Diagnosis for 6.14.23: 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.

— Stop the drop —

This week, Federal authorities called on states not to drop people from Medicaid for administrative reasons.

According to the latest figures compiled by the Kaiser Family Foundation, more than 1 million people nationwide have been disenrolled from Medicaid so far this year.

Florida still leads the nation with the most people disenrolled with roughly 249,000, but that is based on data released in May. States were required to submit disenrollment numbers last week. But the Department of Children and Families handles eligibility determinations for the safety net health care program and still needs to provide the updated data to Florida Politics.

Kaiser maintains a dashboard of state’s disenrollment but, as of press time, only had data from what had already been published.

In a letter to Governors, Health and Human Services Secretary Xavier Becerra said, “I am deeply concerned with the number of people unnecessarily losing coverage, especially those who appear to have lost coverage for avoidable reasons that state Medicaid offices have the power to prevent or mitigate.”

He added, “Any avoidable loss in coverage is concerning, but I am particularly concerned that children may lose coverage because their parents do not understand that even if they experience a transition in coverage, their children are very likely still eligible for coverage through Medicaid or children’s health insurance program.”

Becerra outlined several steps states could take to avoid dropping enrollees, including letting managed care organizations assist beneficiaries in filling out required forms. He also noted that states could spread out renewals for Medicaid over 12 months.

States could not disenroll people from Medicaid during the public health emergency connected to COVID-19. That changed this spring, and states like Florida have begun reviewing the rolls to remove people no longer eligible for coverage.

In addition to the HHS letter, National Association of Medicaid Directors Executive Director Kate McEvoy issued a statement telling states that they must clarify that Medicaid enrollment is open year-round.

“Medicaid is always open for new enrollment or re-enrollment. Unlike private insurance, which has open enrollment periods with limited exceptions for life events, Medicaid is always available to people who need it and qualify for the program. Even if a person loses eligibility because they have not been able to respond timely or only learn they have lost eligibility when they visit the doctor, they can be restored to eligibility at any time.”

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— No. 31 —

Florida ranks 31st in the 2023 KIDS COUNT report released Wednesday.

The ranking is based on the state’s performance in four categories: economic well-being, health, family and community and education. The report uses 2021 household data developed by the Annie E. Casey Foundation.

Florida ranked 37th in economic well-being, including children in poverty, high housing costs, parental employment security, and students who dropped out of high school.

Compared to the pre-pandemic 2019 KIDS COUNT survey, Florida held steady with 18% of children living in poverty, 36% of families reporting high housing costs and 7% of students dropping out of high school. Parents reporting job insecurity rose from 27% to 29% over the past four years.

Florida ranked 33rd in health, with the state losing ground compared to 2019 on three of four components: low birth weight babies; child and teen deaths per 100,000; and children aged 10-17 who are overweight. There were fewer children without health insurance in 2021 (7%) compared to 2019 (8%), said Florida Policy Institute (FPI) senior policy analyst and KIDS COUNT Director Norín Dollard.

The state ranked 32nd in the family and community category. In 2021 7% of children lived in high-poverty areas, a reduction from 12% in 2019. The rate of teen births per 1,000 dipped from 16 in 2019 to 13 in 2013, and the percentage of children living in single-family households in 2021 fell to 38%, down from 39% the prior year.

Finally, Florida ranked fifth in education, improving the number of fourth grade children not reading on grade level, dropping from 62% to 61% compared to 2019.

— Child care ‘crisis’ —

In Florida, costs for infant child care are higher than college tuition, according to the 2023 KIDS COUNT Data Book released Wednesday.

In Florida, 13% of children from birth to age 5 lived in families where someone quit, changed, or refused a job because of problems with child care, the Data Book shows.

The national online group MomsRising/MamásConPode is launching a campaign in Florida on Thursday, encouraging lawmakers and policymakers to do more to provide access to quality child care, MomsRising national campaign director Nina Perez said.

“Child care is an incredibly important solution to the inability for folks to access the workforce. Families can’t make ends meet, businesses can’t hire and retain employees they need, and our loved ones don’t get the early education and the social supports that help them succeed in school and our economy suffers,” she said.

