BEYOND THE NUMBERS
Florida Governor Rick Scott announced Wednesday that Florida is “working with the Trump Administration to secure a commitment of $1.5 billion in LIP [Low-Income Pool] funding,” about $900 million more than the state was scheduled to receive. As we’ve explained, the LIP supports health care providers that provide uncompensated care to Floridians who are uninsured or underinsured. Contrary to Governor Scott’s claim that the added funding “will truly improve the quality and access to health care for our most vulnerable populations,” the LIP is not a health coverage program, and the funding won’t expand coverage to the uninsured or get more providers to participate in Florida’s Medicaid program.
Giving Florida almost a billion dollars in additional LIP funding is a sharp departure from principles that the Centers for Medicare & Medicaid Services (CMS) communicated to the state in 2015. CMS explained that federal funding for uncompensated care would no longer be available to pay for health care for people that Florida could cover under the Affordable Care Act’s Medicaid expansion. (Florida is one of 19 states that haven’t yet adopted the expansion.) The letter also stated that Medicaid payments should support services for Medicaid beneficiaries and low-income uninsured individuals, and ensure adequate provider participation and access to care for beneficiaries.
Moreover, the apparent approval of additional LIP funding doesn’t align with Health and Human Services Secretary Tom Price and CMS Administrator Seema Verma’s stated commitment to improving Medicaid beneficiaries’ access to health care services. Secretary Price has repeatedly argued that Medicaid needs to be radically restructured because many doctors won’t take new Medicaid patients. Not only is that claim dramatically overstated, but increasing LIP funding won’t encourage new providers to participate in Medicaid.
The additional LIP funding is also hard to square with the Administration’s stated view that Medicaid should provide better care at lower cost. The funding isn’t going to improve people’s health because it’s not coverage – it simply reimburses hospitals for uncompensated care.
The lack of transparency associated with the new funding is also troublesome. The state apparently never made an official request to amend its Medicaid waiver; nor did CMS give official approval. Under the standard waiver process, a state submits a formal request to CMS for consideration and both the state and CMS post that request to obtain public input on the proposed changes. If CMS approves the request, it posts the terms and conditions of the agreement. Without a transparent process, there’s no way to hold state and federal officials accountable for the extra money Florida is getting.