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everything in new perspective ... especially the big decisions."

For weeks, Scott has said the debate on expanding Medicaid was directly tied to the state's application for waivers it needs to allow private companies to run the program.

His endorsement of the expansion came hours after the federal government agreed to grant Florida a conditional waiver to privatize Medicaid statewide for the state's more than 3 million current recipient, more than half of whom are children or people under age 21.

Scott and GOP lawmakers have repeatedly warned that Medicaid's roughly $21 billion annual costs were consuming Florida's budget and proposed the managed care plan to save money and improve care.

The privatization expands on a five-county pilot program that has been rife with problems. Critics worry for-profit providers are scrimping on patient care and denying medical services to increase profits. Some doctors have dropped out of the pilot program, complaining of red tape and that the insurers deny the tests and medicine they prescribe. Patients have complained they struggled to get doctor's appointments. The participating counties included Broward.

Several health plans also dropped out of the pilot program, saying they couldn't make enough money. Patients complained they were bounced from plan to plan with lapses in care. Nearly half of the 200,000 patients enrolled in the pilot have been dropped from at least one plan, federal health officials noted at one point during negotiations.

Lawmakers say they have fixed the pilot program's shortcomings, with provisions including increased oversight and more stringent penalties, including fining providers up to $500,000 if they drop out. The measures also increase doctors' reimbursement rates and limits malpractice lawsuits for Medicaid patients in hopes of increasing doctor participation in the program.

Medicaid, a joint state-federal, government-run health care program, is voluntary for states. But every state participates, in part because of the good financial terms. The federal government covers about 55 percent of all Medicaid costs in Florida and covered about 68 percent in recent years with additional stimulus funding.

The health care law tried to entice states to expand eligibility to Medicaid by raising income eligibility limits. To do so, the federal government agreed to fund 100 percent of the cost for states to expand Medicaid for three budget years. The federal government would then cover 95 percent of the costs in 2017, 94 percent of the costs in 2018, 93 percent of the costs in 2019 and 90 percent of the costs in 2020 and beyond.

Recent polls conducted by the American Cancer Society's Cancer Action Network and the Florida Hospital Association indicated that most Floridians supported the Medicaid expansion, though conservatives were less likely to agree.

Scott said Wednesday that he had to look past his long-standing opposition to the health care law to reach his decision.

"It doesn't matter what I believe. It doesn't matter what anybody believes," Scott said. "The Supreme Court's already made their decision. We had an election in the fall, and the public made their decision."

Miami Herald reporter John Dorschner and The Associated Press contributed to this report.

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