First, the state has fulfilled a few requirements in transitioning Medicaid to a privatized, managed care program. The federal government granted a waiver to the state to do this, which was Scott's condition for taking the expansion money. In order to seal the deal, though, the state will have to: create a strategy to meet quality measures determined by the feds; beef up its monitoring and evaluation of the managed care plans; and prove that it will engage all stakeholders—providers, patients, communities—to make the program successful.
What might be an even bigger hurdle for Scott is getting his state legislature to go along with the program. For one thing, former Gov. Jeb Bush is apparently privately lobbying against him with Republican legislators. For another, the far right has gone nuts.
But then there's the argument that led Scott to take the money: reality. Florida has the second highest population of uninsured residents in the country. In 2011 alone, hospitals there had to swallow $2.8 billion in caring for the uninsured, spending that's both unsustainable and unnecessary. Beyond that, the expansion could create more than 70,000 jobs, and $8.9 billion in economic activity.
Even a committed tea partier like Scott apparently has to bow to reality every now and then. At least he does if he wants to run another statewide election. Whether his extremist colleagues in the state legislature feel the same constraints will be seen in the next few weeks.