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Pallone & Wyden Raise Concerns Over CMS’s Sudden Reversal to Fund Florida’s LIP Medicaid Program

April 26, 2017

“CMS has cited significant concerns with the structure and functioning of the Florida LIP in the past”

House Energy and Commerce Ranking Member Frank Pallone, Jr. (D-NJ) and Senate Finance Ranking Member Ron Wyden (D-OR) announced a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma today requesting information about CMS's sudden and opaque decision to grant $1.5 billion to the state of Florida to fund its Low-Income Pool (LIP) program.

CMS's grant announcement was reported earlier this month, which reversed Obama administration requirements that the level of funding through Florida's LIP should not act as a surrogate for coverage, and should support actual services provided to Medicaid beneficiaries and other low-income individuals and promote provider participation and access.

"CMS has cited significant concerns with the structure and functioning of the Florida LIP in the past," Pallone and Wyden wrote. "We are deeply concerned with CMS's lack of transparency and documentation around the approval of the additional funds and the absence of a clear plan moving forward to ensure that the statutory objectives of the Medicaid program are met."

In prior extensive communication with the state of Florida, CMS outlined how Florida's LIP could meet the statutory objectives of the Medicaid program and qualify for additional funding. However, CMS's sudden approval of the $1.5 billion in funding was inconsistent with its own previously outlined principals for funding qualification.

Furthermore, upon receiving news of CMS's funding decision, Florida Governor Rick Scott called for new state funding for infrastructure projects and tourism promotion, which the LIP is not authorized to fund. The Democrats' letter notes that the Social Security Act prohibits federal Medicaid funds from being spent on any item or service not covered under a state Medicaid program.

To help better understand CMS's sudden decision to reverse course and grant $1.5 billion to the state of Florida, the top Democrats asked for documentation on CMS's decision process and answers to several questions including:

  • Please provide documentation for CMS's waiver to provide $1.5 billion in funding for the Florida LIP, including documentation of when the decision was made to grant the waiver.
  • What was CMS's rationale for granting this waiver?
  • How will Florida distribute the LIP funding?
  • How will CMS ensure that Florida spends LIP funding only on items or services authorized by federal law?
  • What evaluations or audits will the state of Florida be subject to regarding the operation of its LIP and the disbursement of the funds granted under this waiver?
  • How will CMS ensure that the issues it previously identified with the LIP will not continue with the $1.5 billion in funds provided under this waiver?
  • Is CMS changing its policy on approving and funding uncompensated care pools?

As the Ranking Members of the key Committees in Congress with jurisdiction over the Medicaid program, Pallone and Wyden are charged with protecting and advancing the statutory objectives of the Medicaid program.

A copy of the letter to Administrator Verma is available here.

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Issues:Health