Report's Forecast Grim for Hospitals

Jan 14, 2015

Florida’s “safety-net” hospitals – the ones that provide the most charity care -- received another in a series of depressing projections Wednesday in a report from Florida Legal Services.  

Joan Alker
Credit Georgetown Health Policy Institute

Taken together, the three reports issued to date by the patient-advocacy organization describe a pending loss of $2 billion a year to the state’s health-care providers for the poor. Federal funding that has propped them up is scheduled to end June 30, Florida Legal Services said.

“These losses threaten both the safety-net’s viability and the health of low-income uninsured state residents that rely on those facilities,” they say. “These threats, however, could be averted if the Florida Legislature accepts funding allocated under the Patient Protection and Affordable Care Act (ACA) for covering an expanded Medicaid population."

Hospitals are the most visible losers, but some of the money also goes to community health centers and other health-care providers. Others affected include the counties that help support the hospitals, employers and insured patients who pay extra to cover unpaid bills, and ultimately uninsured patients who may find fewer services, the reports say.

“It’s an issue that affects everybody,” said Joan Alker of Georgetown University, who conducts grant-funded research on Florida’s health-care system.

The reports were produced by two attorneys in the Miami Advocacy Office of Florida Legal Services. All can be downloaded from this website.

The report released on Wednesday, which focuses on Brevard County, says that the end of charity-care funding will cost the county $15 million a year. That would be more than offset by the $114 million that Brevard would gain if the state accepted the Medicaid-expansion money it has previously turned down.

In previous reports on the issue, Florida Legal Services has forecast that the end of the charity-care funds would cost Miami-Dade County $600 million a year. Overall, the state’s health-care providers are forecast to lose more than $2 billion a year.

The larger of the two threatened programs is the state’s Low-Income Pool (LIP), which draws $1.8 billion this year in federal funds. The state funnels the money to medical facilities that treat low-income uninsured people.

The pool received a one-year extension last year from the federal Centers for Medicare and Medicaid Services, but language in the lengthy agreement hinted that Florida was unlikely to receive further reprieves. The cut-off is scheduled June 30.

The smaller program is the Disproportionate Share Hospital (DSH) program, which gives Florida $240 million this year. It was created in the 1980s to help hospitals that serve a “disproportionate share” of poor people. DSH is not ending, but being cut sharply.

The programs were targeted because the Affordable Care Act was designed to make them obsolete. The law provided coverage to almost all low-income uninsured through an expanded Medicaid program, financed mostly with federal dollars, beginning in 2014. But the U.S. Supreme Court said the states could not be forced to take the money.

In 2013, Florida’s legislature said no to the federal funds, estimated at $51 billion over 10 years. It did not consider the issue in 2014, and it is unclear what will happen in the 2015 session that begins in March.

Florida Legal Services is presenting the report to county commissions and legislative delegations, said Charlotte Joseph Cassel, co-author of the report with Miriam Harmatz, senior attorney in the Miami office of Florida Legal Services.

Cassel said the next two reports on the issue will focus on Hillsborough and Orange counties.