Daniel Chang and the Miami Herald should be commended for excellent ongoing coverage of complicated topics related to funding for safety nets, such as Jackson Memorial Hospital, and Medicaid expansion. These are profoundly important issues and need to be understood by Herald readers, including stakeholders and decision makers.
As noted in the Jan. 16 article Florida hospitals may lose $1.3B, the federal government has announced that a major funding stream in Florida’s safety nets, the Low Income Pool (LIP) program, is scheduled to end this June.
This makes sense because LIP, which helps cover the costs of caring for the uninsured, with the feds paying slightly more than half, was established before the Affordable Care Act provided states with enhanced federal funding to reduce the number of uninsured through expanded Medicaid eligibility.
With the exception of some immigrants, virtually all low-income uninsured adults would be eligible for coverage, and — unlike LIP and the current Medicaid program — the federal government would pay most of the cost (100 percent tapering to no less than 90 percent).
Thus, with expanded Medicaid eligibility, the federal government’s rationale for continuing to fund Florida’s current LIP program no longer exists, and the loss is scheduled to occur with or without Medicaid expansion. It is not connected to the Legislature’s refusal, to date, to accept federal funding for expanded Medicaid coverage.
However, a number of states have included LIP-type programs with expanded Medicaid, and Tennessee’s governor has just announced a plan to expand Medicaid, along with a request to extend the state’s uncompensated care pool. This makes sense given the fact that not everyone will be covered even under expanded Medicaid.
Moreover, even if LIP were continued at its current rate, which is not on the table under the current federal terms, there is simply not enough money in the LIP program to pay for the cost of care for all low income uninsured residents. For example, in response to complaints regarding barriers in accessing Jackson’s charity care program, the hospital cited limited resources while noting that only approximately 29,000 residents are enrolled in the charity care program. This is only 15 percent of the county’s 190,000 low-income uninsured who would be eligible for Medicaid if the Legislature accepts federal expansion funding.
Miriam Harmatz, senior health law attorney, Florida Legal Services, Miami