Miami-Dade County

Facing cuts to uninsured healthcare pool, lawmakers aren’t ready to talk solutions

Jackson Memorial Hospital is Miami-Dade County’s safety net hospital and will definitely be affected by the outcome of negotiations over the Low Income Pool of funding for uninsured patients.
Jackson Memorial Hospital is Miami-Dade County’s safety net hospital and will definitely be affected by the outcome of negotiations over the Low Income Pool of funding for uninsured patients. hgabino@elnuevoherald.com

The pot of money set aside to fund healthcare for the poorest Floridians is expected to shrink dramatically next year.

Yet, lawmakers taking up the issue Wednesday in advance of their annual session are showing no urgency to try to fill the gap.

Sen. Rene Garcia, R-Hialeah, the healthcare budget chairman, said Wednesday that he is aware the state has only been authorized for $608 million in its so-called Low Income Pool (LIP) funds from the federal government to reimburse hospitals for unpaid care. But he’s not ready to suggest a backup plan to help hospitals, some of which rely heavily on LIP funds.

“I think it’s premature,” he said.

State agency staff who have been negotiating with the federal government on the LIP say the fund is all but guaranteed to shrink next year. The Centers for Medicare and Medicaid Services told the state this summer that the program could not exceed $608 million.

That $608 million pool — which includes both federal and local tax dollars — would be $400 million smaller than the current year, and more than $1 billion smaller than the pool from 2014.

The number is based on federal estimates of how much the hospitals would need to cover uncompensated procedures for those who would not be insured if the state expanded Medicaid.

“If we’re not going to go down that track, we’ll have to face a declining low income pool,” Garcia said. Florida has not expanded Medicaid, despite a major attempt by the Senate this summer. So the population of those who do not have healthcare coverage would be even larger than what the federal government intends to cover by LIP.

Regardless, the $608 million estimate might be too low even to cover what the federal government anticipates, said Tony Carvalho, executive director of the Safety Net Hospital Alliance of Florida.

“We think, we hope, we are optimistic that they’ll reassess that number,” he said.

Though the amount is still being finalized in negotiations between the Agency for Health Care Administration and the federal government, the state’s Medicaid director, Justin Senior, said Wednesday that he doubts it will change.

In that case, safety net hospitals across the state would have to eat the costs of caring for those who don’t have insurance or cannot afford it. That could mean big cuts or higher rates for those who do have insurance.

“You can’t tell your nurses you’re not going to pay them for uninsured patients,” Carvalho said. “So you either have to cut programs or you have to pass along the costs to insured patients.”

This is not the first time the safety net hospitals have faced possible deep cuts to the LIP. Just months ago, LIP was going to be eliminated completely by the federal government. Instead it’s being gradually phased out.

Contact Michael Auslen at mauslen@tampabay.com. Follow @MichaelAuslen.

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