Rick Scott is all about accountability and efficiency in government. Unfortunately, the Medicaid bill on his desk is about neither.
That's why I have every confidence the governor will veto HB 5301, if not swiftly, at least emphatically.
This bill was the thief that came in the night.
HB 5301 tiptoed into the Senate chamber in the 12th hour of a 13-hour session, on the last day the 2012 Legislature convened.
In all of 28 minutes -- counting reading the bill and voting on it -- the Senate rammed through legislation that will force 67 Florida counties to pay tens of millions of dollars in bills created mostly by a chronically error-plagued Medicaid billing system -- a system that duplicates and misdirects bills and requires that virtually every county employ at least one full-time worker to validate claims.
See below the attached county-by-county list of fiscal carnage.
Twenty-eight minutes to dump the burden of the state's bad accounting practices on local taxpayers.
Even Senate President Mike Haridopolos got 110 minutes earlier in the day for his tribute and portrait unveiling.
This turkey of a bill was going down until Democrats in the House attached KidCare to it. KidCare, remember, is the measure that makes children of state employees eligible to receive subsidized health insurance. With KidCare, Democrats ready to vote against the conforming Medicaid bill voted for it instead. In the end, 5301 passed 23-17.
In case you're not entirely sure what HB 5301 is all about:
All Florida counties are required to pay a portion of the state's share for certain Medicaid services. But HB 5301 proposes what the Florida Association of Counties correctly calls on its website "a statutory change that would require every county to pay inaccurate, old bills and withhold their half-cent sales tax distribution for Medicaid each month moving forward, regardless of the bills' accuracy."
Explains FAC, "Local governments would have to apply to the state for a refund if they believe a charge is incorrect."
Estimated statewide fiscal impact for 2012-2013 is $70.5 million, meaning that counties will have to pay $70.5 million over and above the coming year's estimate for their share of the cost. In these recessionary times, the counties already have cut their budgets by $3 million.
The bill is a colossal unfunded mandate.
The real problem in all this is that HB 5301 does nothing to solve the inefficiencies in the Medicaid billing system. Over the past four years, as I mentioned earlier, bills have consistently included incorrect address information, duplicative charges and incorrect rates. One particularly dramatic example: Orange County received the same bill not twice or three times, but 15 times.
Cragin Mosteller, communications director for FAC, told Sunshine State News, "In 2008 the Agency for Healthcare Administration switched over from paper to electronic billing. It's no exaggeration to say the system never worked.
"How," she said, "can the Legislature say, 'OK, we know the system is broken, but we're not fixing it -- just pay'?"
In a telephone interview Wednesday night, FAC President Doug Smith, a commissioner in Martin County, said he trusts the governor to do the right thing. "Rick Scott understands that charging local governments before they can determine residency is an irresponsible use of taxpayer dollars. I think he will see the absurdity of this bill."
Counties, Smith explained, have a fiduciary responsibility to their taxpayers to ensure that the services they are paying for are services that were provided to their residents. But the language in 5301 makes each county pay first and hope for a refund later.
Sen. Don Gaetz, R-Niceville, who supported and spoke for the bill during its 28-minute flash on the Senate floor, explained that the main reason he voted for it is because Medicaid needs to get the money it's owed. Period. "This isn't for the general fund, it's for every county's frail elderly, it's money that goes right back into the program in each county," he said.
"I proposed a 15 percent discount to help counties out," said Gaetz, "because I understand these are hard times and it won't be easy paying this backlog. I also made sure there's a way for counties to make their case on billing discrepancies with AHCA and I pushed to extend the payback period if necessary, so it all didn't come due at once."
Smith said he appreciated Gaetz's efforts, but if a bad economy is to blame at all, it certainly isn't the chief culprit -- a bad billing system is. Inefficiency is. An unbusiness-like approach to the business side of government is.
"Our hope," he said, "is that the governor will say, 'Time out. Let's make sure the billing system is fixed and let's hire a third-party auditing firm to come in and tell us what's right to pay.' We would happily abide by their decision. But HB 5301 as it stands is nowhere near the good-government standard Governor Scott set for us."
Scott won the gubernatorial election in 2010 largely because voters wanted state government run on sound business principles. The majority of them trusted that he could do that, and therefore run a tighter ship, steer a straighter course and keep the ship of state off the shoals.
Counties, like individuals and businesses, have a fiduciary duty to review bills for accuracy before taxpayer dollars are spent. That plain hasn't been done here. And like Doug Smith, I have faith the governor will do the right thing, take his heavy-leaded veto pencil and strike this bill down.
Reach Nancy Smith at firstname.lastname@example.org or at (850) 727-0859.