Diagnosis for 8.14.24: Checking the pulse of Florida health care news and policy
Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics. — Savings, then increases— State economists have finalized new projections for Florida's safety net health care program that show projected s…
Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.
— Savings, then increases—
State economists have finalized new projections for Florida's safety net health care program that show projected savings for the current fiscal year but are projected to rise next year.
The latest numbers show that Medicaid, which is financed by a combination of state and federal dollars, will cost $33.2 billion through June 30, 2025. That means there will be a surplus of nearly $539 million, including $166 million in state tax dollars.
But the costs are expected to climb back up in the 2025-26 fiscal year to $34.6 billion which would require state legislators to set aside an extra $1.17 billion in state dollars during the Session next Spring.
The surplus will be eaten away by expected cost increases in the next budget year.
The Medicaid program saw its enrollment rise sharply during the COVID-19 public health emergency because states were required to keep people on the rolls. But Congress lifted that requirement last year and Florida began a redetermination process (also called "unwinding") that resulted in a steep drop in the number of people in the program (and triggered a federal lawsuit asserting Florida did not do this properly.)
But even with these changes Florida's overall Medicaid enrollment is now projected to remain higher than it was prior to the pandemic. The current forecast estimates that roughly 4.4 million people will be enrolled in Medicaid during the 2024-25 fiscal year and that the number will tick up to 4.45 million between next Summer and Summer 2026.
Economists will use the latest forecast to create a three-year financial outlook that is presented to the Legislative Budget Commission in September. They will also create another forecast right before state lawmakers convene for the 2025 Session when they draft a new state budget.
I welcome your feedback, questions and especially your tips. You can email me at SextonHealthNewsletter@gmail.com or call me at 850-251-2317.
— KidCare limbo —
Economists have also drawn up new forecasts for Florida KidCare — the program that includes subsidized children's health insurance — but those estimates may or may not hold up in the months between now and the 2025 Legislative Session.
KidCare, which includes Florida Healthy Kids, is in a bit of limbo amid a legal battle between the state and federal government over continuous eligibility requirements. Federal government guidance issued last year said that once enrolled families must remain in the program for up to 12 months. But Florida officials are challenging that requirement and meanwhile continue to drop families who fail to pay their Healthy Kids premiums.
Caseload estimates are lower, but that could change based on the outcome of an ongoing legal challenge.
Additionally, legislators had signed off on raising the income eligibility threshold for subsidized coverage for families from 200% of the federal poverty level to 300%. But that change has yet to be approved by the federal government, so economists have removed it from enrollment forecasts for now.
The bottom line is that caseload estimates for Florida KidCare are now significantly lower for the next fiscal years. And that has placed the overall cost of the program at nearly $688 million for the current budget year that ends on June 30 — or nearly $99 million lower than what was initially projected. The overall cost would still be about $14 million below the current appropriated amount in the 2025-26 fiscal year as well.
If the enrollment and cost estimates remain accurate it would mean that legislators would not have to set aside any extra money for the program in next year's Session. But that assumes that the legal battle and the expansion of Florida KidCare remain unsettled at that time.
— Death by a thousand cuts—
The House Democratic Caucus sent a letter to Gov. Ron DeSantis, Department of Children and Families Secretary Shevaun Harris, and Agriculture Commissioner Wilton Simpson this week, urging the state move to accept federal funding for the 2025 Summer EBT program before the Aug. 15 deadline.
The Summer EBT food assistance program was authorized by the Consolidated Appropriations Act of 2023 to combat food insecurity. Thirty-seven states currently participate and are receiving $2.6 billion in federal food assistance benefits for about 21.3 million children from food insecurity.
According to the Democrats, if the state allocated $13 million in funds or less than 1% of its budget surplus, Florida would pull down $259 million in federal funding to provide grocery assistance to over 2 million children of low-income Floridians.
