CUTTING MEDICAID HURTS FLORIDA
BLOCK GRANTS AND PER CAPITA CAPS
All of the recent health care reforms have called for drastically cutting Medicaid through what are called 'per capita caps' and 'block grants.'
Florida’s Governor has stated his support for per capita funding. Under either proposal, federal Medicaid dollars would no longer be based on actual state needs and expenditures.
Instead, separate funding caps would be established for distinct populations- seniors, people with disabilities, children and adults (such as pregnant women and low-income parents). The state would receive an overall federal funding amount that is the sum of each population’s per capita cap multiplied by the number of people enrolled in each group.[i]
Putting Medicaid under a per capita cap or block grant system would be damaging for Florida’s budget and the residents who rely on it as a critical lifeline including children, people with disabilities and the elderly.
PER CAPITA CAPS ILLUSTRATED
WHAT GETS CUT?
To make up for the loss of federal funds there would be deep Medicaid service and eligibility cuts, as well as reduced provider payment rates.
Florida’s Medicaid- provider payment rate, which is 56 percent of Medicare rates, is one of the seven lowest rates in the nation. The national average is 66 percent.[i]
A further reduction in Medicaid funding could lead to even lower reimbursement levels, leading providers who remain in the program to further restrict the number of Medicaid patients they serve.
Funds Per Enrollee
Florida is further disadvantaged by its low annual spending per enrollee relative to other states. Under the AHCA and BCRA, Florida would have been permanently locked into substantially less federal Medicaid funding relative to other states.
Florida Medicaid spending compares with the national average as follows:[i]
Children with disabilities: $13,373 in Florida vs. $16,758 nationally.
Non-elderly adults: $15,584 in Florida vs. $18,912 nationally.
Seniors: $14,253 in Florida vs. $17,522 nationally.
(Not So) Optional Services
Large federal cuts and cost-shifting to states will likely force Florida to consider deep cuts to the Medicaid programs, including eliminating optional services.
With capped federal Medicaid funding as proposed under the BCRA and AHCA, the state would have likely targeted optional Medicaid coverage groups and services for cuts.
This could mean Floridians losing their Medicaid eligibility and access to health care services. For others who maintain eligibility, cuts could mean losing services vital to maintaining their health and independence.
[i] Section 409.902(1), Florida Statutes (2017). Accessed via: http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0409/Sections/0409.902.html
[i] Policy Basics: Introduction to Medicaid, Center on Budget and Policy Priorities, 2016, pp. 3-4. Accessed via: https://www.cbpp.org/sites/default/files/atoms/files/policybasics-medicaid_0.pdf
[i] Solomon, J., Schubel, J., Medicaid Cuts in House ACA Repeal Bill Would Limit Availability of Home and Community Based Services, p. 4, Center on Budget and Policy Priorities, 2017. Accessed via: http://www.cbpp.org/research/health/medicaid-cuts-in-house-aca-repeal-bill-would-limit-availability-of-home-and
[i] Zuckerman, S. et al. 2014. Reversing the Medicaid Fee Bump: How Much Could Medicaid Physician Fees for Primary Care Fall in 2015? Table A2, p. 14, Urban Institute. http://www.urban.org/sites/default/files/publication/33741/2000025-Reversing-the-Medicaid-Fee-Bump.pdf
[i] Solomon, J., Schubel, J. 2017. Center on Budget and Policy Priorities. Medicaid Cuts in House ACA Repeal Bill Would Limit Availability of Home and Community-Based Services. Appendix, Table 2. Accessed via: https://www.cbpp.org/sites/default/files/atoms/files/5-18-17health.pdf
[i] Wagnerman, Karina et al. 2017. Georgetown University Center for Children and Families, and the University of North Carolina Rural Health Research Program. Medicaid in Small Towns and Rural America: A Lifeline for Children, Families, and Communities. pp.14-15. https://ccf.georgetown.edu/wp-content/uploads/2017/06/Rural-health-final.pdf