The federal government remains “flexible” in its approach to Medicaid expansion in Florida, according to Patrick Conway, chief medical officer and deputy administrator for innovation and quality at the Centers for Medicare and Medicaid Services, who spoke during a national healthcare conference at the University of Miami on Monday.
UM President Donna Shalala led the discussion at UM’s annual Business of Health Care conference. This year’s conference emphasized the impact of new technology on healthcare and changes in access.
Access to affordable care in Florida has been in the spotlight in recent weeks as the state Legislature continues debating the future of the state’s healthcare landscape. A Florida Senate committee passed a proposal this month that would expand healthcare coverage to about 800,000 uninsured Floridians. The proposal would help close a healthcare gap caused when Florida refused federal funds to expand its Medicaid program under a provision of the Affordable Care Act.
The more conservative Florida House will be the first barrier for the proposal and the second would be CMS, which will have to approve any proposal. The Senate proposal includes two provisions that have been rejected by CMS in other states.
Conway said at the conference that the goal of CMS is to improve access to care, and is willing to work with any state that wants to expand Medicaid.
“There are some principles that we have to adhere to, but we are willing to be flexible,” Conway said.
No state has been able to get approval from CMS to charge premiums to those below the federal poverty level, a provision of the Senate proposal. Another provision calling for work requirements for beneficiaries, or a substitute such as searching for a job, job training or additional education, has also been blocked by CMS on several occasions.
Also on the horizon is the future of tax credits — financial assistance to lower monthly premiums for consumers with health insurance through the Affordable Care Act — which has been challenged before the U.S. Supreme Court in King v. Burwell. The case calls into question a line in the Affordable Care Act that states tax credits will only be available in exchanges established by the state and not the federal government. Florida is one of 37 states with a federally facilitated marketplace that would stand to lose that financial assistance.
Conway declined to comment on the case.
The conference also tackled the scope-of-practice issue for nurse practitioners and physician assistants. The topic is also on the Florida Legislature’s radar. A Senate bill would expand the abilities of nurse practitioners and physician assistants when it comes to writing prescriptions, a role that could help mitigate a growing primary care physician shortage.
“Since the Affordable Care Act, more and more people have been flooding into the system,” said Patrick Geraghty, chairman and CEO of GuideWell and Florida Blue. “We have to have better ways of serving that increased population.”
As healthcare continues to find better ways to serve more patients faster and at higher quality outcomes, the system has to adjust to that population, Geraghty said.
“Utilizing all of our clinical professionals in a more effective manner has to absolutely be part of the equation,” he said.
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This story was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.