The membership of the Florida Association of Counties identified addressing the flawed state Medicaid billing system as a legislative priority.  Last week, FAC’s Legislative Executive Committee voted for FAC to advocate for legislation that would allow counties to leave the Medicaid billing system and pay an annual cost-share based on a to-be-determined formula and for those counties who wish to remain in the current system the ability to do so.

The Governor put forward a Conforming Bill as a part of the Administration’s budget package that would eliminate any accountability measure counties currently have access to under state law to dispute AHCA’s data. Instead, the Conforming Bill assigns counties with a base cost, growth rate and proportionate share using incomplete and disparate data.  The proportionate share for Medicaid assigned to each county is based on 5 months of annualized data. These data demonstrate that during the first months of implementing advanced refund requests, the vast majority of counties were billed inaccurately. More than $8 million in billings was disputed – 26% was billed to the wrong county and 12.4% (close to $1 million) was written off by AHCA. FAC supports steps to address a burdensome and problematic billing relationship, but any formula used to assign costs must be based on reliable and applicable data sets.  

FAC Leadership has directed staff to pursue the concept of streamlining using the following guidelines:

  • A base amount that is fair, equitable and incentivizes counties as partners
  • Basing county allocations on the best available and accurate data
  • Providing a cap on the growth rate to provide counties with fiscal certainty
  • Providing counties with flexibility in its source of payment

Before large shifts in Medicaid policy are made at the state level, a good faith effort should be made to address the current state-county relationship in a way that meets the goals of all parties.  FAC hopes to work with legislators to engage in deliberative dialogue, avoid making decisions in a vacuum and implement changes collaboratively and transparently. Together, there is an opportunity to reduce administrative burdens and provide a win - not just for counties and the state – but all of Florida’s taxpayers and the most vulnerable who utilize these services.

Medicaid cost sharing has been a four decade-long unfunded mandate but the state and Florida’s counties can find common ground by agreeing on a solution that provides fiscal certainty and is - at the same time - fair, mutually acceptable and in everyone’s best interest.   

In the Legislature:

County Contributions to Medicaid Program

SB 1244 (S. Soto)/HB 1117 (R. Wood)

  • Summary: Creates study group to evaluate percentage of funds that counties are required to contribute to Medicaid program & provide recommendations to the Governor and Legislature.
  • Status: Four committee referrals in the Senate; three in the House (currently in Healthcare Appropriations).
For more information or questions, please contact FAC Health & Human Services Advocate Susan Harbin.