DeSantis asks Biden administration for $1.1B for Medicaid

TALLAHASSEE — Gov. Ron DeSantis’ administration is asking the federal government for an additional $1.1 billion in federal Medicaid dollars over the next two years to bolster access to home- and community-based programs and steer steer hundreds of millions of dollars to poor, elderly and disabled Floridians to purchase technology and make home improvements that enable them to age in place.

Florida submitted a proposal to the Centers for Medicare and Medicaid Services late Monday night that, if approved, would also direct $191 million to enroll more individuals in the state’s home- and community-based Medicaid waiver program — dubbed the “iBudget” program — for people with intellectual and developmental disabilities.

The additional federal Medicaid funding the state is seeking is available under a provision in the American Rescue Plan Act, a stimulus package signed by President Joe Biden in March, that allows the state to draw down a 10 percentage-point increase in federal funds to bolster home- and community-based services in state Medicaid programs.

Florida’s decision to seek such a large influx of federal cash for health-care programs runs counter to previous years, in which Republican leaders have been skeptical about tapping into additional federal money for health care.

If the Biden administration signs off on the plan, none of the money could be spent without approval from the Legislative Budget Commission, according to Sen. Aaron Bean, R-Fernandina Beach.

The 14-member panel, composed of seven state representatives and seven state senators, is authorized to make spending decisions on behalf of the Florida Legislature.

Advocates for poor, elderly and disabled individuals, who have been pressing the DeSantis administration to leverage the additional funding since spring, hailed the plan.

“Oh my God. This is absolutely fantastic news,” Valerie Breen, executive director of the Developmental Disabilities Council of Florida, told The News Service of Florida Monday night. “We are pleased with the governor’s decision to move ahead with the home- and community-based waiver dollars. We know that our families and individuals will be extremely pleased with this decision.”

Jim DeBeaugrine, a former secretary of the state Agency for Persons with Disabilities, said he was “thrilled” with the proposal.

“It definitely looks good,” said DeBeaugrine. “I’m pretty excited to see this and I look forward to learning more.”

The state’s proposal notes that more than 108,000 Floridians in different Medicaid waiver programs receive home- and community-based services.

Some of those people have intellectual and developmental disabilities and are enrolled in the iBudget program or are on a waiting list for the program. Roughly 20,000 people are on the waiting list for the program, which is administered by the state Agency for Persons with Disabilities.

Other people who are frail enough to qualify for nursing-home placement who choose to live at home with the assistance of home- and community-based services are enrolled in — or on a waiting list for — the state’s long-term care waiver program. Approximately 60,000 people are on the waiting list for the waiver program, which is administered by the Florida Department of Elder Affairs.

While the proposal submitted to the Biden administration this week would target $191 million to reduce the iBudget waiting list, the plan does not include money to reduce the waiting list for the long-term care waiver program.

According to the proposal, the state is asking for nearly  $128 million in federal funds to provide one-time stipends to people age 60 and older in the long-term care waiver program. The stipends can be used for purchases ranging from air conditioners to technology.

The state’s plan also shows that the DeSantis administration wants to provide another $127 million in stipends to other Medicaid enrollees receiving home- and community-based services. Half of the funds — $63,584,500 — would be directed toward technology stipends and the other half would go toward stipends for home improvements or other purchases that promote aging in place.

The lion’s share of the state’s proposal would direct $623,030,996 toward one-time payments to businesses that provide home- and community-based services to Medicaid clients.

But the plan doesn’t provide details about how the money would be distributed among different providers.

“That’s one of the $64 questions. What is the split between the DD (developmental disability) population and the elderly receiving home- and community-based services and other adults with disabilities that aren’t covered through the Agency for Persons with Disabilities?” DeBeauigrine said.  “How’s that going to split out? A lot of people in our world are going to be pretty interested in knowing those details.”

Miriam Harmatz, the director and founder of the Florida Health Justice Project, also said that the document doesn’t distinguish how provider payments will be distributed between the waiver programs. Harmatz, whose association advocates for universal health-care coverage, said that salary increases are needed for providers in both waiver programs.

“These are heroes we have to pay a living wage and provide benefits and make it a career path for people who are called for caregiving. And there are some angels among us. That’s a very hard job,” Harmatz said.

And while the potential for a $1.1 billion infusion is promising, Harmatz emphasized the need for a continued commitment to provide additional funds for home- and community-based services.

Harmatz helped spearhead a letter to Florida’s congressional delegation asking lawmakers to continue the increased funding for home- and community-based services. The letter was signed by more than 400 individuals and organizations that support the additional funding.