Florida’s LIP Medicaid Waiver Amendment Now Open for Public Comment – National Implications

It’s hard to miss the ongoing debate about Florida’s Medicaid expansion and the related subject of how the federal government plans to respond to the state’s request for continued funding of its Low Income Pool. But it would be easy to miss that the federal government just opened that amendment up for public comment.

As an aside, it was, in my view, very unfortunate that CMS tipped their hand last week on LIP amounts by sending a letter to the state of Florida before the state public comment period had even come to a close. Public comment periods are important and should not be ignored so blatantly.

Back to the federal process though — comments are due by June 27th, 2015 at 11pm.
We here at Georgetown CCF will be submitting public comments along with our colleagues at the Center on Budget and Policy Priorities.

The underlying issues are bigger than Florida’s specific request. In April as we blogged about here, CMCS Director Wachino wrote to the state of Florida outlining the principles by which they will consider such requests for uncompensated care pools. One of those principles is that CMS will not provide federal funding to cover the uncompensated care costs for those people that would be covered in a Medicaid expansion.

Florida just happens to be the first state where this debate is unfolding and where the state has not chosen to accept federal Medicaid expansion funding.

At the time that CMS wrote Florida’s letter, they also notified eight other states (AZ, CA, HI, KS, MA, NM, TN, TX) with uncompensated care pools that these same principles will apply. Three of these states – Kansas, Tennessee and Texas – have not yet expanded Medicaid so they will be watching the outcome of Florida’s LIP saga closely.

The principles that CMS laid out are worthy of close public scrutiny. Waiver policy has always been opaque, and CMS’ letter signaled some new directions with a level of transparency that is welcome. I encourage interested readers to submit public comment on this important issue.

Joan Alker is the Executive Director of the Center for Children and Families and a Research Professor at the Georgetown McCourt School of Public Policy.

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