Low Income Pool (LIP)

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 [1.25MB 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 [1.25MB 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.

In accordance with HB 3 B and codified in s. 409.911(9), 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 [20KB PDF] shall consist of 17 members, including 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, and 1 representative of family practice teaching hospitals. The council shall:

(a)  Make recommendations on the financing of the low-income pool and the disproportionate share hospital program and the distribution of their funds.

(b)  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.

(c)  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.

(d)  Submit its findings and recommendations to the Governor and the Legislature no later than February 1 of each year.”

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

Ami Flanigan flanigaa@ahca.myflorida.com (850) 414-1554

Lecia Behenna behennal@ahca.myflorida.com (850) 488-9354

LIP Council Recommendations to Governor and Legislature for SFY 2008-09

Letter to Holly Benson, Secretary regarding the Low Income Pool Council Full Report for State Fiscal Year 2008-09

Letter to Dr. Andrew C. Agwunobi, Secretary regarding Low Income Pool Council recommendations for State Fiscal Year (SFY) 2008-09 [84KB PDF]

MODEL 21B as Approved by LIP Council, LIP Projections - STATE FISCAL YEAR 2008-2009 [149KB PDF]

Averaged (2002, 2003, & 2004) Audited DSH Data & 2006 FHURS Data used for the SFY 2008-2009 LIP Council program recommendations

Online Reporting Tool

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. Click on the Online Reporting Tool link above to access the Reporting Forms.

Upcoming Meetings

Click here to see the scheduled of upcoming meetings.

Edwin Stephens stephene@ahca.myflorida.com (850) 414-2759

Previous Low Income Pool Council Meetings

Related Documents

LIP, DSH, and Exemptions Funding and Distribution Projections [238KB PDF]

Letter to Dr. Andrew C. Agwunobi, Secretary regarding Low Income Pool Council completing recommendations for State Fiscal Year (SFY) 2007-08 [1.32KB PDF]

Low Income Pool Council Recommendationsfor SFY 2007-08 [231KB PDF]

Cost Limit Worksheet for County Health Departments [17KB Microsoft Excel]

Cost Limit Worksheet for Federally Qualified Health Centers [20KB Microsoft Excel]

Cost Limit Worksheet for Hospitals [266KB Microsoft Excel]

Funding Request Criteria for State Fiscal 2007-2008 [15KB PDF]

Milestone Reporting Requirements [22KB Microsoft Excel]

LIP Milestone Reporting Document Terms and Definitions [20KB PDF]

Permissible Expenditures Certification Form [32KB PDF]

Final Reimbursement and Funding Methodology, March 20, 2008 [1.25MB PDF]

Special Terms and Conditions (STC) [58KB PDF]

Evaluation of the Low-Income Pool Program Using Milestone Data: SFY 2005-06 and SFY 2006-07 [1.27KB PDF] 5/6/08