Low Income Pool SFY

Transcription

1 Low Income Pool SFY Tom Wallace Chief, Medicaid Program Finance Agency for Health Care Administration Public Meeting August 16,

2 Goals of Today s Meeting Share what is known about the draft SFY LIP program design Provide a roadmap to final LIP model design Seek input on LIP model design 2

3 Overview 1. History of the LIP program 2. SFY LIP program 3. SFY LIP Legislation 4. Vision on the road map (next steps) 3

4 Low Income Pool: History Began in 2006 as part of Medicaid Reform demonstration Original purpose: provide supplemental funding to hospitals, clinics, and other entities to improve access to health care services in rural communities and ensure continued government support for the provision of health care services to the uninsured and underinsured. Current purpose: provide government support for safety net providers for the costs of uncompensated care for low income individuals who are uninsured. 4

5 Historical Low Income Pool Funding State Fiscal Year (SFY) / Demonstration Year (DY) Total LIP Funding Amount SFY (DY 1) SFY (DY 2) SFY (DY 3) SFY (DY 4) SFY (DY 5) SFY (DY 6) SFY (DY 7) SFY (DY 8) SFY (DY 9) SFY (DY 10) SFY (DY 11) $ 1 billion $ 1 billion $ 1 billion $ 1 billion $ 1 billion $ 1 billion $ 1 billion $ 1 billion $ 2.17 billion $ 1 billion $ 608 million 5

6 Low Income Pool Provisions The Agency has received approval/extension of the 1115 waiver, including provisions relating to the Low Income Pool (LIP). Approval includes: A LIP of approximately $1.5 billion; The LIP will provide support for the costs of uncompensated charity care for individuals with incomes up to 200% FPL; and It will not include uncompensated care for insured individuals, bad debt, or Medicaid or CHIP shortfall. 6

7 Additional Flexibilities Allows expenditure of LIP funds for up to three provider groups: hospitals, FQHCs/RHCs, and Medical School Physician Practices. Allows additional categorization into up to five tiers for each group which can be based on: ownership or licensure type, including public ownership; statutory teaching hospital; freestanding children s hospital; and/or by uncompensated care ratio. Up to $50 million may be apportioned to FQHCs/RHCs. 7

8 Participation Requirements Same for hospitals and Medical School Physician Practices as in SFY FQHCs/RHCs: must contract with each health plan in their region must agree that the supplemental wrap around payment will be included in the capitation rates and paid to the FQHC/RHC by the MCO must be enrolled in Medicaid 8

9 Agency for Health Care Administration Fully Funded LIP Model SFY LIP Model Summary LIP $1,508,385,773 Total FMAP SMAP $929,467,313 Federal $0 State GR $578,918,460 Local 9

10 Agency for Health Care Administration LIP Fully Funded Model Group 1 - Hospitals Tier 1 Charity care to commercial costs greater than or equal to 10% for statutory teaching hospitals and public hospitals (paid 100% of charity care cost) Tier 2 Charity care to commercial costs less than 10% for all statutory teaching hospitals, all freestanding children s hospitals and charity care to commercial costs greater than 19% for all other hospitals (paid 97% of charity care cost) Tier 3 All other hospitals not included in Tiers 1 and 2 (paid 93% of charity care cost) Group 2 Medical School Physician Practices Tier 1 Medical Schools (paid 100% of charity care cost) 10

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19 Agency for Health Care Administration Historical Funded LIP Model SFY LIP Model Summary LIP $909,954,866 Total FMAP SMAP $560,714,188 Federal $0 State GR $349,240,678 Local 19

20 Agency for Health Care Administration LIP Historical Funded Model Group 1 - Hospitals Tier 1 Charity care to commercial costs greater than or equal to 17% for statutory teaching hospitals, all public hospitals and all freestanding children's hospital s (paid 100% of charity care cost) Tier 2 Charity care to commercial costs greater than or equal to 20% for all hospitals not included in Tier 1 (paid 65% of charity care cost) Tier 3 All other hospitals not included in Tiers 1 and 2 (paid 30% of charity care cost) Group 2 Medical School Physician Practices Tier 1 Medical Schools (paid 100% of charity care cost) 20

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29 Florida Legislative Direction The 2017 General Appropriations Act (GAA) gives the Agency full spending authority for the projected LIP Allotment ($1.5 billion). The funds are placed into reserve pending submission of a budget amendment to the House of Representatives and Senate requesting release of the funds. Will include a Low Income Pool distribution model which will show the funding distribution by entity and the entities contributing intergovernmental transfers (IGTs). Will include the Reimbursement and Funding Methodology Document. Per GAA: If the chair and vice chair of the Legislative Budget Commission or the President of the Senate and the Speaker of the House of Representatives object in writing to a proposed amendment within 14 days after notification, the Governor shall void the action. 29

30 Vision of Road Map (Next Steps) Draft timeline (subject to change): August 2017: Agency will send out Letters of Agreement (LOAs) Per 2017 SB 2514 by October 1: An executed LOA must be submitted to the Agency Agency submits budget amendment shortly after October 1 Legislature has 14 days to approve/disapprove LIP model Per 2017 SB 2514 by October 31: IGT funds are due to the Agency 30

31 Public Comment: 31

32 Public Comments You may provide comments: in writing at the meeting by to or in writing through the US Mail to the address listed below. Medicaid Program Finance Agency for Health Care Administration 2727 Mahan Drive, MS #23 Tallahassee, Florida