The first crucial date is a mere six weeks away for Florida to obey a requirement to start paying Medicaid providers higher rates, but even with the recent softening tones of the state’s Republican leadership, it’s unclear whether the state will approve the payments.

Under the Affordable Care Act, Medicaid payments to primary care doctors increase starting Jan. 1 to the much higher rates paid by Medicare, with the feds picking up the total cost of the increase for two years.

“In the state of Florida, where payment rates are very low, this is huge,” said Julia Paradise, a Medicaid specialist with the Kaiser Family Foundation, a Washington nonprofit studying healthcare issues.

The Kaiser website shows that primary care Medicaid rates in 2008 were 55 percent of Medicare rates. That means a doctor who had been getting $50 to see a Medicaid patient would likely get about $90 under the new plan.

Medical associations complain that Medicaid rates in Florida are so low many doctors don’t accept the state-federal insurance that covers the poor. Federal policymakers want the increased payments to provide better primary care to keep people out of expensive visits to emergency rooms, and to increase the number of doctors taking Medicaid to prepare for a large expansion of the program slated for 2014.

“It is a federal law,” Paradise said. “There isn’t a provision for the statute not to be followed.”

Federal officials are telling journalists in Washington that the funds will flow automatically and don’t require any state action, but a Tallahassee spokeswoman says the state needs to take actions that are far from automatic.

“The Florida Legislature must provide authority for the Medicaid program to draw down federal funds to cover the fee increase,” said Shelisha Coleman, spokeswoman for the Florida Agency for Health Care Administration.

That process can happen during the two-month legislative session — which starts in March, two months past the federal deadline — or could be considered earlier by the Legislative Budget Commission, Coleman said.

Several former legislators told The Herald that the commission generally considers only items presented to it by the governor.

Gov. Rick Scott’s press office did not respond directly to an inquiry about whether he planned to present the Medicaid pay increase to the commission. Press secretary Jackie Schutz said Friday that the commission needed to act. “We are waiting to see if the LBC will meet in December.”

Scott on Friday also sent a letter to Health and Human Services Secretary Kathleen Sebelius saying the state would not meet the Friday deadline for another provision of the reform act, one requiring the states to announce whether they will establish healthcare insurance exchanges for people seeking insurance without fear of being turned down for pre-existing conditions. Under the law, the federal government will set up exchanges for any state that doesn’t set them up on its own.

Scott asked for a meeting with Sebelius “at your earliest opportunity” to discuss ways to deal with “the ever-increasing cost of healthcare and the need for better access by all Florida families to quality healthcare.”

Scott said that with the way the Affordable Care Act structured the exchanges, “current information available to us does not offer any indication that … [an] exchange lowers healthcare costs for Floridians.”