The stalemate between the House and Senate over billions of dollars in health-care funding deepened Tuesday, as the federal government suggested that the fate of a pool of money for hospitals and other medical providers was tied to the state's decision on Medicaid expansion.
The letter from a high-ranking official at the federal Centers for Medicare & Medicaid Services, and the back-and-forth between legislative leaders that surrounded it, made even more remote the already-slim chances that lawmakers would finish a state budget before the scheduled May 1 end of the legislative session.
At issue are two pools of health-care money that have now become intertwined. Both the House and the Senate hope that the federal government will at least partially extend the Low Income Pool, or "LIP" program, which expires on June 30. That $2.2 billion program provides money to hospitals and other health providers that serve large numbers of poor and uninsured patients.
The Senate also wants to use $2.8 billion in federal Medicaid-expansion funding to help low-income Floridians buy private health insurance. The chamber's leaders have argued that the fate of LIP is tied to the expansion plan, something House leaders have repeatedly rejected.
But in a letter sent Tuesday to the Florida Agency for Health Care Administration, CMS official Vikki Wachino wrote that "the state's expansion status is an important consideration in our approach regarding extending the LIP beyond June."
"We believe that the future of the LIP, sufficient provider rates, and Medicaid expansion are linked in considering a solution for Florida's low income citizens, safety net providers and taxpayers," Wachino wrote.
House Speaker Steve Crisafulli, R-Merritt Island, responded to the letter by issuing a statement lambasting the federal government and the Senate.
"It is unthinkable that (the federal government) would leave our state on the hook for over a billion dollars simply because they want a specific policy outcome," Crisafulli said. "We believe the Florida Senate has provided inaccurate and false hope to Washington, D.C., and has muddled negotiations. Let me be clear --- the discussions about LIP and Medicaid expansion must be separate."
Senate President Andy Gardiner, R-Orlando, wrote a memo to senators predicting stark consequences --- including the possibility of closed cancer centers or dialysis units --- if the state didn't get LIP or a health-care expansion done.
"The bottom line is: more than ever, today's correspondence from CMS highlights the link between LIP and expansion and the need to consider a comprehensive Florida solution," Gardiner wrote. "Time is of the essence. The Senate remains open to meeting at any time to discuss our free-market approach to expansion or any alternative the House or governor would like to propose."
The letter came hours after business groups, clergy members and advocates pushed for the House to give in to the Senate on health-care expansion. A coalition of business groups called A Health Florida Works held a press conference at the state's historic Capitol at which Gardiner was given a hearty welcome for the Senate plan.
"We need the Florida House to join him ... on his quest to find coverage for the working uninsured, to save the citizens in our states billions of dollars in annual health-care costs, to spur job creation and to keep Florida's economic engine running smoothly," said Tamela Perdue with Associated Industries of Florida.
At a separate event, Methodist Bishop Ken Carter joined with other advocates to push expansion and took what appeared to be a veiled shot at the House.
"I have a moral issue with persons who have a political principle and expect other people to pay the price for their political principle," Carter said.
But business groups are not united around the proposal. The National Federation of Independent Business in Florida, an organization for small businesses, repeated its stance against the bill Tuesday.
"Small business owners understand that expanding Medicaid jeopardizes our state's solvency," NFIB executive director Bill Herrle said. "They are concerned for the future of our state and our economic viability, and as such remain opposed to Medicaid expansion."
Gov. Rick Scott, who supported a straight-up expansion of Medicaid two years ago but now opposes the Senate plan, told reporters after a Cabinet meeting that the federal government's stance on LIP actually supported his position.
"Would you do business with a group that, you have an experience with them, and the experience you have is, they put together a program, and then they walk away from it?" Scott said, passing over the fact that CMS has repeatedly said it would not extend LIP in its current form. "That's exactly what the federal government's doing right now."
Meanwhile, the Agency for Health Care Administration --- which answers to Scott --- sought to clarify an earlier statement that federal officials had cut off negotiations with the state over LIP.
"However, we have continued to have further communications with CMS --- in fact, we have called CMS regularly to get someone on the phone who could further negotiate with us," the agency said in a statement Tuesday. "However, no one at CMS with any signing authority has been made available. AHCA has had NO face-to-face meetings, NO scheduled phone calls and NO substantive dialogue with CMS since late March."
Aaron Albright, a spokesman for CMS, stressed that the agency was still working with Florida.
"As has been the case for over a year, CMS has been engaged in substantive conversations with Florida," he wrote in an email. "These contacts have continued over the last several weeks, and we are hopeful that Florida leaders will agree to a solution that will provide quality, affordable coverage to their residents."