Indeed, a separate study found that Florida’s average cost of center-based child care for a toddler in 2021 was $8,678, or 9% of the median income of a married couple and 26% of a single mother’s income in the state, according to the Data Book.

While the campaign officially launches Thursday, Perez said the group would work “arm in arm” with child care providers over the summer on letter-writing campaigns and local events. She said the goal is to develop “story books” from families across the state sharing their journey on securing child care.

According to another study, the lack of access to high-quality, affordable child care brings productivity challenges at work, costing Florida an estimated $6.6 billion in lost earnings productivity and state revenue.

President Joe Biden issued an executive order in April to expand access, lower costs, and raise wages for child care workers. It could be a helpful framework, but Dollard said federal, state, and local governments should maximize remaining pandemic recovery dollars to fund needed child care services and capacity.

Public and private leaders should work together to improve the infrastructure for home-based child care in part by increasing access to startup and expansion capital.

Moreover, FPI maintains that Congress should expand the federal Child Care Access Means Parents in School (CCAMPIS) program, which serves student parents.

— Tick, tick, tick —

The deadline for Florida Gov. Ron DeSantis to act on a $117 billion budget is getting closer, but it’s unclear when he will act.

DeSantis, who is now running to become the Republican nominee for President, has spent most of his time on the campaign trail, including a swing through Oklahoma last Saturday. He is also scheduled to be in Nevada over the weekend.

But the Governor’s schedule this week shows he has been meeting with top aides, including two meetings with his budget director, Chris Spencer.

The state’s fiscal year begins July 1, and state legislators passed a spending plan for the 2023-24 year in early May.

Legislators this year had a hefty budget surplus to work with and were able to set aside money for hundreds of local and hometown projects, including many in the health care arena.

The new budget includes spending increases for pediatric physicians, expanded access to Florida KidCare, the subsidized children’s health insurance program, and increased nursing home reimbursement rates.

DeSantis has used his line-item veto power aggressively in the past, but this year state legislators delivered on nearly all of his key priorities.

— Read it here first —

The budget package approved by lawmakers last Session included a substantial funding bump for the Casey DeSantis Cancer Research Program.

In addition to boosting overall program funding, House Speaker Paul Renner and Rep. Sam Garrison championed a change to allow the Mayo Clinic to claim a slice of the funding. The program is currently limited to Florida-based institutions, and Mayo is based in Minnesota.

Only three Florida-based cancer centers have access to the money: the University of Miami Sylvester Comprehensive Cancer Center, Moffitt Cancer Center and the University of Florida Health Cancer Center.

While Mayo is arguably the biggest winner, another change to the Casey DeSantis Cancer Research Program could be a boon for UF in future budget years.

Program funding is awarded to facilities recognized by the National Cancer Institute, the federal government’s principal agency for cancer research and training. Based on the type and breadth of research conducted, the NCI awards one of three designations: comprehensive cancer centers, cancer centers, or basic laboratory cancer centers.

The funding the centers can qualify for is based on their NCI designation level. There are three tranches. UF, which technically isn’t an NCI-designated cancer center, currently is in tier 3, the lowest tranche.

But emails obtained by Florida Politics during Session showed the institution expected to be upgraded from a basic laboratory cancer center to a cancer center this month. The announcement appears imminent, with the university teasing the announcement of a “milestone achievement” next week.

— RULES —

The Board of Medicine has published its emergency rule on gender-affirming care for minors. More here.

— LOBBYISTS —

Slater Bayliss, The Advocacy Partners: NWF Health Network

Al Balido, Anfield Consulting: Premier Bioscience

— ETC —

— Thirty-five states, including Florida, have taken advantage of a Medicaid option to improve maternal health, extending the length of coverage by 10 months. The Department of Health and Human Services announced this week that New York was the 35th state to be approved for the extended coverage, first made allowable under the American Rescue Plan (ARP) and made permanent by the Consolidated Appropriations Act, 2023 (CAA, 2023), which President Biden signed into law earlier this year. The 10-month extension means postpartum women can have continuous coverage for one year following delivery. The extension is part of Biden’s Maternal Health Blueprint.