"While Florida, unfortunately, was one of 13 states that decided not to participate in the 2024 Summer EBT program, there is still time to take advantage of this win-win opportunity next summer and help the one in five children in Florida affected by hunger, while boosting the state economy with an estimated $466 million economic impact," the letter notes." The Florida House Democratic Caucus strongly urges you to act to secure our state's share of the federal funding available to help reduce summer hunger in Florida, and help ensure that children return to school in the Fall of 2025 well-nourished and ready to learn."
The letter also notes that the 2024-25 General Appropriations Act — which passed with overwhelming bipartisan support — includes a specific reference to the Summer EBT program and explicitly authorizes DCF to submit a budget amendment for increased budget authority to support the program.
Democrats on Wednesday took aim at the Republican leadership on a number of fronts during a press conference meant to bring attention to the EBT issue.
Fentrice Driskell and House Democrats are criticizing the DeSantis administration's 'failed strategy.' Image via Colin Hackley.
"The state of Florida continues to drop families for the most technical of reasons," Fentrice Driskell said when asked about the administration's policy to continue to remove children from KidCare for not paying premiums.
"And we think that this is a failed strategy. We wish they would reverse their strategy actually in the litigation over these issues. But I don't know why we have our Governor and administration who continue to deprioritize families in the way that they do."
The House Democratic Leader said the minority party was working on a letter to the administration "letting them know we are paying attention to what's happening."
Driskell said she was also hopeful that there would be some consequences for the administration for flouting the law.
"It's just a very frustrating situation and another example of how Florida families are left to fend for themselves and facing a state administration that is so callous and cold-hearted and not paying attention to the needs of Floridians."
Rep. Kelly Skidmore said the policies have an overwhelming cumulative effect.
"It's a tired expression but 'death by a thousand paper cuts.' It's Medicaid, it's transkids, it's EBT, it's KidCare. It's all about protecting families, which our state is just intentionally failing to do, and the cumulative effect is having a very negative impact on our families' ability to be healthy, prosperous, and safe in the state of Florida," she said.
— Racist policies? —
A former Walt Disney Company manager is suing hospitals in Orlando and Tampa as well as a national nonprofit group that manages organ transplants over a delay in getting a kidney transplant that he says was the result of racial discrimination.
Cortez Fields received a needed transplant in December 2023 but only after he was moved up on a priority list by two-and-a-half years in the wake of changes made by the organ transplant network after the organization acknowledged that a test had overestimated how well the kidneys of Black patients functioned.
Fields is suing in federal court in Orlando and says he was forced to leave his job because, starting in 2022, he had to spend five hours a day receiving dialysis treatment. The lawsuit states he experienced "grave financial difficulties" and was forced to deplete his retirement savings.
The lawsuit states that "defendants' admitted discrimination against Black Americans by use of the race-based coefficient, at minimum, ruined Mr. Fields's life through years of delay and resulting debilitating dialysis treatments, rendering Mr. Fields unable to continue his previously successful career. There must be serious consequences for hospitals and transplant organizations that engage in such racist discrimination."
The lawsuit says the race-based coefficient caused discriminatory delays for transplant patients.
Fields' lawsuit is against Tampa General Hospital, AdventHealth and the United Network for Organ Sharing. He's asking for compensation for economic, medical and personal injuries as well as for pain and suffering and punitive damages.
Advent Health Central Florida Division spokesperson Tom Johnson said the hospital does not comment on pending litigation. TGH declined to comment on the lawsuit that was first filed in early August.
In June 2022, UNOS announced it had approved the use of a race-neutral calculation for kidney transplants. In the announcement, UNOS acknowledged it had used a modifier that had led to an underestimation of kidney disease severity for many Black patients. In January 2023, hospitals were advised to investigate whether or not patients should have their wait times for organs adjusted. The Associated Press reported in April of this year more than 14,000 Black kidney patients were given credit for lost waiting time and moved up on priority lists.
In his lawsuit, Fields said that he was told by Tampa General Hospital in October 2023 that he was getting a two-and-a-half-year adjustment, which resulted in him getting his transplant two months later. Fields was on waiting lists for both Tampa General and AdventHealth.
The lawsuit also criticizes both UNOS and the hospitals for relying on "junk science only supported by racial stereotypes" for the use of tests that had diminished the need of Black patients to get a transplant.
