On February 20, 2013, Cindy Mann – the Director of CMS’s Center for Medicaid & CHIP Services – issued a letter to Florida’s Medicaid Director acknowledging the “significant progress” CMS and Florida Medicaid have made and the “agreement in principle” they have reached concerning Florida’s request to amend its section 1115 Medicaid demonstration project. That project, which began in a limited number of Florida counties in 2005, requires most Medicaid recipients in affected counties to enroll with a Medicaid managed care plan in order to receive covered services. Florida is seeking to expand that waiver statewide, and CMS has now signaled that the parties are close to reaching a final agreement that will permit Florida to do so. In the letter, CMS indicated that certain items still need to be addressed, including: assurance of a comprehensive quality strategy with data-driven goals and strategies; enhancement and clarification of the monitoring and evaluation of plans; and development of enhanced stakeholder engagement strategies to ensure Florida benefits from input of beneficiaries, providers and other stakeholders. With Florida’s 2013 Legislative Session scheduled to open on March 5, 2013, the focus will shift to how Governor Scott and the Florida Legislature approach the issue of optional Medicaid expansion in light of the U.S. Supreme Court’s Affordable Care Act ruling.