By Christine Sexton, Florida Phoenix
The Context:
According to the latest available data, about 11.8%, or approximately 6,400 Apopka residents, were enrolled in Medicaid.
As of 2023, approximately 17.4% of Orange County residents, or approximately 261,000 individuals, are receiving Medicaid benefits in the county.
The latest available data in Orange County indicates that approximately 17.4% of children are enrolled in Medicaid or the Children's Health Insurance Program (CHIP), which includes Florida KidCare.
The nearly $965 million in potential liabilities at Florida’s Agency for Health Care Administration (AHCA) could significantly impact Apopka and Orange County residents, particularly those relying on Medicaid and other state-funded healthcare programs. Here’s how it could affect the local community:
1. Reduced Medicaid Funding and Services
If the state is forced to repay hundreds of millions of dollars to the federal government, state lawmakers may need to cut funding for Medicaid, which provides health care for low-income families, seniors, and people with disabilities. In Apopka and Orange County, thousands of residents depend on Medicaid for doctor visits, hospital care, prescription drugs, and other essential health services. A reduction in funding could lead to:
- Fewer available Medicaid providers.
- Longer wait times for appointments and treatments.
- Reduced coverage for prescription medications and specialized care.
2. Pressure on Local Hospitals and Health Care Providers
Hospitals and health care providers in Apopka and Orange County that serve a high volume of Medicaid patients could face financial strain if Medicaid reimbursements are delayed or reduced. This could result in:
- Staffing shortages.
- Cuts to specialized services or outreach programs.
- Potential financial instability for community health clinics and hospitals.
3. Disruption to Children’s Health Insurance and Drug Rebates
The state faces a $123 million liability related to children’s health insurance contributions dating back 25 years. If these funds are clawed back, it could lead to increased costs or reduced coverage for children enrolled in programs like Florida KidCare. Additionally, the $211 million in disputed drug rebates could result in higher prescription costs for Medicaid recipients in the area.
4. Increased Local Health Care Costs
If Medicaid funding is cut or delayed, some hospitals and clinics may shift costs to patients or increase charges for services not covered by Medicaid. This could disproportionately affect low-income families in Apopka and Orange County, who may struggle to afford out-of-pocket expenses.
5. Greater Strain on Emergency Services
Cuts to Medicaid could lead to increased reliance on emergency rooms for non-urgent care, as patients may have fewer options for regular doctor visits or preventive care. This could put additional pressure on local hospitals, increasing wait times and reducing the quality of care.
6. Uncertainty for Future Health Care Policy
With state lawmakers now tasked with addressing these financial issues, there’s uncertainty about how Medicaid and healthcare funding will be handled in the next budget cycle. If the state chooses to reduce healthcare spending to offset these liabilities, Apopka and Orange County residents could see long-term healthcare access and quality changes.
In short, AHCA's financial issues could create instability in Florida’s healthcare system, with local impacts ranging from fewer Medicaid options and longer wait times to higher healthcare costs for Apopka and Orange County residents.
Christine Sexton of Florida Phoenix writes about the alarming overspending by the state Agency for Health Care Administration (below).
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A House committee has criticized the DeSantis administration for overspending by the state Agency for Health Care Administration, with one Republican estimating the liability at the state’s largest health agency might exceed $965 million.
Administrators conceded the agency has big problems.
“We have a lot to do as far as a complete overhaul, is kind of how I look at it, of documenting things and making sure we are documenting, mapping, and giving our employees the tools they need to go forward and be successful,” Lynn Smith, assistant deputy secretary for health finance, told members of the House Health Care Budget Subcommittee Wednesday.
GOP Rep. Hillary Cassel said she appreciated Smith’s candor but that the agency needs to do better.
“When we’re dealing with the level of funding that we’re dealing with and the population that we’re dealing with, we need to do our best to eliminate that as best as possible,” Cassel said.
Chairman Rep. Alex Andrade kicked off 90 minutes of tough questions from committee members Wednesday by conceding that cash management for the Medicaid program “is complicated,” entailing “multiple revenue sources from various federal grants, interest earning, refunds, transfers, accounting adjustments, and expenditure reporting.”
Additionally, that the federal government sometimes attempts to claw back money it’s sent to the agency to help fund Medicaid, a safety net program for the poor, elderly, and disabled, he said.
“As we move forward with crafting the budget for the upcoming year, it is necessary for our subcommittee to have a thorough understanding of the cash management of the agency and analyze the impact of federal disallowances and improper accounting has on the health care budget,” Andrade said.
A lot of money
Committee members pressed Medicaid director Brian Meyer and Smith over a number of accounting errors and financing disputes Florida has had with the federal government that have resulted in “disallowances” — those clawbacks.
Florida Phoenix obtained a copy of a document prepared by AHCA that shows more than $965.6 million in potential liabilities, although Meyer stressed that the agency is in discussions with the federal government about the disputed amounts.
The disputes include the return of:
- $310,154,246 in ineligible Medicaid supplemental low-income pool payments made to Jackson Health System and other hospitals between 2009 and 2018;
- $320,495,618 in rebates from Medicaid managed care companies, back to 2015 when the statewide Medicaid managed care program was launched;
- $211,178,965 in drug rebates; and
- $123 million in children’s health insurance contributions, back 25 years ago.
When asked about some of the accounting errors, Smith mentioned two instances when the agency placed revenue in the wrong trust funds (she said there are eight trust funds in total). She attributed the mistakes to “human error, a failure of process, failure of communication.”
Smith discussed the agency’s accounting practices during the meeting.
“What I have found since I’ve been there, there are procedures and policies for some things. What I’ve found is they need to be updated, and we are doing that,” she said. “We have, based on recent events of transactions not being done properly, we have instituted new procedures for the team to follow.”
Rep. Mike Redondo, a Republican, and Rep. Mitch Rosenwald, a Democrat, both touched on audits — how often they are conducted and whether the results are shared with the committee, and whether the agency has a undergone a third-party outside audit during the past decade.
Smith and Meyer have been at the agency less than a year. Former Deputy Secretary for Data and Finance Tom Wallace unexpectedly resigned last year.
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Disclosure: Research and sourcing for the "In Context" portion of this article was produced using ChatGPT, an AI language model, to enhance research, generate ideas, or draft content. The Apopka Voice performed all final edits and fact-checking to ensure accuracy and alignment with our journalistic standards.
