Florida’s Medicaid Waiver Won’t Improve Coverage or Access

The Centers for Medicare & Medicaid Services (CMS) has renewed Florida’s Medicaid waiver for the next five years and, with it, included $1.5 billion in annual Low-Income Pool (LIP) funding for health care providers that furnish care to uninsured low-income Floridians. That’s about $900 million more than the state previously received under the waiver — but, despite the Trump Administration’s claims to the contrary, that funding won’t expand access to care. That’s because, regardless of its funding level, the program doesn’t expand coverage to the uninsured or prompt more providers to participate in Florida’s Medicaid program.

As we’ve explained, the LIP supports health care providers that provide uncompensated care to uninsured or underinsured Floridians. But contrary to CMS Administrator Seema Verma’s claim that the renewed waiver, with its added LIP funding, will have “…a positive and direct impact on people’s lives and their ability to access care,” the LIP is not a health coverage program and therefore does nothing to broaden access to care, such as encouraging more providers to participate in Florida’s Medicaid program.

In fact, by authorizing the additional $900 million, the Administration is departing sharply from key principles that CMS communicated to the state in 2015. Back then, CMS stated that the federal government would no longer provide funding for uncompensated care to pay for health care for people who Florida could cover under the Affordable Care Act’s Medicaid expansion. (Florida is one of 19 states that haven’t yet adopted the expansion.) CMS also stated that Medicaid payments should support services for Medicaid beneficiaries and low-income uninsured individuals and ensure adequate provider participation in the state’s Medicaid program and access to care for Medicaid beneficiaries. For example, in lieu of increasing LIP funding, CMS urged the state to increase its Medicaid managed care payments to encourage provider participation as well as to improve care coordination for Medicaid beneficiaries.

In approving the additional LIP funding as part of the waiver’s renewal, however, the Administration is fulfilling none of those principles. Instead, it’s doubling down on a health care delivery model that’s less efficient and more costly than providing Medicaid coverage.

As a result, the additional LIP funding won’t improve people’s health since it won’t pay for coverage. It will merely reimburse hospitals that provide uncompensated care. That’s far from fulfilling Verma and Health and Human Services Secretary Tom Price’s ostensible commitment to improving Medicaid beneficiaries’ access to health care services, despite their claims.