Things Got Weird In Florida When a Medicaid Official Went Missing

The CMS negotiator went on vacation, but state officials are seizing the chance to criticize the Obama administration.

Gov. Rick Scott speaks at a news conference on Wednesday, Jan. 30 2013, at the Capitol during the The Associated Press' annual legislative planning session in Tallahassee, Fla. Scott said he would propose that state legislators boost overall funding for public schools by $1.2 billion in the coming year. (AP Photo/Steve Cannon)
National Journal
April 2, 2015, 1:43 p.m.

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.”

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