Peter Schorsch
The Florida Association of Community Health Centers says its membership will have trouble making ends meet if lawmakers don’t increase the Medicaid prospective payment rate for Florida’s federally qualified health centers.
In the leadup to the 2024 Legislative Session, FACHC shared data with lawmakers showing that the prospective payment rate for Florida FQHCs falls short of covering actual patient care costs, with a $106.00 reimbursement gap for every Medicaid patient visit. If the rate is not increased, FACHC said the shortfall could reduce health care access for some of the state’s poorest and most vulnerable populations.
“Florida’s health centers are lifelines for our communities, delivering crucial healthcare services. However, the current Medicaid reimbursement rates in our state fail to reflect the true cost of providing care, placing an unsustainable burden on these vital centers,” said Healthcare Network CEO and Chair of the FACHC Legislative Affairs Committee Jamie Ulmer.
“It’s imperative that Florida prioritize a Medicaid reimbursement adjustment to ensure Florida’s health centers can continue their mission of providing high-quality care to all, regardless of income or circumstance,” Ulmer continued. “We appreciate the efforts of our legislators, especially Senate President Kathleen Passidomo, for her work on the Live Healthy bill to help address the complexities of delivering essential care to our communities.”
FACHC said the current shortfall is being exacerbated by Medicaid “unwinding”— the process of eligibility redeterminations for the health care safety net program following the expiry of a federal emergency declaration that prevented states from removing Medicaid enrollees during the COVID-19 pandemic. As many as one million Floridians could be disenrolled during the unwinding process.
Community health centers provide essential primary care services to individuals and families, including preventive care, chronic disease management, and behavioral health services. They also serve as a critical safety net for vulnerable populations who may not have access to other health care options.
Florida’s FQHCs include 54 community health centers with over 800 locations. Every year, they provide primary and preventative care services to 1.8 million patients, 51% of whom are covered by Medicare or Medicaid and 28% of whom are uninsured. In 2023, Florida community health centers served more than 627,800 children, 14,400 veterans and 77,500 patients struggling with housing instability. More than 87% of patients served by community health centers live below the federal poverty level.
But FACHC says if Medicaid prospective payment rates don’t increase, these centers will not be able to sustain their services, and many of them may need to scale back the services they provide or limit the number of patients they serve.
“After an extensive analysis to determine the average cost of care, we are calling on state lawmakers to increase Medicaid prospective payment rates to ensure these providers’ continued sustainability, so all Floridians have access to the health care they need,” said Jonathan Chapman, President and CEO of FACHC. “By investing in our community health centers, we are investing in our communities through improved health outcomes and reduced health care costs in the long run.”
FACHC Board Chair and Suncoast Community Health Centers CEO Brad Herremans added, “Florida deserves a healthy and robust healthcare system of which the FQHCs are a key component. Our state Medicaid reimbursement rates have traditionally lagged behind many other states for years. An increase in this rate would go a long way to assure a growing and healthy system. One desperately needed to help with our ever-growing population.”
