Florida's Medicaid Millionaires

Florida recently elected to turn down – again – over $2 million in Federal money to pay the administrative costs of expanding its Medicaid long term care program’s home and community based services.

In March 2011, Florida qualified for over $35 million to join most of the rest of the nation in participating in the Money Follows the Person program.  The program was created during the Bush Administration as a way of helping people move back out of nursing homes into the community. 

It became so popular in the 29 states (and District of Columbia) participating in it that it was expanded as part of health reform.  Thirteen additional states, including Florida, were invited to participate.  Former Governor Charlie Crist authorized Florida’s Agency for Health Care Administration (AHCA) to file Florida’s application.

Rejecting the program means that people who want to leave Florida nursing homes won’t be given control of the resources they need to do so. 

On the other hand, as a result of Florida’s 2011 Medicaid reform legislation, people who don’t want to leave Florida nursing homes may be forced out, and the money will go to managed care companies.

When Florida’s current Governor Rick Scott took office there was some question as to whether he would pursue the Money Follows the Person program.  After saying he would not implement anything in the Affordable Care Act, he changed his mind and said that he would accept the federal money for this program.  He sought approval from the Legislature to draw down the dollars. 

Then, he apparently changed his mind in May, and allowed the legislative session to pass without pushing for the action needed to allow AHCA to accept the money. 

After a strong reaction from the public against this decision, the Governor asked legislative leaders to revisit the issue in late June.  Key Senators cast a bipartisan vote to accept the money, but House members refused on a party line vote.

Though DHHS earlier said that it would leave the door open to Florida for the remainder of the year, this action may finally kill Florida’s participation in the program.

According to an Associated Press article, at least one of those who voted against it argued that Florida did not need to duplicate its existing programs.

But Florida spends only about half as many of its Medicaid dollars on home and community-based services as the national average.  In 2009, AARP put Florida’s percentage at 14%, while the national percentage was 27%.

This would suggest that at the very least, Florida does need to “duplicate” its existing programs.

Another House member correctly pointed out that although these dollars could have lessened the burden on state taxpayers, they were still federal taxpayer dollars.

This begs a bigger question.  Why would Florida’s elected officials not want tax dollars Floridians pay to Washington to come back to Florida to help meet our needs?  Because of this decision, Florida’s share of these federal home care tax dollars is going to be sent to, and used by, residents of 41 other states and the District of Columbia instead of Florida. 

It was a nice gesture for Florida’s state legislators to send $35.7 million to the people of Texas, Arkansas, North Carolina, Georgia, Louisiana, Mississippi, Kansas, Iowa, and Ohio, among others.  But they don’t represent these states. 

What they did to the Floridians they do represent was the equivalent of either imposing $35.7 million in additional taxes without adding new services, or cutting $35.7 million in services without reducing taxes.  Either way, Floridians lose.

These home and community-based dollars typically provide for the care of adults with disabilities.  About a third of program participants nationwide have physical disabilities, and about a third more have developmental disabilities.  Most of the people in Florida who would have benefited from the program are among the almost 900,000 Medicaid recipients between the ages of twenty and sixty-five. 

In nursing homes, many will become Medicaid Millionaires.  The lifetime cost of their nursing home care will probably exceed $1 million.  So long as they remain institutionalized, there is zero chance that they will ever be able to contribute independently to the cost of that care.

If they were to return home, that picture changes.  People with significant disabilities on the Money Follows the Person program are living and even working in the community again, spending – and sometimes even saving – a little money.  Early evaluation data from the Kaiser Family Foundation also suggest that the program is less costly per person than either nursing home care or other home and community-based programs, like Florida’s.

Nationwide, twelve thousand people had returned to homes and apartments because of the Money Follows the Person program as of the end of 2010.  It’s too bad at least some don’t get to call Florida their home today.  Perhaps they’ll retire here.

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