— Limited power—
Keep an eye on this.
Judges with the 1st District Court of Appeal on Wednesday sided with several hospital districts and two school boards against Attorney General Ashley Moody and said that she did not have the legal authority to block other governments from filing their own lawsuits over the opioid crisis.
The ruling is not a surprise given the tenor of the hearing the judges held back in May, but it still represents a stinging rebuke of Moody.
Acting on lawsuits first filed by then-Attorney General Pam Bondi Florida negotiated several settlements with opioid manufacturers and distributors worth $3.1 billion.
The outcome of the case could have an impact on the state's opioid settlement payout.
But as part of that deal Moody sought to block hospital districts such as Halifax Health and Broward Health, as well as the Miami-Dade School Board, from being able to pursue their own lawsuits. A circuit court judge last year sided with Moody and ruled that she did have the power to override the lawsuits filed by other governments.
That point of view was echoed by David Costello, Moody's Deputy Solicitor General, who argued before the appeals court back in May that the Attorney General has broad and flexible power to initiate litigation on behalf of the state.
"Sometimes the state has to speak with one voice when it comes to its litigation power, but the state has placed its power in the hands of the Attorney General," Costello told Judges.
But the three-judge panel sharply disagreed with its decision and said that while there were "laudable goals" in the opioid settlement, the judges firmly stated that there were limits to Moody's power.
"The Attorney General has more authority to litigate such claims than the claims of a private hospital asserting its own individual damages," wrote Judge Brad Thomas for the panel. "To hold otherwise would make the Attorney General equal to the Governor and the Legislature. But the Attorney General is not the supreme executive of Florida, who may assert policy prerogatives on behalf of the Governor and the Legislature. The Governor exercises the supreme executive power."
The final outcome of this is worth watching because Costello suggested an adverse ruling could affect the ultimate payout to the state.
— Doctors' orders —
The Florida Medical Association PAC has delivered a bevy of endorsements to candidates it deems pro-medicine leading up to Tuesday's Primary.
The endorsements include Mitch Rosenwald for House District 98, the seat currently held by term-limited Democratic Rep. Patricia Willams.
In HD 94, FMA endorsed Meg Weinberger. The district includes part of Palm Beach County and is currently represented by Republican Rep. Rick Roth, who is term-limited.
In HD 19, the committee is backing Sam Greco. House District 19 includes Flagler and part of St. Johns County and is an open seat currently held by term-limited House Speaker Paul Renner.
FMA PAC gave the OK to another set of state legislative candidates in the final week ahead of the Aug. 20 primary.
FMA also endorsed Rep. Ashley Gantt in her re-election for House District 109, which covers part of Miami-Dade County.
Yvette Benarroch in her bid for House District 81. Florida's House District 81 includes part of Collier County. This is an open seat currently held by Naples Republican state Rep. Bob Rommel, who is term-limited.
Loreal Arscott is the pick in Miami-Dade County's House District 107, the seat currently held by Rep. Christopher Benjamin, who is not running for re-election.
And FMA also endorsed Democratic Rep. Bruce Antone in his re-election bid for House District 41, which covers part of Orange County.
FMA PAC was established in 1974 to elect candidates to state office who will support our mission of making Florida the best state to practice medicine. The FMA PAC President is Charles Chase, D.O.
— RULES —
The Board of Osteopathic Medicine proposes amending Rule 64B15-6.003 to incorporate the application for Temporary Certificate for Physician Assistants to Practice in an Area of Critical Need and will also update the rule text. More here.
The Board of Medicine proposes amending Rule 64B8-30.003 to incorporate changes to the Temporary Certificate for Physician Assistants to Practice in Areas of Critical Need and will also update the rule text. More here.
The Board of Medicine proposes amending 64B8-4.009 to incorporate the revised application form —DH-MQA 1072 – Application for Medical Faculty Certificate for Allopathic Physicians into the rule. More here.
