Florida proposes new Medicaid fees and premiums

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President Barack Obama
President Barack Obama
As part of the sweeping Medicaid reforms approved by the Florida legislature earlier this month, the state wants to be the first to implement $10 monthly premiums on Medicaid recipients who are not in nursing homes.

Additionally, the state is proposing a $100 fee for Medicaid patients who use emergency rooms for routine care, according to Kaiser Health News.

State officials and consumer advocates say they do not expect the Obama administration to approve Florida's proposals because they allegedly violate the Affordable Care Act. While the 2010 law gives states more flexibility, it does not allow them to enact new fees and premiums for existing beneficiaries. While four states currently have premiums for Medicaid recipients, it only applies for those who earn more than 150% of the federal poverty level, which is $16,335 annually for an individual or $33,525 for a family of four.

While a dozen states charge Medicaid co-pays for ER visits, none charges more than $20 for those earning less than the federal poverty level. But Florida proponents contend that the changes would make Medicaid more like private insurance and generate about $9 million a year. Medicaid recipients use the ER about three times as much as people with private insurance, according to recent studies.

But opponents of the ER fee argue it would be potentially lethal for impoverished Florida residents.

"You can imagine a host of examples, such as chest pains, false labor, children having problems breathing, where a very low-income person would have to make the decision not to go to the ER or risk being fined $100," Laura Goodhue, the executive director of the patient advocacy group Florida CHAIN, told Kaiser.