In an effort to encourage personal responsibility and cut program costs, the state of Florida plans to implement a $10 per month per person premium for Medicaid recipients in 2012, pending federal approval. Researchers at Georgetown University’s Health Policy Institute estimate that the imposition of that premium, in addition to other planned changes, including a $100 co-pay for non-emergency visits to hospital emergency rooms, may result in up to 800,000 beneficiaries leaving the program. While recently, Florida was lauded for reducing the number of uninsured children by 160,000, the researchers found that approximately 82 percent of the beneficiaries who would leave Medicaid would be children. According to Joan Alker, a Georgetown researcher, “This proposal would turn back the clock on all that progress and would have a devastating impact on the growing number of Florida children living in poverty.”
Alker compares the Florida plan to Oregon, in 2003, when it implemented premiums between $6-$20 for adults under the poverty level. Subsequently, adult enrollment dropped from 104,000 to 24,000 persons. Precedents from other states have, similarly, not been encouraging. When Maryland beneficiaries at higher income levels were required to pay $37 per month premiums, within a year, 28 percent of enrolled children dropped from the Medicaid rolls. Likewise, in Missouri, the imposition of new premiums in 2005 led to a 30 percent reduction in Medicaid enrollment within two years.
The Florida Agency for Health Care Administration (AHCA) argues that Georgetown’ s findings are not supported with adequate evidence regarding the incomes and budgets of Florida Medicaid recipients and their ability to pay the monthly premium. Governor Rick Scott emphasizes that Medicaid costs must be controlled so that Florida can create jobs and fund education. Lawmakers in the state contend that the $100 emergency room co-pay will not pose a problem because it will encourage recipients to seek less expensive primary care for non-emergency conditions. True emergencies will not require the co-pay. Lawmakers further insist that the monthly premium is fair because it will permit the Medicaid plan to be privatized, which will ensure that beneficiaries receive care comparable to those residents who pay for private insurance.
Still, to some advocates, like Greg Mellowe, the Florida Center for Fiscal and Economic Policy health policy director, it is simply not appropriate to impose the premium on poor families. He argues, “These families already must make untenable choices in order to make it through. How is a family of three…scraping to survive on a few hundred dollars per month going to come up with $30 in premiums? The short answer is, they aren’t.”