Florida might have to pay the federal government $40 million in fines for managing the state Medicaid program.
Jacey Cooper, Director of State Demonstrations Group at the US Department of Health and Human Services, wrote to two top Florida Medicaid officials on Thursday, informing them that the state faces fines and a corrective action plan unless the Agency for Health Care Administration (AHCA) submits the status reports by the end of the year.
“This letter serves as written notice that if the state does not come into compliance with submitting the deliverables, CMS [the federal Centers for Medicare & Medicaid Services] will place the state on a corrective action plan (CAP),” according to the note.
“Additionally, the state’s failure to submit all required monitoring reports, evaluations, and other deliverables will be considered by CMS in reviewing any application for an extension, amendment, or for a new demonstration.”
The letter cites eight documents, including six quarterly reports and two yearly reports, that have been pending for up to two years. The reports are meant to show that the state is using federal funds to provide necessary services for low-income persons who seek health insurance.
The federal government has “offered alternative deadlines and technical support,” Cooper stated, but “the state has still not submitted” the necessary paperwork.
According to the letter, Cooper discussed the required reports with former Deputy Secretary for Data and Finance Tom Wallace and Austin Noll, deputy secretary for Medicaid policy, quality, and operations. They agreed that the state would submit a report by the end of the month (September) and all required information by the end of the year.
‘This is a non-issue’
In response to the issue at hand, Collins confidently expressed that it is not a matter of concern. He emphasized that Florida has been actively collaborating with CMS and has already established a schedule to promptly deliver the remaining reports. Collins even encouraged the Phoenix to reach out to CMS directly for confirmation on this matter.
According to State Rep. Kelly Skidmore, a Democrat representing Palm Beach County, officials at AHCA have been neglecting their responsibilities by diverting their attention to matters beyond their jurisdiction. Skidmore expressed her concerns in a telephone conversation with the Phoenix on Friday.
Skidmore urged AHCA to focus on their intended tasks instead of interfering in controversial matters. He specifically mentioned AHCA’s webpage that presented contentious arguments against Amendment 4, which supports abortion rights.
“Not standard fare”
Medicaid, a health care safety net program for the less fortunate, seniors, and individuals with disabilities, receives funding from both state and federal sources.
More than 3 million Floridians currently depend on managed care plans as a requirement for receiving Medicaid services. This includes individuals of all ages, from infants to the elderly.
The state is permitted by the federal government to require enrollment in managed care plans through a “Medicaid 1115” waiver. These waivers provide states with flexibility regarding federal rules and regulations. However, in exchange, states with 1115 waivers must submit regular reports on program administration and expenditure.
According to Joan Alker, executive director of the Center for Children and Families at Georgetown University, state and federal officials, as well as advocates, have a clear understanding of the Medicaid 1115 reporting requirements.
According to Alker, it is common for states to file Section 1115 waivers and reports, but it is unusual for a state to refuse to do so and for CMS to threaten fines in response. Alker mentioned that many states, including Florida, have been submitting these reports for years without any issues. She also noted that she cannot recall a situation where CMS had to impose fines on a state for failing to file these reports.
Wallace received the letter on Thursday and promptly resigned. He had been employed since 1999 and earned an annual salary of $183,855, as stated on a government website.
Another wrinkle
Florida’s Medicaid program has recently encountered a new challenge. A class action lawsuit has been filed against AHCA Secretary Jason Weida by individuals from Florida who claim that their Medicaid benefits were unjustly terminated after the conclusion of the COVID public health emergency.
In August, the trial was conducted. KFF, a nonprofit health policy research group, reported that the state has removed 1.9 million people from Medicaid since last year.
The DeSantis administration is currently persisting with its legal battle against a CMS rule that prevents states from removing children from Florida KidCare, the subsidized health care program.
