Miami-Dade County

Florida healthcare agency hits the road for feedback on its proposed extension of hospital funding program

Justin Senior, deputy secretary for Medicaid at the Agency for Health Care Administration, at a public comment meeting in Doral to discuss AHCA’s request to the federal government to expand a $2.1 billion hospital funding program known as the Low Income Pool.
Justin Senior, deputy secretary for Medicaid at the Agency for Health Care Administration, at a public comment meeting in Doral to discuss AHCA’s request to the federal government to expand a $2.1 billion hospital funding program known as the Low Income Pool. MIAMI HERALD STAFF

With the Florida Legislature at a healthcare impasse, the state Agency for Health Care Administration took to the road Thursday to hear public comments on its request to continue a $2.1 billon federal program that may help solve some of Florida’s healthcare money issues — for now.

At a meeting in Doral — the second of three around the state this week — Justin Senior, AHCA’s deputy secretary for Medicaid, listened to local healthcare executives comment on the agency’s proposal to extend the federal program, which helps fund facilities that serve low-income patients, past its June 30 expiration date.

The pot of money, called the Low Income Pool or LIP, was extended for one more year last summer and provided just over $2.1 billion in funds to safety-net institutions such as Jackson Health System in Miami-Dade and Broward Health in North Broward to treat their neediest patients.

But the program is set to expire this summer and federal government officials have repeatedly insisted that it will not be extended again. The Florida House and Gov. Rick Scott remain opposed to expanding Medicaid to include about 850,000 low-income and uninsured Floridians. The Senate has proposed its own plan to offer Medicaid to the state’s uninsured but the House refused to consider it and the legislative session ground to a halt this week with no budget. A special session is likely in June.

At Thursday’s meeting, Senior reiterated that the federal government had said the safety-net funding program would not continue as it was last year. But he said a revised version of the program might be considered.

“Our hope is that even though the federal government says that it can’t continue in its current form, that it can continue in some form or fashion,” Senior said.

The agency’s proposal includes extending the program until June 30, 2017, and redesigning portions of it, including sending money more broadly to hospitals that care for low-income patients. But the pricetag would remain the same: $2.1 billion.

The redesign would aim to distribute funds more equally and allow more hospitals to benefit, as well as reduce the link between local government contributions and the money distributed to each hospital.

Under the current agreement, hospitals receive funds based on the amount their local government contributes to the state for the safety-net funding program. In the agency’s proposal, distribution of money would be based on the size and scope of the hospital’s initiatives to treat low-income patients.

About 30 Miami-area healthcare executives and agency heads attended Thursday’s meeting, many showing support for the agency’s proposal.

Carlos Migoya, president and CEO of Jackson Health System, said Jackson would stand to lose $200 million if the current LIP program is eliminated. Jackson is Florida’s largest provider of Medicaid care, with more than 40 percent of patients on Medicaid.

But Medicaid only reimburses less than half of the cost to care for these patients, meaning Jackson would be left without money it now uses to pay for uncompensated care if the program is eliminated.

“Jackson will be forced to eliminate and reduce services if LIP is not renewed and not replaced,” Migoya said.

Scott Davis, director of revenue cycle management at Memorial Healthcare System in South Broward, said the loss of its $100 million in funding would add complications to an already disproportionate amount of uncompensated care.

“The loss of that money won’t make the patients any healthier,” Davis said. “They still come through the ER, they come to our hospital, we have still have to take care of them and cover that cost somehow.”

Senior emphasized that AHCA’s proposed changes would not be a substitute for Medicaid expansion, but rather focus on the facilities’ uncompensated care costs.

“Even if Florida did the expansion, there would still be a need and a place for the Low Income Pool,” Senior said. “Any independent study from the left or the right would verify that in fact there will be a significant amount of uncompensated care particularly in a big international state like Florida.”

Davis said Memorial’s own studies show the need for the extension of the program.

“[Medicaid] expansion is not an adequate solution to the problem,” Davis said. “Uncompensated care still exists well beyond that. The amount of uncompensated care that we incur even after the Low Income Pool dollars is still significant.”

AHCA submitted its extension request last week and will have to wait 30 days from that date before it can submit its amendment to the safety-net funding program. Senior hopes the federal government will be willing to reach an agreement before that time — and before the Florida Legislature must finalize its budget on July 1.

“We are hopeful that they will be willing to have discussions with us while the amendment is pending and that we can still reach an agreement in principal,” Senior said. “As long as we’ve got that type of agreement with them then I think our budget folks in the House and the Senate could really go to work and use that in order to form the basis of the state’s budget for next year.”

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This story was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation