Low Income Pool (LIP)

On December 15, 2011, the Centers for Medicare and Medicaid Services (CMS) approved the 3-year waiver extension request the Agency submitted on June 30, 2010. The waiver extension period for Florida’s Section 1115 Research and Demonstration Waiver is December 16, 2011 through June 30, 2014. For more information, please visit the Medicaid Reform Pilot program website.

All meeting are located at the Agency for Health Care Administration, 2727 Mahan Dr., Tallahassee, FL 32308

Nicole.Maldonado@ahca.myflorida.com or 850-412-4287.

Meetings Archive

STC 62 Top 15 Milestone Requirement

Please submit ALL of the following reports to Lip_Providers_Rpts@ahca.myflorida.com:

Reporting for all Providers

Due Date	Report	Provider Access Systems	Corresponding State Fiscal Year
October 31, 2012	SFY 2011-12 Milestones	All Providers	SFY 2011-12
March 31, 2013	SFY 2010-11 Cost Limit	All Providers	SFY 2010-11

Milestones must be filed online, using the link provided here:

http://apps.ahca.myflorida.com/lips

Failure to file reports timely will result in LIP and DSH payments being withheld until Provider is in compliance.

Primary Care Recipients’ Reporting

Due Date	Report	Provider Access Systems	Corresponding State Fiscal Year
October 31, 2012	Primary Care ($34 Million)	Only recipients of the $34 million Primary Care award	SFY 2010-11 and SFY 2011-12

STC 62 Top 15 LIP Hospital Reporting

Due Date	Report	Provider Access Systems	Corresponding State Fiscal Year
October 15, 2012	First Quarter STC 62 Top 15 Reporting	Top 15 LIP Hospitals	First Quarter SFY 2012-13 (July 1, 2012 through September 30, 2012)
January 15, 2013	Second Quarter STC 62 Top 15 Reporting	Top 15 LIP Hospitals	Second Quarter SFY 2012-13 (October 1, 2012 through December 31, 2012)
April 15, 2013	Third Quarter STC 62 Top 15 Reporting	Top 15 LIP Hospitals	Third Quarter SFY 2012-13 (January 1, 2013 through March 31, 2013)
July 15, 2013	Fourth Quarter STC 62 Top 15 Reporting	Top 15 LIP Hospitals	Fourth Quarter SFY 2012-13 (April 1, 2013 through June 30, 2013)

STC 61 Quality Add-On Reporting

Due Date	Report	Provider Access Systems	Corresponding State Fiscal Year
September 20, 2013	STC 61 Quality Add-On ($15 million)	Only recipients of the $15 million award	SFY 2012-13

If you need assistance or have questions, please contact us at:

• Bill Perry – bill.perry@ahca.myflorida.com or (850) 412-4131
• Ryan Perry – ryan.perry@ahca.myflorida.com or (850) 412-4132
• Lecia Behenna – lecia.behenna@ahca.myflorida.com or (850) 412-4130
  
• Nicole Maldonado – nicole.maldonado@ahca.myflorida.com or (850) 412-4287

Instructions

Forms

Reference Documents

The LIP Online Reporting Tool will allow Provider Access Systems (PAS) to submit the required LIP Milestone Reporting document and LIP Cost Limit reports through the website. The LIP Online Reporting Tool will enable the PAS to submit and view previously submitted reports online, for their PAS. This system is now available. Only one User ID will be assigned per PAS. The provider passwords will be sent to the email address provided on the LIP Provider User Account Agreement.

Information regarding the SFY 2008-09 Cost Limits will be forthcoming.

What is the Low Income Pool?

On October 19, 2005, the Centers for Medicare and Medicaid Services (CMS), approved the 1115 Research and Demonstration Waiver Application for the State of Florida , relating to Medicaid reform. The Florida Legislature passed House Bill (HB) 3B [119KB PDF] on December 8, 2005 authorizing implementation of the waiver effective July 1, 2006. In the Waiver Special Terms and Conditions (STC) [58KB PDF], # 91, the Low Income Pool (LIP) is "established to ensure continued government support for the provision of health care services to Medicaid, underinsured and uninsured populations. The low-income pool consists of a capped annual allotment of $1 billion total computable for each year of the 5 year demonstration period." The parameters of LIP are defined in STCs 91 through 106.

