CMS renews Florida's Medicaid waiver, low income pool

The CMS has approved Florida's Medicaid waiver that allows the state to keep most of its Medicaid populations on managed-care contracts and continues a controversial fund that helps hospitals pay for uncompensated care.

The waiver, which was renewed Thursday is largely a continuation of the state's prior waiver that was approved in 2014.

In the agreement, the Trump administration indicated it would fund Florida's hospital low-income pool at $1.5 billion annually through 2022, which is what the state received this year after the Obama administration planned to only give the state $600 million.

"This program gives Florida the ability to care for its most vulnerable and at-risk citizens," CMS Administrator Seema Verma said in a statement. "It's renewal also provides flexibility to use the funds in a way that meets the unique needs of the state."

Obama-era officials questioned the need for the low income pool as the state had the option of expanding Medicaid. If Florida had expanded Medicaid, the state could have drawn down as much as $51 billion in federal Medicaid dollars over 10 years, according to the Kaiser Family Foundation.

To that end, the CMS began to wind down funding for the pool giving the state $1 billion in 2015, which was about half of what the state has been receiving, and $600 million for the final year of the state's waiver which ended June 30.

Other non-expansion states including Tennessee and Texas also rely on the uncompensated-care pools, and faced similar opposition from the Obama administration about continuing funding at pre-2014 levels after Medicaid expansion came into play.

Florida's Republican Gov. Rick Scott is against expansion as he said he did not trust the federal government would continue to pay the enhanced match for expansion outlined in the ACA.

The law fully funded Medicaid expansion though the end of 2016, and then the federal match rate fell to 95% in 2017, 94% in 2018, 93% in 2019, and then 90% in 2020 and beyond. The impasse between Scott and the CMS under Obama made the future of the funds uncertain beyond this year.

The state's fortunes changed after Donald Trump became president and named Dr. Tom Price as HHS Secretary, as both men oppose the ACA and have sought to reduce federal Medicaid spending.

As of March 2017, Florida had enrolled more than 4.3 million individuals in Medicaid and CHIP—a net increase of 17.68% since 2013. Florida did not expand Medicaid, and it attributes the growth mostly to increased enrollment of people already eligible for the program thanks to the Affordable Care Act.