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Wednesday October 22nd 2014

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Viewpoint: More Practical Approach to Medicaid

By Grover Robinson, Escambia Co. Commissioner

Another Florida Legislative Session has just ended and for 19-million Floridians there are a host of new issues and opportunities that have been created.

For local government in Florida no issue was perhaps bigger and more dominant that Medicaid. Long, simmering concerns of errors and questionable billings led to a boiling point in 2012, when the State significantly increased the cost share for local governments. However, due to the billing system considerable government time and resources, both at the State and Local levels, was spent on arguing about proper record keeping and mistakes.

In order to conserve those resources both the State and Local governments agreed to find a permanent solution and remove counties from the billing altogether. The end result was a bill which cost counties $270-million out of a $74-billion budget.

While this is less than 0.4% of the State budget it becomes a significant payment for counties and creates winners and losers across Florida within its local governments. In Escambia County alone the cost doubled from $2-million in 2011, to $4-million in 2012, and another $350,000 increase projected for 2013. That amount alone is more than 1% of the County’s total budget but more importantly over 4% of the amount it generates from property taxes.

This significant increase in cost adversely impacts local government’s ability to deal with the other missions it administers and creates shortfalls throughout its programs. Still it appears to be settled as of this Session, or could something better be done with that money? My thought is yes.

At 0.4% surely in a soon-to-be increasing budget could the State cover this cost? The answer is probably yes but the better question is why. Certainly it would not do so simply to allow counties to pursue other opportunities. However, what if it allowed counties to spend money in healthcare in turn driving down the cost of healthcare that the State is responsible for?

Said another way what if Escambia County took $4-million and put it directly into indigent healthcare? What cost-savings impact would that have for the State of Florida?

My belief is the cost-savings would be dramatic. Consider this; currently Escambia County only spends about $400,000 for indigent healthcare with Escambia Community Clinic’s collaboration between Baptist Healthcare and Sacred Heart. However, what if the County was to take the money it spends with the State and instead spend it on actual indigent healthcare?

If we actually provided more funds so the people could get access to healthcare and the opportunity to address their health concerns quicker and better imagine the savings to both the Federal Government and the State Government. Perhaps we wouldn’t have to move so drastically to healthcare programs such as Obamacare. However you feel about it one way or the other it is a drastic change. What could $4-million of direct indigent healthcare benefit do for both the State and the individual communities within it?

I do not know the direct answer to that question but I cannot help but believe that somehow it would be better than the current system we have or the one we are looking to pursue. Towards that end local government is always happy to find solutions; we simply need partners who are willing to work with us.

Thank you
Grover C. Robinson, IV
Escambia County Commissioner
District 4