Guide to Understanding Florida's FQHCs and 330 Expansion ...

organizations (PPO,) provider sponsored networks (PSN), minority physicians networks and
rural healthcare networks. Vendors will develop a variety of healthcare plans with unique sets of
covered services to compete for enrollment. Florida proposes that Medicaid recipients, with the help
of counselors, will use their state supplied premium to purchase a healthcare plan or “opt out” of
Medicaid and use their premium to purchase private insurance, and enroll in a flexible spending
account.
Another important element in Florida’s Medicaid reform proposal is replacing the state’s current
upper payment limit financing (UPL) with a $1 billion annual Low income pool” (LIP) fund to
pay for care provided to the uninsured. Prior to the development of the low income pool, only
hospitals could participate in the UPL program, restricting any efforts to reduce the inappropriate
use of emergency rooms. The new low income pool allows other providers of primary and
preventative care to benefit from the federal LIP funding. FQHCs will participate in the low income
pool, along with an additional 80 hospitals that previously did not benefit from the UPL financing.
The FQHC UPL funds will help divert the inappropriate use of emergency rooms by increasing the
capacity of health centers to provide services for the uninsured, including increasing the number of
hours that services are available, aiding the state in reducing access barriers to primary care for the
uninsured.
A quarter of the revenue that allows Florida’s FQHCs to keep their doors open comes from
Medicaid. Changes to the program have serious implications for the survival of FQHCs and other
safety net providers. If the state fails to provide recipients with sufficient funds to purchase
adequate low-deductible insurance coverage, patients are likely to go to FQHCs when they have
exhausted their coverage elsewhere or if they are unable to meet the cost sharing requirements of
their plans. Under the new system FQHCs could potentially lose their current Medicaid patients to
other plans and receive them back as uninsured patients, losing a significant source of revenue and
jeopardizing their financial viability. Florida’s Medicaid reform proposal requires local plans to
make a “good faith effort” to include FQHCs, rural health clinics, and county health departments in
their network. However, if a plan can demonstrate to the state and CMS that adequate capacity and
an appropriate range of services is available for vulnerable populations without contracting with
FQHCs, rural health clinics and CHDs then the plan can be relieved of this requirement.
Conclusion of Section Two
Florida is a large and complex state that is home to a diverse population, including a number of
“Special Populations” that face unique healthcare challenges. Our population is growing at a rapid
pace. Increases in poverty and uninsurance rates exacerbate the need for affordable healthcare. Like
other states, Florida needs to address disparities in healthcare based on race, ethnicity and
geographic factors. Florida FQHCs can serve as a stable source of quality healthcare for low income
Floridians. It is critical to the health of our state that the FQHC role as safety net providers be
recognized and preserved under any new and evolving system.
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