Diagnosis for 9.7.23: 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.

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— Pot poll —

A new public opinion poll shows that residents still are skeptical about COVID-19 vaccines and there is strong support for adult use of recreational marijuana.

Conducted by researchers at the University of South Florida and Florida Atlantic University, 14% of survey respondents believed that COVID-19 vaccines contained microchips; 24% thought it was probably or definitely true that the vaccines could cause infertility; and 26% thought it was probably or definitely true that COVID-19 vaccines could alter your DNA.

Respondents also generally support the legalization of medical and recreational marijuana. A majority (60%) of Floridians said they support legalizing recreational marijuana and support for medical marijuana is even higher at 83%.

And while the scent of marijuana seems ubiquitous these days, the poll shows that less than half of those polled (45%) agreed that medical marijuana is being abused.

The survey included a representative sample of 600 adult Floridians, fielded Aug. 10-21, 2023. Respondents are representative of the state’s population based on age, gender, race, ethnicity and political affiliation. Results are reported with a confidence level of 95% and a margin of error of +/- 4%.

Respondents did not believe that people with HIV should be required to disclose their status to potential sexual partners, though 47% of respondents said people should be required to disclose their status before kissing. Meanwhile, 40% of respondents support disclosure before intercourse.

Also, 88% of respondents strongly or somewhat supported making condoms free and easily accessible, while 85% strongly or somewhat supported making HIV medications easily accessible and free.

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— Abortion arguments —

The Florida Supreme Court is poised to make a major decision that will affect the future of abortion restrictions in the state, which remain less stringent than those in most other Southeastern states.

Justices will hold oral arguments Friday on whether Florida’s existing 15-week abortion violates the privacy clause in the state constitution, enacted by voters in 1980. