Agenda 09/09/2025 Item #16D9 (Low Income Pool Letter of Agreement with the Agency for Health Care Administration, to participate in the Medicaid Low Income Pool Program)9/9/2025
Item # 16.D.9
ID# 2025-2809
Executive Summary
Recommendation to approve the Low Income Pool Letter of Agreement with the Agency for Health Care
Administration, in the amount of $732,403.27 to participate in the Medicaid Low Income Pool Program, (b) authorize an
additional allocation of $111,592.27 to allow for the maximum allocation of federal matching funds, (c) authorize the
County Manager to execute and submit the Low Income Pool agreement and the required Provider Questionnaire and (d)
authorize the necessary Budget Amendment. (Fiscal Impact $732,403.27)
OBJECTIVE: To provide additional health care services to the low-income citizens of Collier County and further the
County’s strategic plan focus area of supporting access to health, wellness and human services.
CONSIDERATIONS: The Agency for Health Care Administration (AHCA) is a State entity that provides Medicaid
services in Florida and operates the Medicaid Low Income Pool (LIP) Program. The LIP Program leverages local funds
to obtain federal matching dollars. The County's participation in the LIP Program is outlined in the attached LIP Letter
of Agreement between Collier County and AHCA. AHCA requested that the County execute the LIP Letter of
Agreement using DocuSign; therefore, staff is requesting that the Board of County Commissioners (Board) authorize the
County Manager to execute and submit the agreement and IGT Provider Questionnaire.
Healthcare Network of Southwest Florida (Healthcare Network) desires and is qualified to administer the LIP Program
with AHCA using County ad valorem tax dollars. These funds may only be allocated to those Federally Qualified
Health Centers (FQHC). In FY 25 Healthcare Network provided $6,162,500 in charity care.
Currently, FY 26 has budgeted $620,811 to support the LIP program and this would yield a federal match of
$830,360.21, with the additional $111,592.27 the federal match would increase the funds made available to Collier
County residents by $260,851.52.
The allocation of County and matching funds is as follows:
Collier
County FY
26 Budget
Allocation
FY 26
Additional
Funds
Requested
Collier County
Proposed LIP
IGT
Federal Matching Funds
Provided to CHSI as Program
Administrator
Total Funds
Benefiting Collier
County Residents
$ 620,811 N/A N/A $830,360.21 $1,451,171.21
$ 620,811 $111,592.27 $732,403.27 $979,619.46 $1,712,022.73
Healthcare Network will utilize the total funds under the LIP Program to provide additional healthcare services for low-
income individuals in Collier County. An agreement that outlines the contractual arrangement between Collier County
and Healthcare Network will be presented at a future board date. Healthcare Network will make payments in an amount
not to exceed $200,000 for eligible medical services to eligible residents authorized by County staff.
Furthers the County’s strategic plan focus area of supporting access to health, wellness and human services
FISCAL IMPACT: In FY 2026, a budget amendment is required to reallocate funding in the amount of $111,592.27
within the General Fund from Contributions to Grants cost center (969010-0001) to Community & Human Services
(CHS) Mental Health cost center (156010-0001) to cover the full IGT amount of $732,403.27 for the County’s
contribution payment to the State of Florida Agency for Healthcare by October 31, 2025. The County funds will
generate $979,619.46 in federal matching funds for the benefit of Collier Health Services to assist in meeting the state
match obligation.
GROWTH MANAGEMENT IMPACT: There is no Growth Management impact associated with this action.
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9/9/2025
Item # 16.D.9
ID# 2025-2809
LEGAL CONSIDERATIONS: This item has been reviewed by the County Attorney, is approved as to form and
legality, and requires majority vote for Board approval. -JAK
RECOMMENDATIONS: Approve the Low Income Pool Letter of Agreement with the Agency for Health Care
Administration, in the amount of $732,403.27 to participate in the Medicaid Low Income Pool Program, (b) authorize an
additional allocation of $111,592.27 to allow for the maximum allocation of federal matching funds, (c) authorize the
County Manager to execute and submit the Low Income Pool agreement and the required Provider Questionnaire and
(d) authorize the necessary Budget Amendment. (Fiscal Impact $732,403.27)
PREPARED BY: Carolyn Noble. Grant Coordinator, Community & Human Services Division
ATTACHMENTS:
1. LIP LOA Healthcare Network 8.26.25 CAO Signed
2. LIP IGT_Provider_Questionnaire CNkf
3. BA 156010
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Low lncome Pool Letter of Agreement
THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the _
day d-2025. by and between Collier County BoCC (the "lGT Providei') on behalf
of Healthcare Network and the State of Florida, Agency for Health Care Administration
(the "Agency"). for good and valuable consideration, the receipt and sufficiency of which is
acknowledged.
DEFIN ITIONS
"Charity care" or "uncompensated charity care" means that portion of hospital charges reported
to the Agency for which there is no compensation, other than restricted or unrestricted revenues
provided to a hospital by local governments or tax diskicts, regardless of the method of
payment. Uncompensated care includes charity care for the uninsured but does not include
uncompensated care for insured individuals, bad debt. or Medicaid and Children's Health
lnsurance Program (CHIP) shortfall. The state and providers that are participating in the Low
Income Pool (LlP) will provide assurance that LIP claims include only costs associated with
uncompensated care that is furnished through a charity care program and that adheres to the
principles of the Healthcare Financial Management Association (HFlilA) operated by the
provider.
"Low lncome Pool (LlP)" means providing government support for safety-net providers for the
costs of uncompensated charity care for low-income individuals who are uninsured.
Uncompensated care includes charity care for the uninsured but does not include
uncompensated care for insured individuals, "bad debt," or Medicaid and CHIP shortfall.
"Medicaid" means the medical assistance program authorized by Title XIX of the Social Security
Act, 42 U.S.C. $$ 1396 et seq., and regulations thereunder, as administered in Florida by the
Agency.
A. GENERAL PROVISIONS
1. Per Senate Bill 2500, the General Appropriations Act of State Fiscal Year 2025-
2026, passed by the 2025 Florida Legislature, the IGT Provider and the Agency agree
that the IGT Provider will remit IGT funds to the Agency in an amount not to exceed the
total of $732,403.27.
a The IGT Provider and the Agency have agreed that these IGT funds will only
used to increase the provision of health services for the charity care of the lG
Provider and the State of Florida at large.
b. The increased provision of charity care health services will be accomplished
through the following Nledicaid programs:
be
T
Collier County Bocc_Healthcare Network LIP LOA SFY 2025-26
" lntergovernmental Transfers (lGTs)" means transfers of funds from a non-l\4edicaid
governmental entity (e 9., counties, hospital taxing districts, providers operated by state or local
government) to the Medicaid agency. lGTs must be compliant with 42 CFR Part 433 Subpart B.
i. LIP payments to hospitals, federally qualified health centers, Medical
School Physician Practrces, community behavioral health providers, and
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rural health centers pursuant to the approved Centers for lvledicare &
Medicaid Services Special Terms and Conditions.
2. The IGT Provider will return the signed LOA to the Agency no later than October 1,
2025.
3. The IGT Provider will pay IGT funds to the Agency in an amount not to exceed the total
o'f $732,403.27.
Per Florida Statute 409.908, annual payments for the months of July 2025 through
June 2026 are due to the Agency no later than October 31, 2025, unless an
alternative plan is specifically approved by the agency.
b. The Agency will bill the IGT Provider when payment is due
4. The IGT Provider and the Agency agree that the Agency will maintain necessary records
and supporting documentation applicable to health services covered by this LOA.
a. Audits and Records
The IGT Provider agrees to maintain books, records, and documents
(including electronic storage media) pertinent to performance under this
LOA in accordance with generally accepted accounting procedures and
practices, which sufficiently and properly reflect all revenues and
expenditures of funds provided.
ii. The IGT Provider agrees to ensure that these records shall be subject at
all reasonable times to inspection, review, or audit by state personnel and
other personnel duly authorized by the Agency, as well as by federal
personnel.
iii. The IGT Provrder agrees to comply with public record laws as outlined in
section 1 19.0701 , Florida Statutes.
b, Retention of Records
The IGT Provider agrees to retain all financial records, supporting
documents, statistical records, and any olher documents (including
electronic storage media) pertrnent to performance under this LOA for a
period of six (6) years after termination of this LOA, or if an audit has been
initiated and audit findings have not been resolved at the end of six (6)
years, the records shall be retained until resolution of the audit findings.
a
Collier County BoCC_Healthcare Network_LlP LOA SFY 2025-26
ii. Persons duly authorized by the Agency and federal auditors shall have full
access to and the right to examine any of said records and documents.
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The rights of access in this section must not be limited to the required
retention period but shall last as long as the records are retained.
c Ivlonitoring
i. The IGT Provider agrees to permit persons duly authorized by the
Agency to inspect any records, papers, and documents of the IGT
Provider which are relevant to this LOA.
d. Assignmenl and Subcontracts
5. This LOA may only be amended upon written agreement signed by both parties.
The IGT Provrder and the Agency agree that any modifications to this LOA shall be in
the same form, namely, the exchange of signed copies of a revised LOA.
6. The IGT Provider confirms that there are no pre-arranged agreements (contractual or
otherwise) between the respective counties, taxing districts, and/or the providers to
redirect any portron of these aforementioned charity care supplemental payments in
order to satisfy non-lvledicaid, non-uninsured, and non-underinsured activities.
7. The IGT Provider agrees the following provision shall be included in any agreements
belween the IGT Provider and local providers where IGT funding is provided pursuant
to this LOA: "Funding provided in this Agreement shall be prioritized so that designated
IGT funding shall first be used to fund the Medicaid program (inctuding LIP or DSH) and
used secondarily for other purposes."
8. This LOA covers the period of July 1, 2025, through June 30. 2026, and shall
be terminated September 30, 2026, which includes the state's certified forward
period.
9- This LOA may be executed in multiple counterparts, each of which shall constitute an
original, and each of which shall be fully binding on any party signing at teast one
counterpart.
Col er County BoCC_Healthcare Network LIP LOA SFY 2025-26
i. The IGT Provider agrees to neither assign the responsibility of this LOA
to another party nor subcontract for any of the work contemplated under
this LOA without prior written approval of the Agency. No such approval
by the Agency of any assignment or subcontract shall be deemed in any
event or in any manner to provide for the incurrence of any obligation of
the Agency in addition to the total dollar amount agreed upon in this
LOA. All such assignments or subcontracts shall be subject to the
conditions of this LOA and to any conditions of approval that the Agency
shall deem necessary.
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LIP Local lntergovernmental Transfers (lGTs)
Program / Amount State Fiscal Year 2025-2026
Estimated lGTs
$732,403.27
Total Funding Not to Exceed
$732,403.27
WITNESSETH:
lN WITNESS WHEREOF, the parties have caused this (4) page Letter of Agreement
to be executed by their undersigned officials as duly authorized.
COLLIER COUNTY BOCC STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
SIGNEO
BY:
NAME:
TITLE:
DATE:
SIGNED
BY:
NAME:
TITLE:
Stephanie Scanlon
Chief of Medicaid Program
Finance
a
DATE:
and legality
County Attomey
II V
Collier County BoCC_Healthcare Network LIP LOA SFY 2025-26
Jeffrcy
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Intergovernmental Transfers Questionnaire
IGT Provider Name:Collier County
Health Care Provider Name:Healthcare Network of Southwest Florida
IGT Amount: $732,403.27
State Fiscal Year Ending: 6/30/2026
1. What type of governmental entity is your organization considered? (county, city, hospital taxing
district, or other)
County
If other, please explain
2.Does your organization have a relationship with the provider for which you contribute IGTs as named
in the preamble of the enclosed Letter of Agreement (LOA)?
Yes
If yes, please describe your relationship, including services provided to/by the provider to/by the
organization and any other financial transactions between the provider and the organization.
The County provides IGT to Healthcare Network of Southwest Florida. They are also a
subrecipient of our grant programs providing healthcare services to citizens of Collier County.
3.Please describe the source of the IGT funding for your organization, including whether the source is
from a tax, a provider donation, or other funds. Provide the amount of funding from each source.
Source Amount
General Fun Ad Valorem Tax $732,403
$-
$-
If other, please explain
a.Verify whether the funds are public funds as defined by 42 CFR § 433.51, and exclude any
federal funds.
Yes
If no, please explain
4.Does your organization have taxing authority?
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Yes
5. If the source of IGT funding is from taxes, please answer the following questions:
a.Is the tax a state, county, city, or hospital district tax?
County
If other, please explain
b.What entities are taxed?
Property Owners in Collier County
c.What is the tax structure (i.e. property tax, percentage of revenue, assessment, etc.)?
Ad Valorem/Property Tax
d.What is the amount or percent of the tax?
3.5645 per $1000 value
e.Does at least 85% of the burden of the tax revenue fall on health care providers as defined in 42
CFR §433.55? (Provide the total tax revenue and the health care provider tax burden) If so,
please answer the following questions:
Amount
Total Tax Burden $-
Healthcare Provider Tax Burden $-
0.00%
i)Is the tax broad based? A broad based tax can be defined as a tax that is imposed on at
least all health care items or services in the class or providers of such items or services
furnished by all non-Federal, non-public providers in the State, and is imposed uniformly,
pursuant to 42 CFR § 433.68.
No
If no, please explain
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ii)Is the tax uniform across all entities being taxed? Based on 42 CFR § 433.68, a health care-
related tax will be considered to be imposed uniformly even if it excludes Medicaid or
Medicare payments (in whole or in part), or both; or in the case of health care-related tax
based on revenue or receipts with respect to a class of items or services, if it excludes either
Medicaid or Medicare revenue with respect to a class of items or services, or both. The
exclusion of Medicaid revenue must be applied uniformly to all providers being taxed.
No
If no, please explain
The tax is general property tax.
iii)Is the tax generally redistributive and a waiver of the broad-based or uniform tax requirement
was granted in accordance with 42 CFR §433.68(e)?
No
If no, please explain
The tax is general property tax.
iv)Does the tax program comply with the hold harmless provisions included in 42 CFR §
433.68(f)?
No
If no, please explain
The tax is general property tax.
v)Does every tax paying entity receive a supplemental payment equal to or exceeding its tax cost?
If yes, please explain
6.Please answer the following regarding provider funds received from the healthcare entity and/or
other health care entities.
a.Are provider voluntary payments or in-kind services received by the organization as defined in 42
CFR § 433.52?
No
b.How much of the organization’s revenue is received from provider-related donations (Provide the
total revenue and the provider-related donation amounts)?
Amount
Total Revenue $-
Provider Related Donations $-
c.Do individual provider donations exceed $5,000 per year or $50,000 per year for a health care
organizational entity?
No
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If yes, please list the provider and payment amount.
Provider Name Funding Source Amount
$-
$-
$-
d.Does any portion of the provider donation constitute as a “bona fide donation” pursuant to 42
CFR § 433.54? 42 CFR § 433.54 requires donations will not be returned to the individual
provider, the provider class, or related entity under a hold harmless provision.
No
e.Is there an agreement between the IGT provider and the health care entity? If so, please specify
whether the agreement is written and provide the details.
7.Were funds utilized for the IGT specifically appropriated by the organization's board?
Yes
If yes, provide the board minutes and date of the appropriation.
I Amy Patterson certify that the statements and information contained
in this submittal are true, accurate, and complete.
Signature of Officer or Administrator
Title
Date
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