TALLAHASSEE, Fla. — Former President Donald Trump's administration gave Florida’s health-care system one last parting gift before he left office Wednesday to return to his adopted home state.
The Trump administration last week agreed to extend a "waiver" for Florida's Medicaid program -- and $1.5 billion in supplemental funding each year until June 2030, which means the move would outlast newly installed President Joe Biden.
"Continuing this essential program means Floridians will have access to quality health care when they need it," Gov. Ron DeSantis, a close political ally of Trump, said in a statement praising the decision by the U.S. Department of Health and Human Services.
But the lengthy extension caught many people off guard, as Florida Medicaid officials initially only requested a two-year extension.
Joan Alker, executive director and a co-founder of the Center for Children and Families and a professor at the Georgetown University McCourt School of Public Policy, said a 10-year extension is unusual, if not illegal.
"Prior to this administration, we have never seen 10 years," she said, adding the Trump administration also extended Texas's Medicaid waiver through September 2030.
"It was a pretty blatant attempt, I think, to reward political allies and block Medicaid expansion," Alker told The News Service of Florida.
But Safety Net Hospital Alliance of Florida CEO Justin Senior, whose association represents large teaching, public and children's hospitals, argued the opposite.
Senior, a former secretary of the Florida Agency for Health Care Administration and Medicaid director, said negotiating and renegotiating what are known as Medicaid 1115 waivers with the federal government is exhaustive and time consuming.
Senior was at the helm of Florida's Medicaid program in 2015 when former President Barack Obama’s administration announced it would substantially scale back, and ultimately eliminate, the supplemental payment program known as the "Low Income Pool."
The Obama administration announced it would rescind what was then $2.1 billion in supplemental payments and urged the state to expand Medicaid to cover more uninsured Floridians. The announcement sent the 2015 state legislative session into overtime.
Then-Gov. Rick Scott, now a U.S. senator, fought the change and filed a federal lawsuit accusing the Obama administration of trying to coerce the state into expanding Medicaid. Such an expansion was a vital component of Obama’s Affordable Care Act, which was staunchly opposed by many Republicans. Florida uses the supplemental payments to help offset costs of uncompensated care provided by hospitals and federally qualified health centers.
"This does take the opportunity for that kind of gamesmanship off the table," Senior said of the 2015 dust-up.
After Obama left office, the Trump administration increased the amount of available funding for the Low Income Pool, but hospitals have not been able to use the full $1.5 billion each year.
"It's not really a political issue. Intertwining the two or conflating the two (Medicaid expansion and LIP) is not particularly helpful," Senior said.
Senior also downplayed the 10-year term of the Medicaid waiver.
"Ultimately, this is a traditional (Medicaid 1115) extension. Being 10 years instead of five is a little different, but there's nothing wrong with a 10-year extension," Senior said.
Last summer, then-Agency for Health Care Administration Secretary Mary Mayhew submitted a request to extend the waiver to June 30, 2022. At the time, she said she was seeking a two-year extension because “there is so much work that needs to be done” to the program.
"What we know is Medicaid is still antiquated" and it "hasn't really invested in the prevention and early intervention services that can produce far better outcomes," Mayhew said at the time.
Mayhew left the agency in October. And in a statement to the News Service this week, the Agency for Health Care Administration said a decision was made in December to amend the request for a longer period of time.
Medicaid, which provides coverage for poor, elderly and disabled people, is jointly funded by the federal and state governments and operates under extensive guidelines. Waivers authorize states to disregard certain Medicaid rules and regulations regarding such things as eligibility and services.
According to the Medicaid.gov website, Medicaid 1115 waivers initially are approved for a five- year period. After that, states "commonly request and receive" waiver extensions for three-year periods. Waivers are awarded -- and rescinded -- by the secretary of the Department of Health and Human Services, who answers to the president.
The Trump administration has moved to prevent Biden from rescinding already-approved waivers. Alker said the Trump administration sent letters to every state with a Medicaid 1115 waiver and also has tried to block the new administration’s authority to quickly cancel waivers.
Seema Verma, administrator of the federal Centers for Medicare & Medicaid Services in the Trump administration, sent letters Jan. 4 to Medicaid directors. Verma, whose former agency is part of the Department of Health and Human Services, asked the Medicaid directors to sign the letters and spelled out a process to prevent the Biden administration from canceling or revoking 1115 waivers for nine months.
"It may not have much effect," Alker said.
The Florida Agency for Health Care Administration did not immediately answer whether the state signed the Jan. 4 letter.