[Congressional Record Volume 164, Number 76 (Thursday, May 10, 2018)]
[Senate]
[Pages S2609-S2610]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                               Healthcare

  Mr. President, I rise today because the State of Florida has again 
proposed to harm thousands of seniors and folks with disabilities who 
rely on Medicaid for their healthcare, as well as for their financial 
security.
  Under current law, critical protections in Medicaid allow those who 
rely on the program for their healthcare to get up to 3 months of 
retroactive coverage after they apply for Medicaid and after they have 
enrolled in the program. To put that in another way, a person who has 
had healthcare problems and who is eligible under Medicaid, once they 
apply, under current law, there is a look-back period of 3 months in 
which those healthcare expenses they incurred would be reimbursed to 
their healthcare 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.
  What the State of Florida is proposing--and this is what is so 
damaging--is to cut those 3 months of reimbursement for Medicaid down 
to 1 month. The current law is 3 months, so why should the State of 
Florida penalize its citizens who are eligible under Florida's law for 
healthcare through Medicaid by saying: We are going to make you 
eligible only for 30 days instead of 3 months. It defies understanding.
  The State proposed to CMS just a week or so ago to eliminate this 
critical protection, and in the process, it jeopardizes many people in 
Florida right now--39,000 of the most vulnerable Floridians and the 
countless medical providers who treat them. If they constrict this 
period, that means a lot of providers will not get compensated by 
Medicaid, such as a hospital. The hospital can't eat all of those 
uncompensated expenses, so what happens? Ultimately, it finds its way 
to the rest of us taxpayers who have private health insurance, and it 
runs up the price of health insurance.
  If what the State of Florida is doing is not enough of an outrage 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 decided over the last several years that it is 
not going to expand Medicaid up to 138 percent of the poverty level. Do 
you know how much money the State of Florida has passed up that, 
otherwise, 800,000 people in Florida would be getting healthcare 
through Medicaid? They passed up $66 billion in Federal funds that is 
sitting there on the shelf ready to be used for healthcare through 
Medicaid for Florida by refusing to expand Medicaid that is allowed 
under the law up to 138 percent of poverty. It is 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 costs associated with long-
term care. So not only are we jeopardizing the pay of the hospitals and 
the doctors and the nurses and all of the medical providers, for which 
they are eligible under current law, we are also putting into financial 
jeopardy the poor people who are sick and need to be treated, and they 
don't have the money because of their income level. They don't have the 
money. Then they start getting all of these dunning statements saying: 
We are going to come after you financially, and we are going to put you 
into the poor house.
  That is why I joined with my colleague in the House, Congresswoman 
Castor. We have a letter signed by half of the Florida delegation 
calling on CMS to reject this heinous provision that the State of 
Florida is asking for.
  I ask unanimous consent that this letter be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                Congress of the United States,

                                     Washington, DC, May 10, 2018.
     Re Oppose Florida's 1115 Medicaid Waiver Amendment to 
         Eliminate Retroactive Eligibility Due to Potential 
         Extreme Harm to Older and Disabled Floridians

     Hon. Seema Verma,
     Administrator, Centers for Medicare & Medicaid Services, 
         Baltimore, MD.
       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,
         Bill Nelson, U.S. Senator; Frederica S. Wilson, U.S. 
           Representative; Charlie Crist, U.S. Representative; 
           Kathy Cas, U.S. Representative; Lois Frankel, U.S. 
           Representative; Kathy Castor, U.S. Representative; Ted 
           Deutch, U.S. Representative; Al Lawson, Jr., U.S. 
           Representative; Stephanie Murphy, U.S. Representative; 
           Debbie Wasserman Schultz, U.S. Representative; Alcee L. 
           Hastings, U.S. Representative; Darren Soto, U.S. 
           Representative; Val Butler Demings, U.S. 
           Representative.

  Mr. NELSON. Mr. President, it is our duty to ensure that folks--our 
folks, the people in our States--have access to care without having to 
go into debt to obtain that care. The State of Florida is attempting to 
take that away. In doing so, it is attempting to wipe out many 
families' pocketbooks and increase the strain on the healthcare 
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 ``enhance fiscal 
predictability.'' That begs the question: For whom? If the State really 
wanted to secure greater financial security, it would expand Medicaid 
and accept the $66 billion of our Florida financial taxpayer money 
sitting on the shelf,

[[Page S2610]]

which Floridians have already paid for with their tax dollars, and 
provide healthcare for up to 800,000 Floridians who don't have it now.
  Perhaps what is even more troubling is that the letter accompanying 
the State of Florida's request stated that the agency--get this--``was 
not aware of any concern or opposition raised by any member of either 
party regarding this provision during extensive budget debate.'' So now 
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. All 
veterans are not taken care of under only the Veterans' 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 CMS in trying to get their waiver approved to cut the 90 
days down to 30 days. Indeed, members of 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.
  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 costs. We need to do 
what is good for the people of Florida.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Nevada.