Florida’s budget showdown over hospital funding may not get resolved until mid-summer, thanks to a little-noticed series of deadlines that accompany the state’s official request to draw down billions in healthcare funding.
The decision by the Agency for Health Care Administration Secretary Liz Dudek on Monday to propose an amendment to the the existing Medicaid waiver and to solicit written input on the proposed amendment triggered time requirements that mean that legislators may not know the fate of the Low Income Pool until July 4.
That’s because the federal government will have until then to render an official response to Florida’s application to revamp the program as proposed by the Florida Senate.
An April 2012 rule makes clear that Centers for Medicare and Medicaid Services must make 1115 waivers or extensions of 1115 waivers available for the public to review and to submit written comments or make comments for 30 days. Moreover, the agency cannot make any decision on the waiver until 15 days after the public comment period has closed.
Before the proposed amendment can be submitted to the federal government, though, Florida, too, has to make the waiver language available for the public to review and to submit comment for 30 days. Florida’s 30-day clock started ticking Monday when Dudek announced the proposed amendment and, in a press release, solicited comments on the proposal from the general public.
After the 30-day clock expires the state can officially send the application to the federal government. The government will have 15 days to determine whether the application is complete. Only complete applications can trigger the time requirements.
Under those guidelines the earliest Florida’s proposed amendment could be officially approved is July 4, or four days after the start of the 2015-16 fiscal year.
The Low Income Pool — a $2 billion pot of money, $1 billion of which is federal — is slated to expire June 30. The federal government notified Florida in April 2014 that the supplemental Medicaid funding would expire this summer.
Florida had been negotiating with the federal government to continue LIP funding but had not officially pursued any proposed changes to the LIP program until Monday. Medicaid Deputy Secretary Justin Senior said last month he was hopeful that he could get an agreement in concept where the federal government advised the state how much LIP money it would receive and that the the terms and conditions be agreed to at a later date.
An agreement in principle still is possible but negotiations between the state and federal government have soured.
The federal government advised Florida last week that it believes insurance — not uncompensated care pools such as the Low Income Pool — are the better use of taxpayer dollars. The correspondence triggered a series of other letters and led Gov. Rick Scott to announce he would sue the federal government for trying to coerce the state into a Medicaid expansion.