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Top Medicaid official warns feds not to ‘coerce’ state into expansion

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One day after receiving a letter from the federal government advising that uncompensated care pools were not a wise use of federal tax payer dollars, Florida’s leading Medicaid official fired off a letter  to the Department of Health and Human Services on Wednesday accusing the federal government of coercing Florida into expanding the Medicaid program.

“(T)he U.S. Supreme Court explicitly warned the federal government against attempting to coerce states into participating in Medicaid expansion — yet that appears to be exactly what the federal government is attempting here,” Deputy Medicaid Director Justin Senior wrote in his letter to Vikki Wachino, acting director of the Department of Health and Human Services.

Senior’s letter also touches on what appears to be a growing controversy: whether Florida ever submitted an amendment to the existing Medicaid 1115 waiver that allows the Low Income Pool to operate. The 1115 waiver allows the state to operate the mandatory statewide Medicaid managed-care program that was started as a pilot project in five counties by Gov. Jeb Bush but expanded statewide by Gov. Rick Scott.

The LIP program was created as part of that waiver, granted to the state back in 2005 and has been subsequently extended. When the federal government approved a three-year extension in 2014 the federal government made clear that it would not extend the Low Income Pool program beyond June 30, 2015.

There has been growing frustration in the Senate that despite having one year’s notice that the program would expire the state Agency for Health Care Administration had not done enough to prepare for the elimination of the program.

In his letter, Senior says that the agency has proposed “multiple” LIP models to the federal government but that the  agency will “promptly file a formal amendment to our 1115 waiver that will renew the LIP for two years.”

Medicaid expansion and the continuation of the Low Income Pool have brought the 2015 legislative session to a near standstill. The Senate has made health care a top priority  and passed an $80.4 billion budget that includes $2 billion in LIP funding as well as  $2.8 billion in federal dollars for Medicaid expansion as outlined in the Senate FHIX proposal, SB 7044.

The House has been steadfast in its opposition to Medicaid expansion. The House also has not included any Low Income Pool funding in its budget.

Senior’s letter is the third piece in two days regarding the future of Florida’s Low Income Pool, a supplemental pot of Medicaid funding that has been used to fund uncompensated care as well as provide dollars for graduate medical education, federally qualified health centers and even HMO payments.

The first letter was sent from Wachino to Senior advising the state that Medicaid expansion is a better use of taxpayers’ dollars than uncompesnated care pool such as LIP. The second letter was sent by six Republicans in Florida’s Congressional delegation to the acting director of the Centers for Medicare and Medicaid Services asking that they provide the state an agreement in principle advising the state how much it could expect in Medicaid supplemental funding by mid April so the Legislature can create a spending plan for the 2015-16 fiscal year.


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