One day after a top federal official informed Florida that the future of the Low Income Pool is tied to Medicaid expansion, Florida Medicaid Director Justin Senior sent a letter back, saying the two healthcare funding issues should be kept separate.
"Your letter, for the first time, clearly links a continued LIP with Medicaid expansion," Senior wrote. "In NFIB v. Sebeli us 132 S. Ct. 2566 (2012), the U.S. Supreme Court explicitly warned the federal government against attempting to coerce states into participating in Medicaid expansion -- yet that appears to be exactly what the federal government is attempting here."
Senior pointed out that his agency does not have the authority to expand Medicaid. But he said the Agency for Health Care Administration would soon file a petition to the federal government to have the $2.2 billion Low Income Pool renewed for two years. The program helps hospitals like Jackson Health System and Tampa General that treat low-income patients.
"We hope the federal government receives our LIP amendment cordially, and recognizes it for the opportunity it presents for every Floridian to have access to quality, affordable private health insurance through the free market," Senior wrote.
One day earlier, Republican U.S. Sen. Marco Rubio and Republican U.S. Reps. Gus Bilirakis, Curt Clawson, Rich Nugent, Ileana Ros-Lehtinen, Ted Yoho made a similar point in a letter to the same federal agency.
"Uncompensated care will still exist in Florida with or without the expansion of Medicaid, and thus it is important to continue the LIP so that the federal government and Florida continue to support providers who serve this ongoing uninsured population," the lawmakers wrote.
The letter estimated the cost at $1.6 billion, even with expansion.
"CMS should not destabilize, eliminate or hold these programs hostage to an expansion decision," the lawmakers wrote. "Continuing LIP, at approximately the current level of funding, would treat Florida equally with other states, like California, that have both expanded Medicaid and continued to receive uncompensated care for their remaining uninsured populations."
Gov. Rick Scott's office pointed Florida Republican members of Congress to the letter last week, saying the governor strongly supported it and suggesting they sign on.
Notably, not everyone did.
Read the two letters below.