Legislators debating more or less Medicaid funding for new moms, sickest babies

Kirby Wilson
·4 min read

In March, Florida Speaker of the House Chris Sprowls announced he was backing a plan to extend the amount of time new mothers could be eligible for Medicaid from 60 days to one year.

Sprowls, R-Palm Harbor, won bipartisan praise for the proposal, which he said would help the state fight racial disparities in maternal mortality. The policy expansion is ambitious and expensive: It would cost the state $93 million and taxpayers about $240 million. Medicaid is funded by a combination of state and federal tax money.

“Every baby should have the opportunity to be born healthy, and every mother should get the maternal healthcare she needs to set up herself, her child and her family to thrive,” Sprowls said at an event in which he announced his support for the policy in March.

A House analysis found that the policy would cover about 98,000 new mothers in Florida.

But as the House negotiates with the Senate over the state’s nearly $100 billion budget, Sprowls’ proposal has turned into one of the main sticking points. The Senate did not include the Medicaid extension in its initial budget. When the House and Senate leaders convened to hash out the differences in their healthcare budgets, the Senate offered to fund the extension — but for just six months. The House has yet to formally respond to that offer, and talks are ongoing.

Lawmakers are trying to figure out where the new Medicaid extension funding would come from. The House initially proposed that the lion’s share of it should be balanced out by cuts to hospitals, which get hundreds of millions of state Medicaid dollars every year. The initial House budget proposed cutting about $226 million in “critical care” funding, which is set aside for the hospitals that take on the highest share of Medicaid patients. About $223 million of those cuts would have come from just nine hospitals.

Any eventual cuts are likely to be far lower than the ones originally proposed by the House, because the state’s revenue estimates have gotten more optimistic in recent weeks. The state should expect hundreds of millions in enhanced Medicaid funding from the federal government, too.

However, hospital executives said they are having trouble squaring the idea of cuts with Sprowls’ enthusiasm for maternal health.

Their boy lived 8 days. They’ll spend the rest of their lives wondering what went wrong

The nine hospitals that the House initially proposed cutting — including Broward Health Medical Center, Jackson Health System and Tampa General Hospital — participate in the Regional Perinatal Intensive Care Center program. That means they provide care to the state’s high-risk new moms, and to underweight or critically ill babies. Many of those complicated births are covered by Medicaid. In total, about 56% of births in Florida are covered by Medicaid.

Hospital advocates said they support extending Medicaid eligibility for new mothers. But they argue the House wants to do so at the expense of sick babies and the already overburdened institutions that care for them.

“I couldn’t possibly make sense of funding one side and cutting off funding on the other when it comes to a mom and a baby,” said Tom VanOsdol, the president and CEO of Ascension Florida. One of his chain’s hospital systems, Ascension Sacred Heart in Pensacola, is staring down cuts if the House gets its way.

House leaders said this is a disingenuous argument. Even if hospitals sustain cuts, they wouldn’t directly affect high-risk moms and babies because hospitals have more than one revenue stream.

“Facing a significant general revenue issue, the House has taken the approach to reduce funding from areas like hospitals — which have multiple funding sources and a greater ability to cost shift — to balance the state budget,” said Jay Trumbull, the House budget chair, in a statement. “RPICC hospitals have hundreds of millions of dollars in funding for charity and uncompensated care, and various supplemental funds throughout the state budget.”

Trumbull added that those hospitals could offset any cuts with a different proposal in the House’s budget: a direct payment program.

Justin Senior, the CEO of the Safety Net Hospital Alliance of Florida, said that program would likely help hospitals, but it might take at least a year for the payments to hit balance sheets — in part because the federal government would need to approve it.

“Our hospitals are NOT in favor of a direct payment program if it means rate cuts,” Senior wrote in a text message.

When it comes to Medicaid funding, the Senate thus far has sided more with the hospitals than it has with the House. In the budget offer the Senate presented to the House last week, the “critical care fund” was spared from cuts. The general hospital reimbursement rate was cut about 1%.

Gov. Ron DeSantis’ budget did not propose any Medicaid rate cuts for hospitals.