CMS has approved a five-year extension of Florida’s statewide Medicaid managed care demonstration, including $1.5 billion in funding for support uncompensated care for low-income patients.

“This program gives Florida the ability to care for its most vulnerable and at-risk citizens. Its renewal also provides flexibility to use the funds in a way that meets the unique needs of the State while reducing burden by eliminating duplicative reporting and documentation requirements,” CMS Administrator Seema Verma, MPH, said in a statement. “This extension has a positive and direct impact on people’s lives and their ability to access care. Florida’s program offers an innovative and realistic pathway to tackling some of Medicaid’s biggest challenges.”

The program will now run through June 2022. First taking effect in 2014 under what are known as section 1115 waivers, the Florida Managed Medical Assistance (MMA) program requires most Medicaid beneficiaries in the state to enroll in managed care plans, covering an estimated 3.3 million people in the current fiscal year.

The new administrations at CMS and HHS have encouraged greater use of section 1115 waivers to focus on “solutions that focus on improving quality, accessibility, and outcomes in the most cost-effective manner.” In contrast, CMS under President Barack Obama rejected some Medicaid waivers from Republican-run states, such as Ohio’s 2016 proposal which included charging beneficiaries premiums.

The biggest change in the Florida MMA extension is the $1.5 billion low-income pool. CMS said this funding can only be used for uncompensated for low-income, uninsured patients, not for charity care for insured individuals, hospital bad debt or shortfalls from Medicaid or Children’s Health Insurance Program (CHIP) payments.

There’s no guarantee all $1.5 billion in funds will be used each year and unspent funds can’t be rolled over or used for other costs. Any payments from the funds to hospitals would also be considered Medicaid hospital revenue for calculating the hospital-specific Medicaid disproportionate share hospitals (DSH) limits.

Sen. Marco Rubio, R-Florida, praised the increased funding as “good news for millions” in his state.

“The extension will enable our state to continue providing care to Medicaid recipients through a managed care program, and the annual $1.5 billion low income pool allotment will provide federal resources to Florida hospitals to ensure the most vulnerable patients have access to quality health care,” he said in a statement.