The state’s largest health care agency is facing a legal crisis. And it’s not the result of any lawsuit.
The Agency for Health Care Administration’s (AHCA) legislative budget request for state Fiscal Year 2023-24 paints a dire picture of its Office of the General Counsel, as well as the Medicaid Fair Hearings Unit within the office, with high turnover rates for lawyers working in either position.
Fifty-eight lawyers have resigned from the agency since 2016, and there are 13 open positions in the agency’s Office of the General Counsel, according to the legislative budget request.
The Medicaid Fair Hearings Unit has just three hearing officers on board and six open positions, causing the agency to note that it’s not “feasible” that the unit continue as is.
AHCA attributes the churn in its General Counsel’s Office to the low salaries of its lawyers coupled with the demanding work.
The starting salary for an entry level attorney at AHCA is $41,186.08 according to the agency’s legislative budget request (LBR), about $11,000 less than the average salary for the position. The same is true for senior attorneys. Senior attorneys at AHCA earn $54,404.48 much less than the $74,350.37 the state pays on average for a senior attorney.
“The OGC has had significant difficulty in attracting well-qualified candidates for these positions at the base salary, and the OGC will continue to experience turnover unless it is able to provide rate increases for its current staff and higher salaries for incoming candidates,” the agency wrote in the LBR.
In addition to requesting higher wages, the state is asking that it be allowed to eliminate three administrative positions in the General Counsel’s Medicaid Fair Hearing Unit and use the $180,000-plus to hire additional senior attorneys to serve as Medicaid fair hearing officers. Since March 2017, the unit has experienced a 114.29% turnover in staff.
The lawyers in the unit serve as “Medicaid fair hearings officers,” who listen to the complaints from Medicaid beneficiaries whose services have been changed or denied. They also hear cases when beneficiaries’ requests to change health plans for “good cause” are denied.
There were 1,534 requests for Medicaid fair hearings in Fiscal Year 2021-22. And the requests for the hearings continue. AHCA noted 321 requests for a fair hearing have been made by beneficiaries in the first quarter of Fiscal Year 2022-23.
The agency has not been able to hire attorneys to serve as hearing officers and puts the blame on the positions being classified as OPS, which it says “does not attract candidates with the skills necessary to conduct these types of hearings.”
LBRs signify the beginning of the annual appropriations process. State agencies are asked to prepare legislative budget requests in advance of Regular Legislative Sessions. The LBRs are wish lists, but they are also used by Governors who rely on the documents as they prepare their own legislative spending proposals.
In addition to requesting money to increase the wages of lawyers, AHCA also has pushed for an additional $390,003 to increase the wages of staff in its Bureau of Financial Services, which is responsible for agency’s financial operations.
Those operations include managing federal grants, analyzing agency trust funds, disbursing payments, maintaining accurate financial and accounting records, collecting fees and fines from licensed health care entities, and maintaining the agency’ budget operations, from developing proposed budget amendments to completing the annual legislative budget requests.
Though the LBR doesn’t discuss turnover, the agency wants to increase what it pays registered nurse (RN) specialist positions and registered nurse consulting positions and wants $3.847 million to make it happen.
The money will be used to pay 141 RN specialists on staff $65,000 annually and the 44 RNs it consults with $70,000 annually.
In addition to raising the pay for RN consultants, AHCA also wants lawmakers to approve $770,000 to augment its information technology staff and to hire a certified project management professional, an advanced business analyst and application developers to ensure SunFocus, the agency’s financial management system, coordinates with the Florida Accounting Information Resource (FLAIR) in the Department of Financial Services.