Florida Sues Feds Over Medicaid Expansion

     (CN) – Florida Gov. Rick Scott sued the federal government this week, claiming it cut funding for a low-income program because the state has not expanded Medicaid.
     Scott and the State of Florida, through attorney general Pamela Bondi, filed two legal challenges April 28 against the U.S. Department of Health and Human Services, its secretary Sylvia Burwell, the Centers for Medicare and Medicaid Services and centers administrator Andy Slavitt in Federal Court on Tuesday.
     The complaint alleges violation of the Administrative Procedures Act, while a separate petition sought a writ of mandamus asks the Pensacola Federal Court to intervene.
     Scott and Bondi are suing over the federal government’s attempt to “coerce states into dramatically expanding their Medicaid programs by threatening to cut off federal funding for unrelated programs unless they ‘agree’ to do so,” according to the complaint.
     The Florida officials say the Centers for Medicare and Medicaid Services told the Sunshine State in April that it would no longer fund the state’s Low Income Pool, or LIP, program because it decided not to opt in to Medicaid expansion.
     The LIP program was created to offset healthcare costs for uninsured, underinsured and low-income residents, the complaint states. Florida says the program will likely end in June without funding.
     “CMS’s eleventh-hour refusal to fund the LIP program has put Florida in an impossible position. Come June 30, the fiscal year will end in Florida and LIP funding will run dry. And without federal approval and that anticipated $1.3 billion in federal funding, it is exceeding unlikely that the LIP program can continue at all,” the lawsuit states.
     “Without LIP, healthcare providers could face more than $1 billion in uncompensated care. Children’s hospitals in Florida will lose $125 million in funding, again for care that would not be covered by Medicaid expansion. Medical schools, which rely on clinical services to train the next generation of Florida doctors, will lose $200 million in funding to offset those costs. And all of this solely because Florida has exercised its constitutional prerogative not to opt into Medicaid expansion.”
     Florida says the LIP program and expanded Medicaid serve different populations and have different goals. The lawsuit claims the state tried to work with the Centers for Medicare and Medicaid Services over its concerns about LIP’s transparency and channeling of funds, but the centers “abruptly changed course” in April and threatened to pull funding.
     “CMS’s strong arm tactics are not confined to Florida. CMS has levied the same coercive threat at other states that have declined to adopt Medicaid expansion. Like Florida, these states have been warned: opt into Medicaid expansion now or lose hundreds of millions in unrelated federal healthcare funding,” Scott and Bondi’s complaint states. “In these states as well, there can be no serious dispute that CMS is using vital healthcare funds as its trump card to bring about its preferred policy choice of Medicaid expansion.”
     The mandamus petition makes the same allegations as the complaint and asks the court to order the defendants to reconsider their LIP funding decision.
     “The harm the state and its residents stand to suffer without judicial relief greatly outweighs any possible disruption to the agency that would result from compelling it to abide by the constraints of the constitution,” the petition states. “The state seeks nothing more than an order that would require CMS to promptly reconsider Florida’s LIP program proposal without taking into consideration the unconstitutional factor of whether the state has opted into Medicaid expansion.”
     Ben Wakana, press secretary for the Department of Health and Human Services, told Courthouse News that neither the department nor the centers comment on pending legal action.
     Courthouse News, however, was provided a statement from Centers for Medicare and Medicaid Expansion spokesman Aaron Albright, who said funding for pools like Florida’s LIP program is not dependant on the state’s decision regarding Medicaid expansion.
     “The decision to expand Medicaid, or not, is a state decision. We will work with Florida and each state that has an uncompensated care pool regardless of its Medicaid expansion status, to support access to health care for low-income residents that works for individuals, hospitals and taxpayers, taking into account the state’s specific circumstances,” Albright said. “CMS will review proposals regarding uncompensated care pools based on the same principles whether or not a state has expanded Medicaid.” The Administrative Procedures Act complaint seeks a declaration that withholding federal funds from Florida’s LIP program violations that law and the U.S. Constitution. Scott and Bondi also ask the court to grant injunctive relief stopping the federal government from penalizing Florida for not opting into Medicaid expansion and compelling the government to reconsider renewal of the LIP program without considering the state’s decision on Medicaid expansion.
     The petition for writ of mandamus asks for the same relief.
     The Florida officials are represented by Allen Winsor from Bondi’s office in Tallahassee.

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