Who receives the Low Income Pool funds?

STC # 94 states that "LIP funds may be used for health care expenditures (medical care costs or premiums) that would be within the definition of medical assistance in Section 1905(a) of the Act. These health care expenditures may be incurred by the State, by hospitals, clinics, or by other provider types for uncompensated medical care costs of medical services for the uninsured, Medicaid shortfall (after all other Title XIX payments are made) may include premium payments for provider access systems (PAS) and insurance products for such services provided to otherwise uninsured individuals, as agreed upon by the State and CMS."

In accordance with STCs # 93 and # 100, the State submitted to CMS on June 26, 2006, the Reimbursement and Funding Methodology [429KB PDF] for LIP expenditures, which includes the definition of expenditures eligible for Federal Matching funds under the LIP and entities eligible to receive reimbursement. Attachment A [35KB PDF] provides the detail of the anticipated distributions by provider, as submitted to CMS, with the Reimbursement and Funding Methodology document as of May 26, 2006.

In accordance to STC #101 a Updated Final Reimbursement and Funding Methodology [238KB PDF] document, including a reporting methodology for the number of individuals and types of services provided through the LIP, was submitted to CMS on November 22, 2006.   In response to CMS' comments on April 27, 2007, the revised document (provided in the link above) was submitted on May 29, 2007.

Who funds the Low Income Pool?

Local governments, such as counties, hospital taxing districts and other state agencies (e.g. Florida Department of Health) provide funding for the non federal share of the $1 billion LIP distributions. Effective October 1, 2006, through September 30, 2007, the Federal Matching Assistance Percentage is 58.76%; and the state non-federal, share is 41.24%.

In accordance with STC # 100(d), the Source of Funds [11KB PDF] for LIP was submitted to CMS. On June 30, 2006, the Florida Agency for Health Care Administration (the Agency) received CMS's approval [20KB PDF] of the Source of Funds.

If you have question regarding LIP, please email or call:

Low Income Pool Council

In accordance with HB 3 B and codified in s. 409.911(10), Florida Statutes [26KB PDF], “The Agency for Health Care Administration shall create a Medicaid Low-Income Pool Council by July 1, 2006. The Low-Income Pool Council [138KB PDF] shall consist of 24 members, including 2 members appointed by the President of the Senate, 2 members appointed by the Speaker of the House of Representatives, 3 representatives of statutory teaching hospitals, 3 representatives of public hospitals, 3 representatives of nonprofit hospitals, 3 representatives of for-profit hospitals, 2 representatives of rural hospitals, 2 representatives of units of local government which contribute funding, 1 representative of family practice teaching hospitals, 1 representative of federally qualified health centers, 1 representative from the Department of Health, and 1 nonvoting representative of the Agency for Health Care Administration who shall serve as chair of the council. Except for a full-time employee of a public entity, an individual who qualifies as a lobbyist under s. 11.045 or s. 112.3215 may not serve as a member of the council. Of the members appointed by the Senate President, only one shall be a physician. Of the members appointed by the Speaker of the House of Representatives, only one shall be a physician. The physician member appointed by the Senate President and the physician member appointed by the Speaker of the House of Representatives must be physicians who routinely take calls in a trauma center, as defined in s. 395.4001, or a hospital emergency department. The council shall:

1. Make recommendations on the financing of the low-income pool and the disproportionate share hospital program and the distribution of their funds.
2. Advise the Agency for Health Care Administration on the development of the low-income pool plan required by the federal Centers for Medicare and Medicaid Services pursuant to the Medicaid reform waiver.
3. Advise the Agency for Health Care Administration on the distribution of hospital funds used to adjust inpatient hospital rates, rebase rates, or otherwise exempt hospitals from reimbursement limits as financed by intergovernmental transfers.
4. Submit its findings and recommendations to the Governor and the Legislature no later than February 1 of each year.