WVHA fails to pay Medicaid share; County seeks payment

Posted On: March 1, 2022

Volusia County Government, through a unanimous vote of the Volusia County Council, is seeking a court order requiring the West Volusia Hospital Authority (WVHA) to pay its share of the Medicaid financial responsibility as determined by the County Council. The county’s legal team filed a complaint for a writ of mandamus with the Seventh Judicial Circuit on Feb. 22. Today, a Volusia County Court ordered WVHA to respond to the county’s lawsuit.

According to the complaint, “Despite taxing its citizens and acknowledging its Medicaid financial responsibility in its budget, WVHA refuses to honor the statutory mandate that it must furnish its share to the county.”

Volusia County is divided into three hospital districts. The districts are responsible for providing health care, or access to health care, to their indigent residents. All three districts have residents on Medicaid and health care providers who treat Medicaid patients. All three districts, including the WVHA, have historically funded their share of the Medicaid financial responsibility. The County Council determined the allocation of the annual Medicaid bill at its Nov. 16 meeting.

WVHA disagrees with the County Council’s division of Medicaid responsibility and contends that it owes nothing because it does not own a hospital and, therefore, does not directly receive Medicaid payments. WVHA argues the Medicaid responsibility should be divided only between the taxpayers in the other districts, which would result in the taxpayers from those districts carrying WVHA’s Medicaid obligation while WVHA’s taxpayers continue to utilize Medicaid as they always have.

WVHA’s attorney advises WVHA will not pay any portion of the FY 2021/22 Medicaid contribution and will not appeal the proration to the Florida Department of Financial Services. WVHA has no authority to refuse to furnish its share without appealing the county’s proration to Florida’s Department of Financial Services, which it has not done.

“This isn’t about not owning a hospital,” said District 1 County Councilwoman Barbara Girtman, a former WVHA board member. “The mission and intention of the WVHA is to provide access to health care for our West Volusia residents in need of health care, and that care stretches beyond the hospital. I hope WVHA reconsiders its decision.”

“I am astonished that the WVHA board members would pursue such an irresponsible course of action,” said At-Large County Council Member Ben Johnson. “They’ve shirked their long established responsibility to all those hard working, tax paying folks in Deltona, Orange City, DeBary and DeLand who have relied on these services for years and years.”

“I too am alarmed by the impact to my residents who will have to bear the burden of WVHA’s action,” said District 2 County Councilwoman Billie Wheeler.

Summary of issue

• A mandamus is a court order to perform a public or statutory duty.
• Medicaid is jointly funded by the federal and state governments. It provides health coverage to millions of low-income Americans. Approximately 19% of Volusia County residents are enrolled in Medicaid.
• The State of Florida charges counties an annual contribution to recoup a portion of the state Medicaid expenditures.
• Volusia County’s required annual contribution for FY 2021-22 is $7,652,381.
• Before 2013, the annual contribution counties made to the state was based on Medicaid usage billing data. County staff reviewed every Medicaid bill to determine eligibility within each hospital district.
• In 2013, the Florida Legislature changed the method for calculating the counties’ annual contribution and eliminated their role in reviewing Medicaid bills. As a result of this change, the basis of the annual contribution shifted from usage data to enrollment data.
• Since FY 2019-20, the state has determined the counties’ annual contribution by comparing the total number of Medicaid enrollees in a county to the total number of Medicaid enrollees in the state.
• In 2015, the county and its three hospital districts agreed to allocate their Medicaid financial responsibility by averaging Medicaid usage in the hospital districts using data from 2010 to 2014. The agreed proration of the remaining balance after the county’s 20.95% contribution was:
  • Southeast Volusia Hospital District: 8.72%
  • Halifax Hospital Medical Center: 52.04%
  • West Volusia Hospital Authority: 39.24%
• In 2021, the Agency for Health Care Administration provided the county with current Medicaid enrollment population by ZIP code. Using this data, the county was able to reasonably estimate current Medicaid enrollment percentages for the three districts. Continuing the county’s 20.95% voluntary contribution, the proration of the remainder based on current enrollment data is:
  • Southeast Volusia Hospital District: 9.65%
  • Halifax Hospital Medical Center: 42.97
  • West Volusia Hospital Authority: 47.38%
• During its Nov. 16, 2021, meeting, the County Council determined that the county would voluntarily continue to pay 20.95% of the Medicaid financial responsibility and allocate the remainder among the three hospital districts in proportion to each district’s share of the county’s total Medicaid enrollment.
• This change will be phased in over four years to give WVHA time to adjust to its proration increase.
• In fiscal year 2021-2022, the WVHA budgeted $2,359,000 for Medicaid reimbursement and taxed its citizens accordingly.