Miami-Dade mayor: State should fill loss of federal healthcare fund

By Daniel Chang and Mary Ellen Klas

Miami-Dade County does not have the money to cover the potential loss of $200 million a year in federal funding that helps Jackson Health System, the county’s public hospital network, provide medical care for the uninsured and Medicaid patients, Mayor Carlos Gimenez said Tuesday.

Gimenez said he expects Florida legislators will tap state dollars to fill a potential shortfall in federal hospital funding — although he could not offer any assurances as to how that would happen.

“To be frank, Miami-Dade County government doesn’t have that amount,” Gimenez said.

Gov. Rick Scott has said that he will not support using state revenue to offset the losses to hospitals, and on Tuesday he called for a Commission on Healthcare and Hospital Funding to be convened to “examine the revenues of Florida hospitals, insurance and healthcare providers and how any taxpayer money contributes to the profits or losses of these institutions in Florida.”

The Legislature is deadlocked over healthcare spending, including the expansion of Medicaid and the potential loss of $1.3 billion a year the federal government sends the state to help safety net hospitals such as Jackson care for the uninsured and Medicaid patients.

Gimenez said he met with legislators in Tallahassee earlier this month to discuss the issue.

“The senators and the representatives I spoke to, they had the same story,” he said, “that eventually they will sit down and they will craft a budget that will make us maybe not whole but it will be about 90 percent.”

As home to the greatest number of uninsured residents in Florida — and to the hospital that receives the most money from the funding program, Jackson Health — Miami-Dade would be among the hardest hit if state administrators and federal officials fail to reach agreement on renewal of the Low Income Pool or LIP.

Carlos Migoya, CEO of Jackson Health, said the $200 million a year the system receives in LIP funds “means being able to stay alive.”

If that money goes away, he said, “I don’t know that we would necessarily have to close but we would definitely be limping along very heavily.”

Renewal of LIP, which is set to expire on June 30, is one of two issues that have caused a stalemate in budget negotiations between the Florida House and Senate for the past two weeks. The other issue is expansion of Medicaid eligibility as provided for under the Affordable Care Act.

State senators have included in their $80 billion budget proposal a renewal of the LIP program, and a plan to expand Medicaid eligibility. The Florida House has not included those programs in its budget, leading to a $4 billion difference.

On Tuesday, Florida House Appropriations Chairman Richard Corcoran, one of the most vocal opponents of Medicaid expansion, said legislators would have to figure out whether they need to use the state’s general revenue to fill any loss in federal funding.

“It’s important that the House and Senate come to a compromise to fulfill our constitutional duty to get a budget out in time,” Corcoran said.

Last week, Scott announced that he will sue the federal government, accusing it of coercing Florida to expand Medicaid by linking any renewal of LIP to Medicaid expansion.

Medicaid and LIP are different programs, but they are designed to work together.

In a letter to state healthcare administrators in April, federal regulators said the ACA establishes a more comprehensive approach than LIP for providing healthcare to the uninsured while supporting safety-net hospitals. Medicaid expansion would increase the number of insured Floridians, reducing the need for direct hospital funding for the uninsured.

But Florida’s refusal to expand Medicaid eligibility — along with 21 other states — means that only a narrow category of low-income adults qualify for the coverage: the disabled, pregnant women and parents with dependent children and annual incomes below 35 percent of the Federal Poverty Level, or $5,575 for a household of two.

That has left an estimated 850,000 Floridians in a healthcare limbo that policy analysts call “the coverage gap,” meaning these residents do not receive Medicaid and they do not earn enough to qualify for financial aid to buy a plan through the ACA.

About 140,000 adults in Miami-Dade fall into the coverage gap, and an additional 80,000 live in Broward, according to the Urban Institute, a nonprofit health policy research group.

Many of those Miami-Dade residents rely on Jackson for low-cost healthcare through a “charity care” program.

In 2014, Jackson officials said, the hospital system spent about $365 million providing charity care to an estimated 40,000 Miami-Dade residents. Jackson will receive about $375 million this year in Miami-Dade property and sales taxes to help achieve its mission to provide healthcare to all county residents regardless of ability to pay.

Losing LIP funds, said Jackson Health’s Migoya, would challenge the hospital system’s ability to provide that care and might jeopardize a nascent turnaround after prior years of large financial losses threatened bankruptcy in 2011.

“Everything we have done from a transformational standpoint would be at risk,” he said.

Frank Sacco, chief executive of Memorial Healthcare System, the public hospital network for South Broward County, said his staff has not yet begun crafting a contingency plan if LIP ends, which would cost the hospital network a little more than $100 million a year in funds.

Sacco said he has budgeted a reduction of $25 million in Memorial Healthcare’s LIP funding for the coming year, but that it’s too early to tell what programs or services might be affected.

“There’s nothing to speculate as to what we’re going to do,” he said. “because nothing has been decided.”