Fla. Medicaid funds in jeopardy over state’s limits on ER visits
The CMS may cut millions in federal Medicaid funds to Florida over a state practice that violates federal law.
The policy in question comes from the state’s decision to reimburse hospitals for only six emergency room visits per Medicaid beneficiary each year.
The policy is inconsistent with federal Medicaid laws, which sets the bar at 12 visits a year, according to the CMS. Florida’s law specifically refers to non-pregnant Medicaid beneficiaries 21 and over.
In an effort to cut the budget, Florida decided in August 2012 to reduce the number of ER visits it would cover. It sent the CMS a proposed amendment to its state Medicaid plan coverage provisions on Sept. 14, 2012. The CMS denied the amendment on Dec. 13, 2012, indicating that the limitation on outpatient services was not consistent with federal law. Despite the red light, the state has continued to enforce the six ER-visit rule, according to the CMS.
“Florida has instituted this visit limit and CMS intends to reduce a portion of federal Medicaid administrative payments, unless the state quickly submits a plan to come into compliance with Medicaid law. We hope the state will realign its Medicaid program with federal standards to avoid this penalty,” a representative from the CMS said.
The CMS has given Florida state officials 30 days from the receipt of the Feb. 20 letter to request a hearing on the cuts. This would be separate from a meeting that Florida officials and the CMS already have scheduled for September to discuss the policy, according to state officials.
If a hearing does take place, and the two parties are unable to resolve their differences, the CMS will reduce federal funding for the state’s administrative Medicaid operations by 10% starting the next fiscal quarter after the hearing. The with- holding percentage will increase by 5% every quarter in which the state remains out of compliance, up to a maximum withholding percentage of 100%. Federal records show that Florida receives just over $20 million annually from the federal government to cover Medicaid administrative costs.