[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.