[fcb-l] Fax numbers: new low income funding

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From: facseemembers-admin at lists.facsse.org

Sent: Friday, March 18, 2011 10:55 AM
To: 'facseemembers at lists.facsse.org'
Subject: [facseemembers]Low Income Pool Funding



House moves a Medicaid rewrite that turns upside down hospital funding

Christine Jordan Sexton, 03/17/2011 - 08:15 PM

The Florida Current

A House panel on Thursday approved a sweeping overhaul of Florida's $20 
billion Medicaid program, but not before releasing a modified version of the 
proposal that packs a punch to Florida's children's, rural and statutory 
teaching hospitals.

The House plan would shift all of the state's Medicaid patients -- including 
those in nursing homes and those who are developmentally disabled -- into 
managed care programs over the next five years. The measure was approved 
along partisan lines.

House Health and Human Services Committee Chairman Rep. Robert Schenck, 
R-Spring Hill, tried to downplay the changes in a draft of proposed 
committee bill 11-01a, saying the changes stemmed from comments made at a 
committee meeting earlier in the week.

But the bill changes a complicated Medicaid financing formula for hospitals 
and turns upside down Medicaid financing for Florida hospitals, which weren't 
discussed at the Monday meeting.

It was a concern for both Republicans and Democrats on the committee who 
requested staff provide the fiscal impact of the change. The Safety Net 
Hospital Association of Florida President Tony Carvalho testified that it is 
a $125 million impact on rural, children's and teaching hospitals.

Other changes included in the bill include moving Indian River County to a 
different health region and adding a requirement that plans that want to bid 
on Medicaid patients disclose any "business relationship" they have with 
other plans. Business relationship is broadly defined to ensure the winning 
bids across the state aren't part of the same managed care company.

The latest version of the proposed committee bill also upped from nine to 
ten the number of managed care plans AHCA can contract with in Miami Dade 
County. To ensure managed care participation in the Panhandle the agency 
must award contracts in Miami Dade to each managed care plan that operates 
in the Panhandle.

The most significant switch between the proposed committee bill 11-01 
discussed on Monday and the draft before members on Thursday, 11-01a,  was 
the change in the sections for hospital rates and how they will receive 
dollars under a $1 billion funding pool now available under Medicaid. The 
money for that pool comes from a combination of local tax dollars and 
federal matching Medicaid money and is intended to reimburse hospitals that 
treat the poor and indigent.

The House's initial Medicaid overhaul had a complicated tiered system: 
Children's, statutory teaching and rural hospitals were so called "Tier 1" 
facilities and would have been eligible for 50 percent of the total Low 
Income Pool  (LIP) available allocation. "Tier 3 facilities" are all 
community hospitals and have been eligible for 15 percent of the total 
allocation. Other hospitals were in a middle section that allocated the 
remaining 35 percent.

But the bill that was approved by the House on Thursday flipped the 
percentages so that the so-called "Tier 1" hospitals got 15 percent and the 
community hospitals would get 50 percent of the funding.

Schenck tried to downplay the significance of the change noting that it was 
just a switch in percentages.   "Since every hospital in the state is 
included in tier 3 we put 50 percent of the money [there]. So it's just a 
bigger piece of the pie everyone is eligible for and that's it."

But Reps. Mia Jones, D-Jacksonville, and Ronald "Doc" Renuart, R-Ponte Vedra 
Beach, pressed Schenck on the change. "Would that mean for the rural 
teaching and children's hospitals there would be a smaller piece of the 
 pie?" Jones asked.

Schenck said no because the facilities are included in both tiers 1 and 3 
and could double dip.

Renuart also expressed doubt, though. "But there's still just one pool of 
money and if there's more in hospitals that are seeing less Medicaid 
patients I think that's going  to affect those that are seeing more of the 
indigent and Medicaid population," he said.

Carvalho -- whose association represents the safety net hospitals that treat 
large indigent populations, which includes the children and statutory 
teaching hospitals, said the changes are significant.

When pressed by Renuart as to whether it would impact graduate medical 
education Carvalho said "there are some teaching hospitals that are 
financially, marginally viable. If they lose this type of money the only 
options they have that don't affect life saving services would be resident 
programs, graduate medical education programs."

The committee voted the bills out of committee along partisan lines. Schenck 
said he expected the measure to be heard by one more committee before it is 
scheduled for a floor vote.



www.fl-counties.com . All About Florida

Kirk Harmon
President & CEO
Florida Disabled Citizens
for Progress
P.O.Box 61794
Jacksonville, FL 32236
PH(904) 783-9896
Cell: (407) 473-2176
DAV/BVA
Life Member

" TURNING HOPE INTO REALITY"
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