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Senate LIP Plan Added to Federal Proposal

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
Agency for Health Care Administration
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

The state agency responsible for Medicaid submitted a new proposal Monday to the federal government for up to $2.2 billion in health-care funding, but the move might be too late to break a budget impasse.

The new model for the Low Income Pool, or LIP, program closely follows legislation approved by the state Senate earlier this month. LIP, which is largely used to cover the expenses of uninsured, low-income Floridians who show up at hospitals needing treatment, is set to expire June 30.

In a statement, Agency for Health Care Administration Secretary Liz Dudek said the federal Centers for Medicare & Medicaid Services should move quickly on the new proposal.

"We are expediting our submission of this LIP model in order to help CMS speed up their decision," Dudek said. "CMS knows that our budget depends on their rapid response to this model."

Senators hammered Dudek at a confirmation last week over the fact that it took until February or March to submit even outlines of LIP concepts to CMS during negotiations about extending the program. State officials have known for about a year that LIP was set to run out without a new deal with the federal government.

The proposal sent to CMS on Monday seems unlikely to quickly resolve the budget standoff. The state's public comment period will be open until May 22, three weeks after the annual legislative session is set to conclude. Lawmakers have already conceded that they will almost certainly miss that May 1 deadline for passing a budget and ending the regular session, prompting either legislative overtime or a special session.

On top of the 30-day public hearing requirement at the state level, federal officials also have to follow a certain time frame, according an official with the Obama administration.

"CMS cannot act on the demonstration request until 45 days, at a minimum, after receipt of the complete application," the official said.

The model submitted Monday also doesn't address a related Senate plan that would use $2.8 billion in Medicaid expansion funds from the federal Affordable Care Act, commonly known as Obamacare, to help lower-income Floridians purchase private health insurance. Gov. Rick Scott and state House leaders oppose that plan.

In a letter to the state dated April 14, a high-ranking CMS official wrote that "the state's expansion status is an important consideration in our approach regarding extending the LIP beyond June."

Scott announced last week that he plans to sue the federal government for tying an extension of LIP to Medicaid expansion. Texas Gov. Greg Abbott, whose state could find itself in a similar situation, issued a statement Monday backing the suit.

"Texas will support Florida in its litigation against the federal government," Abbott said. "Medicaid expansion is wrong for Texas. Florida's approach should be determined by Floridians, not coerced by federal bureaucrats."

But supporters of the Senate plan on expansion say that it makes sense to link the two, because many of the patients who cause hospitals to tap LIP funding would be insured under the Medicaid proposal, lowering the need for LIP.

Some have also suggested that, because of that, any LIP model approved by the federal government will likely give the state less than $2.2 billion, and perhaps significantly less.

The Senate is set to gather Tuesday in a rare forum, with all of its members invited to join a Senate Appropriations Committee meeting for a discussion of the way forward on health care.

Meanwhile, the Florida Democratic Party announced Monday that it would begin a campaign to demand that House members take a vote on Medicaid expansion.

"Lives are on the line, and House Republicans say they are at 'war' against the commonsense, bipartisan solution backed by businesses, health care workers and advocates, and the health care industry as a whole," the party said. "That is a dereliction of their duty."