Medicaid for developmentally disabled, nursing home transparency are tops for Carlos Guillermo Smith

Guillermo Smith, Carlos
Carlos Guillermo Smith vows to spotlight Medicaid funding needs for developmentally disabled population.

Rep. Carlos Guillermo Smith is geared up for the 2022 Legislative Session, one in which he promises to shine the light on what he considers one of the least understood issues in the Florida Legislature: the needs of people with developmental disabilities.

Smith, a Democrat from Orlando, helped lead the charge last Session to secure tens of millions in additional funding to remove 2,000 people from a lengthy waitlist for the iBudget Medicaid waiver program, run by the Agency for Persons with Disabilities (APD).

Created by former Gov. Jeb Bush, who dubbed himself a compassionate conservative, the program allows people with intellectual or developmental disabilities to receive home- and community-based services that allow them to remain living outside of institutions.

It is a waiver program because Medicaid does not cover home- and community-based services. Because it is a waiver program, though, there is no entitlement to the service, which means the wait lists can grow.

But more costly institutional care is an entitlement.

Smith said legislators are not aware of the lengthy waitlist for the service because state economists do not include the projected enrollment needs or program costs like other Medicaid programs.

“They don’t want to shine the light on what they are most embarrassed by, which is that we have left so many Floridians with disabilities behind,” Smith said. “But that’s my goal. My goal is to shine the light on this tremendous need that exists. Many lawmakers do not even know that the APD waitlist is 22,000 persons long and that 40% of people on that list have been on it for more than 10 years. They are shocked to find out. They should be shocked. They should be appalled. And I hope that that brings them into action in joining us trying to make this investment.”

He is not stopping at pressing for another hefty investment to reduce the wait list, either. Smith is co-sponsoring HB 675 along with Rep. Marie Woodson. The proposal establishes a Medicaid buy-in program for individuals between the ages of 16 and 64 who earn too much to qualify for Medicaid.

Increasing financial reporting requirements for Florida nursing homes also remains a top priority for the Representative, who noted the powerful House Appropriations Chairman Rep. Jay Trumbull is also invested in the issue. The House Appropriations Committee is slated to take up Trumbull’s bill, HB 539, when it meets Tuesday.

“We give the nursing home industry, which is a for-profit industry, $4 billion dollars a year in taxpayer money. My goal is to make sure that those dollars that are being spent are transparent and accountable. We want to make sure we are the standards for resident care in our nursing homes. And I feel really good that we have some bipartisan synergy on the House side toward raising the bar in our nursing homes.”

In addition to the health care agenda, Smith will push for increased funding to support the arts, which he says is a $4 billion economic engine in the state. From performing art venues to fine art museums, the businesses were some of the first to close during the pandemic and they still are struggling to reopen.

The Legislature also needs to address workforce housing issues, said Smith, who was part of a group of lawmakers who asked Gov. Ron DeSantis to declare a state of emergency on rising rent.

Christine Jordan Sexton

Tallahassee-based health care reporter who focuses on health care policy and the politics behind it. Medicaid, health insurance, workers’ compensation, and business and professional regulation are just a few of the things that keep me busy.


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