the state of Florida has already decided over the last several years that it’s not going to expand Medicaid up to 138% of poverty. And you know how much money they have passed up? The state of Florida has passed up that otherwise 800,000 people in Florida would be getting health care through Medicaid? They passed up $66 billion in federal funds that is sitting there on the shelf ready to be used for health care through Medicaid for Florida by refusing to expand Medicaid that is allowed under the law, up to 138% of poverty.

Well, it’s just unacceptable. This provision was designed to protect seniors and veterans and pregnant women and individuals with disabilities and parents and their families with high medical bills and the cost associated with the long-term care. So not only are you jeopardizing hospitals and the doctors and the nurses and all the medical providers of not getting paid, of which they are eligible under current law, you’re also putting into financial jeopardy the poor people that are sick that need to be treated, and they don’t have the money because of their income level. They don’t have the money, and then you start getting all these Dunning statements and saying, we’re coming after you financially and we’re going to take you into the poorhouse.

And so that’s why I joined with my colleague in the House, Congresswoman Castor, and we have a letter signed by half the Florida delegation calling on C.M.S. To reject this heinous provision that the state of Florida is asking for.

And, Mr. President, I ask consent that this be inserted in the record. The presiding officer: Without objection. Mr. Nelson: So, it’s our duty to ensure that the folks — our folks, the people in our states have access to care without having to go into debt to obtain that care. And the state of Florida is attempting to take that away. And in doing so, it’s attempting to wipe out many families’ pocketbooks and increase the strain on the health care providers, the doctors, the nurses, the hospitals, and all Florida taxpayers who ultimately on uncompensated care are the ones who pick up the bill.

The state of Florida claims that this proposal will, quote, “enhance fiscal predictability”, end of quote. That begs the question — for whom? If the state really wanted to secure greater financial security — if the state really wanted to secure greater financial security, they would expand Medicaid and accept the $66 billion of our Florida financial taxpayer money sitting on the shelf that Floridians have already paid for with their tax dollars and provide health care to up to 800,000 Floridians that don’t have it now.

And perhaps what’s even more troubling is that the letter accompanying the state of Florida’s request stated the agency — get this, quote, “was not aware of any concern or opposition raised by any member of either party regarding this provision during extensive budget debate”, end of quote.

So now it’s not — not only is the state of Florida trying to harm thousands of Floridians, including many of our seniors and veterans — by the way, veterans are on the Medicaid program as well; don’t forget that. Veterans are not just all taken care of under the veteran’s administration. There are a lot of veterans on Medicaid. So the state is trying to harm these people, and I wonder now, in that letter that I just quoted from, if the state is misleading the federal agency C.M.S. In trying to get their waiver approved to cut from 90 days down to 30 days.

Indeed, members of the Florida Senate — the Florida State Senate, the legislature — raised innumerable concerns and objections to the provision. Most recently, the Florida Senate minority leader called out the governor’s administration for the misleading claims. And instead of making it harder to gain coverage, we ought to be focusing on getting our uninsured neighbors quality and affordable health coverage and reducing uninsured, uncompensated cost. We need to do what’s good for the people of Florida. Mr. President, I yield the floor.