— LOBBYISTS —
Taylor Biehl, Capitol Alliance Group: Lighthouse of Broward for the Blind & Visually Impaired
— ETC —
— Judge Robert Cohen issued a notice this week in the Medicaid managed care challenges filed by two health plans. Cohen will hear the challenges filed by AmeriHealth Caritas and Sentara Care at Tallahassee hearings that have been scheduled for Sept. 4 through Sept. 6 and Sept. 9 through Sept. 13 in Tallahassee. A third plan, ImagineCare, had also filed an administrative challenge as well as a challenge in Leon County Circuit Court. The litigation was dropped though.AHCA wants to roll out the new Medicaid managed care contracts beginning Sept. 1.
— AHCA has reissued a pair of emergency rules on abortion reporting requirements for health care providers and facilities that perform abortions. The rules were republished this week after the initial emergency rules published in May expired. Emergency rules stay in effect for 90 days only. Similar to the published announcement in May the DeSantis administration this week said the emergency rules are necessary to respond to "disinformation" that has come in the wake of Florida's new ban on abortions after six weeks. Voters will be asked in November to weigh in on the abortion debate and whether to enshrine abortion rights in the Constitution.
— ROSTER —
— Sonya Arnold, MSN, MBA, BSN, has been named the new associate director for patient care services at the West Palm Beach VA Healthcare System. Arnold previously served as both Chief Nurse of Geriatrics and Extended Care, and later as the Chief Nurse for Operations for Bay Pines VA Health Care System.
Sonya Arnold is now an associate director at the West Palm Beach VA.
— State Sen. Jay Collins and Rep. Danny Alvarez have been appointed to the Veterans Florida Board of Directors as ex officio members. Their appointments are the result of a mandate in HB 1329 that required two non-voting positions be added to the board, one appointed by the Senate President and the other appointed by the House Speaker." These two men embody the concept of public service; sacrificing their time to serve America in the military and Floridians in the Legislature," said Robert Kirila, Chair of the Veterans Florida Board of Directors. "They will contribute greatly to our mission of ensuring veterans and separating service members begin their civilian careers, or their own businesses, in our great state."
— Florida Health Care Association CEO Emmett Reed was awarded the Walter M. Johnson, Jr. Circle of Excellence Award at the nursing home association's 2024 Annual Conference & Trade Show in Orlando. The award is FHCA's highest honor. Reed has served as CEO of FHCA since 2009.
— ICYMI —
In case you missed them, here is a recap of other critical health care policy stories covered in Florida Politics this past week.
"Dueling polls show different levels of support for legalizing pot for adults" via Christine Jordan Sexton of Florida Politics— Two new polls are showing different outcomes for a proposed amendment that would allow adults in Florida to possess and use recreational marijuana. One new poll from Florida Atlantic University contends that a proposed amendment that would legalize marijuana is falling short of the 60% support needed to pass, although it also found a significant number of voters remain undecided about the initiative.
"Poll: Abortion rights initiative short of 60% needed to pass, but nearly 1/4 of voters undecided" via Gabrielle Russon of Florida Politics — A new poll shows November's abortion rights initiative might not have enough support to pass, although a high number of voters — 23% — are still undecided. To enshrine abortion rights into the state constitution, Amendment 4 needs at least 60% of the vote. But about 56% of all voters support the initiative, according to the latest numbers from Florida Atlantic University Political Communication and Public Opinion Research Lab (PolCom Lab) and Mainstreet Research USA.
"Florida poised to rebid $13B program for medically fragile children" via via Christine Jordan Sexton of Florida Politics — Florida health care officials are expected to drop another invitation to negotiate (ITN) for a Medicaid program, this one for the Children's Medical Services (CMS) Health Plan. The nearly $13 billion contract to provide health care services for medically complex children who are Medicaid or state children's health insurance program eligible expires Jan. 31, 2025, and the Department of Health (DOH) is expected to drop an ITN to procure the program any day.
