Florida Medicaid Reform Pilot extension faces hurdles

The Agency for Health Care Administration today told a Florida Senate health committee that the federal government has concerns over an absent medical loss ratio in Florida’s Medicaid Reform Pilot, as well as the future of Low Income Pool dollars in the state. Right now, the federal government is considering extending the state’s Medicaid Reform Pilot, which operates in a handful of counties.

According to a briefing by Agency for Health Care Administration Deputy Secretary for Medicaid, Justin Senior, the federal government is looking to “phase out” Low Income Pool (aka LIP) money for the state. This “sunset provision” is part of a nationwide effort to get rid of LIP money in time for implementation of the Affordable Care Act.

LIP money is used to reimburse hospitals that provide services to low-income and uninsured people.

State Sen. Eleanor Sobel, D-Hollywood, said that it is “important that LIP continue” in the program.

Senior also told committee members that the Centers for Medicare and Medicaid Services is asking for a medical loss ratio, absent in the state’s current Medicaid Reform Pilot. This “85/15″ requirement mandates that providers spend 85 percent on services and 15 percent on administration.

Sobel expressed her concern that Florida is facing trouble in receiving an extension for the program because the Legislature failed to initially include the medical loss ratio. The agency expects to hear from the federal government about the extension at the end of September.

The agency also reported that the state is currently in a 90-day waiting period for the statewide implementation of its new Medicaid managed care program. The agency expects to hear the federal government’s decision on the proposal or a request for further information by the end of October.