The new funding formula was a little-known part of Florida’s 2011 Medicaid reform law, a Republican-driven overhaul of the state and federal insurance program for the poor.
The provision was intended to make the distribution of an estimated $1 billion a year in federal Medicaid matching funds more equitable. But its unintended consequences are now becoming clear, as the funding mechanism known as “tiering” is scheduled to take effect.
Hardest hit are hospitals that serve large numbers of uninsured and Medicaid patients, and counties such as Miami-Dade that put their own residents’ tax dollars toward Medicaid. Those local dollars are matched by federal funds.