"Donald Trump teases support of Florida marijuana legalization amendment" via A.G. Gancarski of Florida Politics — The Republican presidential nominee may be in favor of Florida legalizing adult use cannabis. During a news conference at Mar-a-Lago, Donald Trump suggested he was open to supporting marijuana legalization, and promised a forthcoming statement on Florida's Adult Personal Use of Marijuana amendment on November's ballot.
— FOR YOUR RADAR —
Aside from coverage by Florida Politics, these stories are worth your time.
"Dozens of pregnant women, some bleeding or in labor, are turned away from ERs despite federal law" via Amanda Seitz of The Associated Press — Bleeding and in pain, Kyleigh Thurman didn't know her doomed pregnancy could kill her. Emergency room doctors at Ascension Seton Williamson in Texas handed her a pamphlet on miscarriage and told her to "let nature take its course" before discharging her without treatment for her ectopic pregnancy. When the 25-year-old returned three days later, still bleeding, doctors finally agreed to give her an injection to end the pregnancy. It was too late. The fertilized egg growing on Thurman's fallopian tube ruptured it, destroying part of her reproductive system. That's according to a complaint Thurman and the Center for Reproductive Rights filed last week asking the government to investigate whether the hospital violated federal law when staff failed to treat her initially in February 2023.
"A Florida first: Orange County hopes to erase medical debt for thousands" via Lauren Brensel of the Orlando Sentinel — Putting leftover pandemic relief funds to use, Orange County will spend $4.5 million to wipe medical debt for thousands in a move that county leaders believe to be a first in Florida. County Commissioners voted 5-2 to partner with a national nonprofit that intends to buy the debt for pennies on the dollar and then forgive those who owe it. The aid will go to residents whose medical debt constitutes 5% or more of their annual household income or who are living in households earning a salary four times below the federal poverty line. In the U.S. that line is $31,200 for a family of four.
"Retired Jacksonville educator: Making a case in support of Florida's Amendment 3" via Barbara Langley for The Florida Times-Union — Beneath the surface, it will create a safer Florida for us all. One of the most pressing concerns I've heard from parents and fellow educators alike is the fear that marijuana legalization will lead to increased use among our young population. However, recent studies strongly suggest otherwise. In April, the American Medical Association reported that there is "no evidence" that marijuana legalization for adults increases youth cannabis use. This finding is consistent with data from states that have already legalized recreational marijuana. As someone who has dedicated her life to the education and well-being of Florida's youth, I believe that Amendment 3 is a step in the right direction. It aligns with our values of promoting safety, health and fairness. I urge my fellow Floridians to look beyond the myths and fears surrounding marijuana legalization and consider the substantial evidence supporting its benefits.
— PENCIL IT IN —
Thursday
11 a.m. — Republican Sen Joe Gruters (R-Sarasota) releases draft legislation aimed at banning smoking in all public places, Microsoft Teams. Meeting ID: 233 831 243 49; Passcode: YWW5S3. Or call 1(850) 688-9472; conference ID: 499 636 393#.
Saturday
Happy birthday to Sen. Ben Albritton!
Monday
11 a.m. — The Florida Department of Health, Division of Community Health Promotion meets with the Information Clearinghouse on Developmental Disabilities Advisory Council to advise the Department of Health on establishing and maintaining a clearinghouse of information related to developmental disabilities on its website. Microsoft Teams. Or, call (850) 7921375; participant code 831588295.
1 p.m. — The Agency meets to discuss its Medicaid provider reimbursement schedules and billing codes. Agency for Health Care Administration, 2727 Mahan Dr., Building 3, Tallahassee.
Tuesday
It's Primary Election Day.
2 p.m. — Diabetes Advisory Council (DAC) meets (850)-792-1375; participant code: 910 600535#. Or join the meeting via Microsoft Teams: Meeting ID: 241 721 898 992; participant code: 32cHPQ
Wednesday
10 a.m. — Blood Clot and Pulmonary Embolism Workgroup meets. Attendees may register for the meeting here. After registering, a confirmation email will be received containing information about joining the webinar, and opportunities to offer comments and questions will be available.
Diagnosis is written by Christine Jordan Sexton and edited by Drew Wilson and Phil Ammann.
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