ORLANDO, Fla. — On September 10, 2024, state health officials planned to brief Gov. Ron DeSantis’ office on a lucrative deal that had been three years in the making. The topic: a $67 million Medicaid settlement that could soon come Florida’s way, newly released records show.

The day after that scheduled meeting, the health agency’s top lawyer shared a new draft of the agreement — one that set off a political firestorm months later in Tallahassee.

The settlement would still be for $67 million, but it would peel off millions for the Hope Florida Foundation, the charity arm of the initiative spearheaded by first lady Casey DeSantis, the documents reveal. Hope Florida ultimately got $10 million, which it funneled to two nonprofit organizations that in turn gave $8.5 million to a political committee controlled by the governor’s then-chief of staff, James Uthmeier. That committee was set up to defeat a ballot initiative to legalize recreational marijuana.

The finalized agreement, with the Hope Florida Foundation a recipient, became public earlier this year, igniting a bipartisan legislative probe and sparking questions about whether highly regulated Medicaid dollars were illegally used for political purposes. Tallahassee prosecutors opened an investigation in May.

Ever since, key questions have lingered about who pushed Hope Florida into the middle of the Medicaid settlement, and when that happened. The newly released records offer clues, casting the planned Sept. 10 meeting as a potential “turning point” that reshaped the controversial Medicaid settlement agreement just as a hard-fought campaign was shaping up, said state Rep. Alex Andrade, R-Pensacola, who led the investigation for the House.

The key record: An email from a staffer with the Florida Agency for Health Care Administration featuring an “EOG agenda” for Sept. 10 in which the settlement was one of the items to be discussed. EOG is an abbreviation for “executive office of the governor.”

None of the records provided to the Orlando Sentinel and other news organizations document whether the meeting was held as planned, who attended or what ultimately was decided. AHCA and the governor’s office did not return messages seeking additional details about the scheduled meeting. The records don’t include a list of attendees, a summary of what was discussed or a definitive accounting of who directed the Hope Florida Foundation be added to the settlement agreement.

Still Andrade said this week, “It looks like the meeting at the EOG was the turning point,” and one that demands scrutiny.

On Sept. 11, a day after the planned meeting, the records show that Andrew Sheeran, AHCA’s top legal adviser, shared a new version of the settlement agreement with then-AHCA secretary Jason Weida. The agreement set aside $5 million for the Hope Florida Foundation — the first time the charity was mentioned in legal drafts. That amount grew to $10 million in subsequent revisions.

The Medicaid contractor, Centene Corp., had been trying to resolve overbilling claims with the state since 2021.The company also was reaching settlements with other states to resolve claims that it overbilled for prescription drugs.

In February 2022, Centene proposed paying $67 million to resolve Florida’s claims. Hope Florida didn’t enter the picture until more than two and a half years later, according to the records of the negotiations.

Once the proposed settlement included Hope Florida, it moved rapidly to a conclusion. But the state’s chief deputy attorney general sought to distance his agency from the unusual proposal, records show. Attorneys for Centene also worked to shield themselves from any potential liability associated with the donation, making it clear the contribution was being directed by the state.

“The fact that it was added at the very last minute is telling,” Andrade said of the Hope Florida donation. “If it had been added far earlier, then obviously it would be kind of exculpatory. But in this case, it makes it seem as if it was added solely because of the campaign environment.”

As officials worked to resolve the Medicaid payment issue, DeSantis was pushing hard to defeat the initiative that would have legalized recreational marijuana.

DeSantis has subsequently defended the settlement, arguing that the state got a good deal and the $10 million donation was an additional “cherry-on-top” payment that served Floridians well. Launched in 2021, Hope Florida’s objective is to connect the needy with nonprofits and faith-based groups and get them off government assistance programs.

The trove of new records, totaling hundreds of pages, includes draft versions of the settlement agreement and correspondence among administration officials. The Orlando Sentinel obtained most of the records through a public records request filed with the attorney general’s office. Other documents were supplied to Andrade through a public request he filed with the health care agency.

