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From the staff of the Tampa Bay Times

Feds hold firm: Low-Income Pool to be capped at $608M



Lawmakers and hospitals that had hoped for more money to pay for uninsured Floridians’ health care are out of luck.

In a letter Thursday, the federal government’s Centers for Medicare and Medicaid Services told state health officials that the Low-Income Pool would be capped at $608 million for 2016-2017, the amount promised in June but a number that many hoped would increase.

“CMS is sticking to what they had said in their previous letter,” said Miriam Harmatz, senior health law attorney at Florida Legal Services.

The Thursday letter includes the terms and conditions for the phase-out of the LIP, which has used local tax dollars and federal money to cover unpaid emergency medical procedures for uninsured Floridians, so-called charity care.

Justin Senior, the state's deputy secretary for Medicaid, told lawmakers last week that the final amount was still being negotiated with the federal government although he did not expect CMS to change it.

The $608 million that will be in the pool is considerably smaller than the approximately $2 billion that were available last year and $1 billion this year. It means some of the safety-net hospitals that care for those without insurance could face serious financial trouble, Tony Carvalho, executive director of the Safety Net Hospital Alliance of Florida, told the Times/Herald last week.

And things could be made worse for some hospitals that have used the fund to shore up other financial losses. In the 2016-17 program, LIP money is only allowed to compensate for unpaid care given to uninsured people who earn less than 200 percent of the federal poverty line.

Further, hospitals will no longer have a guaranteed return on local taxpayers’ investments.

“Now, (the uninsured) have to beg and grovel and hope that their local safety net is sufficiently funded that they can get urgent care when they need it,” Harmatz said.

With a shrunken LIP that is set to disappear altogether in June 2017, lawmakers will face big questions about how to keep the safety net hospitals afloat and how to ensure that low-income Floridians have access to health care.

It’s the same question that blew up the 2015 legislative session and necessitated a special session on the budget this summer. And it has been complicated by the politics of Medicaid expansion, which CMS, the Obama administration and the Florida Senate have pushed for while the Florida House and Gov. Rick Scott fended off attempts to grow the program.

“Gov. Scott should listen to this, and the leadership should listen to this,” Harmatz, a proponent of expansion, said. “We have another option. We can accept federal funding to cover low-income, uninsured adults, and that would eliminate all of these issues.”

For his part, Scott stands firm. At an Associated Press event Wednesday in Tallahassee, he said that the impending $400 million shortfall in the state budget over LIP (that’s the $1 billion in this year’s pool minus the $600 million CMS will allow next year) is on President Barack Obama and his agencies’ heads.

“It’s hard to believe that the Obama administration, who says they’re worried about health care for the poor are fine with reducing a program,” he said.

Miami Herald staff writer Daniel Chang contributed to this report.

[Last modified: Thursday, October 15, 2015 7:52pm]


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