— About 32% of adults in Florida reported symptoms of anxiety and/or depression in 2022. Yet, only 21% of Floridians’ mental health needs are currently being met. Creating an environment where reduced stigma fosters awareness of one’s own mental health needs is a major step we have achieved as a society, according to President and CEO of IMPOWER Anna M. Kesic. More here.

— ROSTER —

— BayCare has promoted Jason Rodriguez to Director of Government Relations and John Learn to Government Relations Manager, effective immediately. Rodriguez joined the BayCare team as a Government Relations Manager five years ago. In his new role, he will oversee our government relations efforts at the federal, state and local levels. He succeeds Clint Shouppe, who has held the interim position for the past five months. Learn, meanwhile, joined BayCare two years ago as a Government Relations Strategist. BayCare Chief of Staff and Chief Communications Officer Keri Eisenbeis said Learn would serve as the organization’s “primary point person for federal issues” going forward. More here.

— HCA Florida Aventura Hospital has named Carolyn Hunter as its chief operating officer. Hunter is not new to HCA, having most recently served as the CA Healthcare’s North Texas Division, where she served as a chief operating officer of Medical City Las Colinas since 2019.

 

— ICYMI —

In case you missed them, here is a recap of other critical health care policy stories covered in Florida Politics this past week.

Big expansion: DeSantis signed HB 121, House Speaker Renner’s top priority, into law. The new law allows Florida families to earn up to 300% of the federal poverty level, or $83,250 annually for a family of four, and continue to qualify for Florida KidCare. Previously, the program was only available to families earning 200% of the FPL, or $55,500 annually for a family of four. HB 121 takes effect upon becoming law, but the children cannot enroll in the program until Jan. 1, 2024. That gives the Florida Healthy Kids (FHK) Board of Directors time to establish premiums and copayments for newly eligible enrollees.

Lotta green: Florida’s largest medical marijuana company just dropped a cool half million on a campaign to legalize recreational pot. Trulieve, a licensed marijuana dispenser with nearly 140 locations, donated $550,000 to the Smart & Safe Florida political committee in May. The May 20 check marked the only fundraising reported by the committee during the month but brings the total raised this election cycle by the committee to more than $29 million. Nearly all of that has come from Trulieve. Smart & Safe Florida is the official effort to place an adult-use constitutional amendment on Florida’s statewide ballot next year. If passed, it would require the decriminalization of marijuana for adults and make Florida the 24th state to legalize recreational cannabis use.

Pay bump: Medicaid Managed Medical Assistance (MMA) plans have been given $181 million to distribute to the home and community-based services (HCBS) providers they contract with to bolster Florida’s provider network. Specifically, the one-time incentive payments are targeted at MMA-contracted companies that provide assistive care, home health care, private-duty nursing services, community behavioral health, and specific durable medical equipment. Providers don’t have to submit any paperwork to get the additional payments. That’s because the state calculated the costs in advance, essentially increasing by 19% the rates paid for home and community-based services during Fiscal Year 2021-22. It’s not entirely clear when providers should expect payments.

Celebrity endorsement: Jim Belushi owns Belushi’s Farm, one of 74 entities that submitted a licensure application to the Office of Medical Marijuana Use in the Florida Department of Health. While the state has posted the names of the 74 applicants on its website, it still has not made available for the public to review copies of the redacted applications. Belushi had operated a 93-acre marijuana farm in Southern Oregon since 2015 when weed became legal there. In 2020, Discovery Channel premiered the reality series Belushi’s Farm. It’s now in its third season. Jim Belushi says marijuana relieves his post-traumatic stress disorder, which he attributes to the death of his brother John Belushi. He also has said he doesn’t think his brother would have died from a mixture of heroin and cocaine had marijuana been legal.

Jobs, jobs, jobs: Supporters of a measure to legalize marijuana in Florida asserted that a “yes” vote would create an additional 24,000 jobs in the state — double the number of jobs in the state’s medical marijuana industry. Smart & Safe Florida, the political committee sponsoring the proposed constitutional amendment, also estimated recreational marijuana sales would generate about $152 million in sales tax revenue from a projected $2.5 billion in overall sales each year. The organization gave its figures to state economists who held a public workshop to look at the potential fiscal impact of the amendment. The Financial Impact Estimating Conference is charged with drafting a proposed statement that will appear on the November 2024 ballot if the state Supreme Court eventually clears it.

