Still no agreement in sight, feds tell Florida to submit another Medicaid waiver extension

October 25th, 2011



The following article was published in The Florida Current on October 25, 2011:



Still no agreement in sight, feds tell Florida to submit another Medicaid waiver extension


By Christine Jordan Sexton


Acting Medicaid Director Justin Senior left a Medicaid medical advisory committee meeting Tuesday to read an email he received from the federal government.

The news? Six days before the latest extension was to expire Senior said federal officials told him to apply for another temporary extension of its Medicaid 1115 waiver. They indicated that no agreement will be reached before Halloween, the expiration date of Florida's latest temporary extension.

The Medicaid 1115 waiver makes possible a mandatory managed care program in five Florida counties to continue and makes available $1 billion  to help pay the health care costs for the poor and uninsured in what is called the Low Income Pool (LIP).

LIP remains the stumbling block, Senior said. The federal government has advised the state that it wants to eliminate all Medicaid supplemental funding programs in the country, including LIP, on Dec. 31, 2013, the eve of the nationwide expansion of the Medicaid program to include those making 133 percent of the federal poverty level.

Florida wants the LIP program to remain intact until June 2014. AHCA claims that to eliminate the $1 billion pool in December, Florida would lose $500 million.

Florida has been negotiating the three-year extension of the Medicaid 1115 waiver for more than a year. LIP funding unexpectedly became an issue, AHCA claims, during the summer.

This will be the eighth temporary extension the agency will request from the federal government to extend the life of the waiver.  Senior joked that he's "going to get the full three years 15 days at a time." But when asked what progress had been made in LIP negotiations over the recent months  Senior said, serously: "From our standpoint, viewing it from the outside in, nothing has changed. It's still their discussion and they are doing it on their timetable."

The waiver is important because to launch its new statewide mandatory Medicaid managed-care program the state needs the waiver. Because the existing five-county pilot program and the new statewide program are not identical the 1115 waiver will need to be amended. Florida already has sent the amendments to the federal government to consider even though the underlying waiver still is pending.

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