Florida could be close to getting an extension of a controversial Medicaid pilot program, as federal officials have agreed to continue funneling extra money to hospitals and other health providers through June 2014.
Negotiations about extending the pilot have crept along for months, amid questions about whether the federal government would end the $1-billion-a-year Low Income Pool program — which is part of the pilot — in December 2013.
If the so-called “LIP” program ended then, hospitals and other providers would lose as much as $500 million that they expected to receive during the 2013-14 fiscal year to treat low-income and uninsured patients.
But Phil Williams, the Agency for Health Care Administration’s assistant deputy secretary for Medicaid finance, said Tuesday that federal officials sent a draft document last week indicating they will go along with full LIP funding through June 2014.
Some hospital industry officials, however, raised questions Tuesday about new conditions that the federal Centers for Medicare & Medicaid Services would place on LIP.
The conditions, in part, would require the state to spend $50 million each year to establish or “significantly enhance” programs aimed at improving quality of care and the health of low-income people, according to the draft document.
Also, 20 hospitals that receive the most LIP funding would be required to start or enhance initiatives to improve quality of care and patient health — and would risk losing part of their money if they don’t meet certain standards.
“The LIP ensures continued government support for the safety net providers that furnish uncompensated care to the Medicaid, underinsured and uninsured populations,” the draft document says. “The LIP is also designed to establish new, or significantly enhance existing, innovative programs that meaningfully enhance the quality of care and the health of low income populations.”
During a meeting of an advisory panel known as the LIP Council, hospital industry officials questioned whether the $50 million would be in addition to money that LIP already provides for improving primary care. If so, that could divert money that would go to covering other patient expenses.
Also, the officials said hospitals have already started initiatives in recent years to improve care and questioned whether those efforts would be allowed to count toward the new federal requirements.
“We’re doing way above and beyond as an industry what CMS wants,” said Deanna Schaeffer, an official with Halifax Community Health System in Daytona Beach. “This stuff is so nebulous.”
State Agency for Health Care Administration officials have said for weeks that Low Income Pool funding was the last sticking point in negotiations with the federal government about extending the pilot program through June 2014.
The pilot, which started in 2006, has been controversial because it requires most Medicaid beneficiaries in Broward, Duval, Clay, Baker and Nassau counties to enroll in HMOs and other types of managed-care plans. It was scheduled to expire June 30.
Federal officials have granted a series of temporary extensions as they try to reach agreement with the state on continuing the pilot for three additional years. The latest temporary extension is scheduled to end Nov. 15.
Williams said Tuesday he was not sure when negotiations with federal officials will be finished. He said AHCA will try to get clarification about the federal government’s position on the concerns raised by the hospital-industry officials.
By Jim Saunders