— FOR YOUR RADAR —

Aside from coverage by Florida Politics, these stories are worth your time.

—“Fraudsters are duping homeless people into signing up for ACA plans they can’t afford” via Daniel Chang of KFF Health News — Potentially hundreds of homeless people in Florida have been approached by commission-seeking agents and brokers, who sign them up for zero-premium health plans on the Affordable Care Act marketplace, according to state insurance regulators, doctors, and enrollment counselors. The presumption is that dishonest agents and brokers are signing homeless people up to earn a sales commission and are engaging in fraud by lying about the enrollees’ income and home addresses. The policies often come with copayments, deductibles, and other out-of-pocket costs that are unaffordable to people earning little to no income. Amid an uptick in reports, state and federal regulators are investigating cases of agents and brokers providing fraudulent information on applications for ACA coverage.

—“Supreme Court preserves Medicaid recipients’ right to sue” via Ariel Cohen of Roll Call — The Supreme Court on Thursday ruled 7-2 to protect the right of Medicaid nursing home residents to seek relief in federal court when state officials do not meet a certain quality of care, a ruling policy watchers hail as a civil rights victory for Medicaid patients. In the case, Health and Hospital Corporation of Marion County v. Talevski, nursing home patient Gorgi Talevski’s wife, Ivanka, accused the Indiana health system of violating a 1987 federal law governing nursing homes that receive federal funding. The law includes a provision prohibiting nursing homes from using psychotropic drugs for nonmedical reasons.

—“Florida rejected federal youth health survey for being too sexual, so it came up with its own” via Katie LaGrone of ABC Action News — Created earlier this year, the Florida-specific youth survey (FSYS) replaces the CDC’s youth risk behavior survey (YRBS). The YRBS is a biannual voluntary student questionnaire that has long been used to chart and compare risky behaviors among teens in the U.S. But last year, Florida’s Education Commissioner Manny Diaz Jr. called the federal survey “inflammatory” and “sexualized.” So, with the help of researchers from the USF, Florida’s Department of Education put together its own youth survey. But when it comes to asking teens about risky behavior, the Florida-specific youth survey deliberately doesn’t go very far. Just three questions address sexual behavior and focus on abstinence awareness.

—“Recreational marijuana may be on Florida ballot; here’s why leading pot advocate isn’t happy” via James Call of the Tallahassee Democrat — The Adult Personal Use of Marijuana proposed ballot measure would legalize marijuana for nonmedical use and has submitted the required number of signatures to qualify for the 2024 ballot. But the executive director of the Suncoast NORML chapter is not celebrating the milestone. Chris Cano said his review of the initiative finds people and consumers were afterthoughts in how it is written. At the same time, the interest of current marijuana industry players will benefit if the proposal becomes law. “The amendment itself does nothing to expand the cannabis industry. It essentially allows the existing limited cartel structure of license holders to start selling over-the-counter adult-use cannabis for a higher price,” said Cano, discussing last month’s proposal.

—“Why we should ban smartphones in schools” via Hugh Hewitt for The Washington Post — Evidence has lately become clear that phones are addling young minds and that there is a causal link between their use and skyrocketing mental health issues among the young. Social psychologist Jonathan Haidt summarizes his findings: “So the time is right for parents and educators to ask: Should we make the school day phone-free? Would that reduce rates of depression, anxiety, and self-harm? Would it improve educational outcomes? I believe that the answer to all of these questions is yes.”

— PENCIL IT IN —

Thursday

10 a.m. — The State Consumer Health Information and Policy Advisory Council meets. Agenda here. Virtual meeting link here.

1:30 p.m. — The Medicaid Drug Utilization Review Board is scheduled to meet. Virtual meeting link here.

Friday

8:30 a.m. — The Medicaid Drug Utilization Review (DUR) Board meets. Agenda here. Virtual meeting link here.

Wednesday

Happy birthday to Rep. Chuck Clemons

Happy birthday to Rep. Linda Chaney

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Diagnosis is written by Christine Jordan Sexton and edited by Drew Wilson.