The records show that on Sept. 5, 2024, Centene’s lawyer, Chris Koster, sent a draft settlement proposal to state officials. That document didn’t mention Hope Florida and directed the entire $67 million settlement go to the attorney general’s office. Koster wrote that the document “aligns with previous settlements in other jurisdictions.”

But the next week — after the planned meeting at the governor’s office — the lawyer for the state’s health care agency shared a revised version with the attorney general’s office. That version included the $5 million donation to the Hope Florida Foundation.

The new version appeared to spark some reservations from then-Chief Deputy Attorney General John Guard. He responded he had approval to sign the settlement agreement on behalf of the attorney general, but he said he thought the payment section needed to be modified. Guard ultimately signed the agreement, however, and didn’t explicitly object to Hope Florida being included.

Medicaid is a joint state-federal program that provides health care coverage to low-income patients. In Florida, the federal government covers about 57% of the cost with the state picking up the rest. As a result, some of the settlement money had to be returned to Washington, D.C.

“Normally, the federal share is explicitly detailed in the settlement agreement and I am not sure AHCA wants us to get the remainder of the money,” Guard wrote in a Sept. 13 email. “If it is just going to the Legislature and GR [general revenue], I can probably make it work, but I believe this is different than I have seen in a settlement with Medicaid monies.”

Guard, who was nominated by President Donald Trump for a federal judgeship, did not return a message seeking comment.

Sheeran wrote that the dollars need to go to AHCA not to the attorney general, “so the money lands in the correct Medicaid-related trust fund(s).” AHCA’s settlement agreements don’t usually detail the federal share, he wrote, but the Medicaid finance staff are experienced in figuring out how much needs to go to the federal government.

The document was then revised to increase the Hope Florida donation to $10 million with the remainder going to AHCA.

Centene’s lawyers sought to add protections for the company. In a Sept. 19 version of the document, the company’s legal team added language that Centene was being directed by the attorney general to make the donation to the Hope Florida Foundation and that it would have no liability in “any dispute that may arise with respect to any such allocation or distribution.”

Guard worked to clarify that the funds were going to ACHA, not his office. Language that the attorney general was directing the donation was removed. Instead, the final version clarified that it was being done at AHCA’s direction.

“I get that they negotiated this in every other state with the AG. But, they are negotiating this agreement with AHCA and it is going to have to look slightly different,” Guard wrote to Sheeran in a Sept. 24 email.

In his revisions, Guard wrote: “At AHCA’s request, the Attorney General is granting a release and that is the extent of the Attorney General’s involvement in this settlement.”

Guard appeared hesitant even after most of his edits were accepted.

“I don’t really want to make a rep, but I am fine with this,” he wrote.

The agreement was finalized on Sept. 27, but controversy erupted months later when a Florida House committee opened a probe into the settlement.

Andrade ended the House investigation in April after several witnesses declined to testify, adding he’d leave the rest of the inquiry to “the FBI and Department of Justice.” He alleged that the flow of funds amounted to “conspiracy to commit money laundering and wire fraud.” Specifically, he accused Uthmeier, now the state’s attorney general, of directing funds from the Hope Florida Foundation to the political committee he controlled.

Uthmeier has denied wrongdoing and said he had no role in the final settlement agreement. His calendar shows he met in 2022 with company executives and attorneys during earlier negotiations. This week, his spokesman, Jeremy Redfern, said in an email that Uthmeier doesn’t know anything about the planned Sept. 10 meeting.

Andrade disagreed with the DeSantis administration’s contention that the $10 million donation to Hope Florida was a separate sweetener on top of a $57 million Medicaid settlement, saying the records show the settlement was always going to be $67 million.

Federal guidance issued in 2008 instructed state health officials that they must provide a “proportionate share” of “the entire settlement or final judgment amount” to the federal government. The state’s settlement terms also justified the donation by noting the health care agency “desires an expanded role for Hope Florida in the Florida Medicaid program.”

In Andrade’s view, that means $10 million should not have been carved out for Hope Florida and belonged in the Medicaid program, which would have restricted how the funds could have been used.

“I’ll leave the majority of what comes next to law enforcement if they feel it’s proper to keep pursuing it,” he said.

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—Orlando Sentinel staff writer Jeffrey Schweers contributed to this report.

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