Low Income Pool (LIP)
Florida Medicaid Reform (2011-2014)
Approved 3-Year Extension of the 1115 Research and Demonstration Waiver
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.
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:
Lecia.Behenna@ahca.myflorida.com
850-412-4130
Bill.Perry@ahca.myflorida.com
850-412-4131
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 [433KB PDF] 11/28/2011 
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:
- Make recommendations on the financing of the low-income pool and the disproportionate share hospital program and the distribution of their funds.
- 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.
- 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.
- Submit its findings and recommendations to the Governor and the Legislature no later than February 1 of each year.”
Upcoming Low Income Pool Council Meetings
Next Meeting - No meetings scheduled at this time.
Nicole.Maldonado@ahca.myflorida.com or 850-412-4287.
Medicaid Supplemental Hospital Funding Programs Fiscal Year 2011-2012 Conference Committee Report on SB 2000
Medicaid Supplemental Hospital Funding Programs Fiscal Year 2011-2012 Conference Committee Report on SB 2000 [4.09MB PDF]
Low Income Pool Reporting Deadlines
Please submit ALL of the following reports to Lip_Providers_Rpts@ahca.myflorida.com:
Due Date |
Report |
Provider Access Systems |
May 2, 2011 |
Alternative Delivery Systems report per STC 105.2a |
Hospitals |
May 20, 2011 |
SFY 2010-11 1st quarter Quarterly Reporting Tool |
FQHCs, Hospitals |
May 20, 2011 |
SFY 2010-11 2nd quarter Quarterly Reporting Tool |
FQHCs, Hospitals |
May 30, 2011 |
SFY 2009-10 Cost Limits |
CHDs |
June 30, 2011 |
SFY 2010-11 3rd quarter Quarterly Reporting Tool |
FQHCs, Hospitals |
September 30, 2011 |
SFY 2010-11 4th quarter Quarterly Reporting Tool |
FQHCs, Hospitals |
September 30, 2011 |
SFY 2009-10 Cost Limit |
Hospitals with Medicaid Fiscal Year End 6/1-12/31 |
March 31, 2012 |
SFY 2009-10 Cost Limit |
Hospitals with Medicaid Fiscal Year End 1/1-5/31 |
September 30, 2011 |
SFY 2009-10 Cost Limit |
FQHCs with Medicaid |
March 31, 2012 |
SFY 2009-10 Cost Limit |
FQHCs with Medicaid |
In addition, the SFY 2010-11 milestones data deadline is approaching.
October 31, 2011 |
SFY 2010-11 Milestones |
All Providers |
Milestones should be filed online, the same as prior years, the link is listed below:
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
Instructions for Cost Limits and Quarterly Tool [608KB PDF]
Forms
STC 105.2a Alternative Delivery system form [27KB Microsoft Excel]
Hospital Cost Limit [117KB Microsoft Excel]
FQHC Cost Limit [69KB Microsoft Excel]
CHD Cost Limit [29KB Microsoft Excel]
FQHC Quarterly Reporting Tool [38KB Microsoft Excel]
Hospital Quarterly Reporting Tool [84KB Microsoft Excel]
Reference Documents
Reimbursement and Funding Methodology Document – June 26, 2009 [239KB PDF]
Reimbursement and Funding Methodology Document – March 20, 2008 [272KB PDF]
Modified Special Term and Condition 105
The program and expenditure information used for the report required under STC #105.2a was provided by the hospitals. This information has not been audited by the Agency and the reporting is anticipated to be refined in the future. The Hospitals were asked by the Agency to identify programs and fiscal allocations within the hospital’s operating budget that relate to non-inpatient settings such as primary care clinics. The Agency reserves the right to request additional information and or supporting documents related to the submission by the hospitals.
Amended Special Term and Condition 105.1a updated and resubmitted to CMS on 6/14/2010 [479KB PDF]
Amended Special Term and Condition 105.1a submitted to CMS 4/30/2010 [608KB PDF]
Letter to Mr. Mark Pahl, Project Office,
Centers for Medicare and Medicaid Services, June 29, 2010 [159KB PDF]
Re:
Florida's Medicaid Reform Section 1115 Demonstration: Special Term and Condition (STC)
#105.1(b)
Amended Special Term and Condition 105.2a [375KB PDF]
State Fiscal Year 2009-10 Low Income Pool funding of Funding Alternative Delivery Systems, Submitted May 31, 2010
- Attachment 1 - Sample Section 1115 2a Letter [111KB PDF]
- Attachment 1 - Continued - Report Template [130KB PDF]
- Attachment 2 - List of Programs [428KB PDF]
- Florida Reform Section 1115 STC 105 Letter [86KB PDF]
Letter to Mr. Mark Pahl, Project Office,
Centers for Medicare and Medicaid Services, June 29, 2010 [156KB PDF]
Re: Florida's Medicaid Reform Section 1115 Demonstration: Special Term and Condition (STC)
#105.2(b)
LIP Council Recommendations to Governor and Legislature for SFY 2012-13 2/1/2012
LIP Council Recommendation SFY 2012-2013 [1.85MB PDF]
Letter to State Officals re LIP Council Recommendations, January 31, 2012 [465KB PDF]
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.
Previous Low Income Pool Council Meetings
Related Documents
Please mail your comments or suggestions to:
- Email your comments and suggestions on Medicaid reform to
Medicaid Reform
Office of the Deputy Secretary for Medicaid
Agency for Health Care Administration
2727 Mahan Drive, MS #8
Tallahassee, Florida 32308
medicaidreform@ahca.myflorida.com
