Floridians woke up to news headlines on Thursday morning that their state’s ongoing negotiations with the Obama administration over a contentious Medicaid funding stream had been unexpectedly and inexplicably suspended.
Florida Health Secretary Elizabeth Dudek said the suspension, which her agency announced, was “sudden and disappointing,” while warning it “could signal the abrupt end of this federal health care program in Florida,” according to The Miami Herald. The local press reported that the Centers for Medicare and Medicaid Services refused to explain what happened.
But there is more to the story.
Joan Alker, a respected health-policy analyst at Georgetown University’s Center for Children and Families, furiously countered the Florida agency’s portrayal of events on Twitter. She said CMS’s lead negotiator in the Florida talks, Eliot Fishman, had simply went on a long-planned Passover vacation.
Alker told National Journal that she knows Fishman professionally and saw him recently, when he mentioned his upcoming vacation. CMS confirmed that Fishman was on leave.
Hold on, what? What’s going on?
All this is taking place while CMS and Florida negotiate over $1 billion in federal funding to the state’s Low-Income Pool program, which pays for uncompensated care, and as some moderate Republicans in the state legislature push for the state to expand Medicaid under Obamacare.
CMS won’t comment on it, but outside experts watching the situation think that the federal agency is using the LIP negotiations to press Florida to accept Medicaid expansion. Gov. Rick Scott himself has tacitly accused the Obama administration of trying to tie the issues together.
So that was background of the state health agency’s announcement that talks had been suspended. To anybody following the negotiations closely, it was easy to conclude that CMS was playing some real hardball by halting their conversations, and Dudek’s warnings that the LIP program’s future was in jeopardy lent credence to that reading.
“We were informed late yesterday by CMS that their lead official discussing the continuation of the federal LIP program in Florida, Eliot Fishman, will not be available for any further negotiations for at least two weeks,” Dudek said in the statement announcing the news. “For CMS to discontinue LIP negotiations now is troubling and could signal the abrupt end of this federal health care program in Florida.”
What wasn’t clear from Dudek’s statement was whether CMS had actually told Dudek that Fishman was going on vacation. Shelisha Coleman, a spokesperson for Dudek, clarified that the agency did explain what Fishman was doing, though she said the notice had been sudden.
“After months of continuing discussions, we were suddenly told Eliot Fishman would be on vacation for two weeks,” Coleman said. “When we asked to meet with the CMS director, CMS said she would be on vacation, too.”
So everybody agrees Fishman left for vacation. For two weeks. The LIP funding doesn’t expire until June 30. So why such strong language from Dudek? Coleman did not respond to follow-up questions.
The Obama administration pushed back in a Thursday afternoon statement against Dudek’s characterization that the federal agency had “discontinue[d]” the LIP negotiations.
“CMS has not stopped conversations with the state of Florida. CMS remains in contact with state officials and continues to share information,” the agency said. “Senior officials from CMS will continue conversations with state officials about our shared goal of securing access to high-quality health care coverage for low-income Floridians.”
It was a bizarre episode in what promises to remain a hot-button issue in the next few months.
“I can’t speak to what the state’s motives are, but I can say that their comments on the LIP have had an element of fiction to them for the past year,” Georgetown’s Alker said. “This is another on a long line of things they say that are just off target.”