As President-elect Donald Trump prepares to tackle an agenda that includes reforming the Affordable Care Act, Gov. Rick Scott is eyeing a long-sought prize.

  • Scott seeking federal grant to allow restructuring of Medicaid
  • Florida has twice rejected federal aid in expanding Medicaid in the state
  • Block grant would allow state to restructure as it sees fit

Scott is pushing for a federal block grant that would allow Florida to restructure its Medicaid program as it sees fit. The increased flexibility, some Republicans say, could even allow the state to expand the Medicaid coverage pool.

It's an ironic prospect, given that Florida House Republicans have for three years running rejected the Obama administration's offer of $51 billion to expand Florida's Medicaid program. The funds would provide health coverage to roughly 850,000 Floridians who don't currently qualify for Medicaid yet can't afford private coverage.

But Scott, a former health care executive, has twice reversed course on expansion. Most recently, he opposed it after his razor-thin reelection victory in 2014.

The sticking point, he said then, was the federal government's top-down control of Medicaid.

A block grant, on the other hand, would let the state determine payments to doctors and hospitals, as well as introduce potential cost-saving options like online tele-medicine appointments. The savings, Scott suggested last week, could be used to sustain and expand other parts of the Medicaid program.

"We pay these federal taxes that they want to give back to us in different programs," Scott told reporters. "Let us run the programs the way we believe for our state."

Medicaid expansion advocates, however, are cool to the block grant approach.

"It really comes fraught with risks and potential peril," said Damien Filer of Progress Florida. "It would be the people who would need this health care the most, people who are in dire economic situations, children, people with mental illness, would be the ones who would be on the front lines facing real challenges if this doesn't go the way that (Scott) is forecasting that it will."

Regardless of how the money is used, it would amount to a significant cash infusion, reforming and potentially enlarging a program conservatives have bemoaned as a definition of government excess.

The difference is that the approach is the brainchild of conservatives and, with a Republican about to assume the presidency, its enactment could be at hand.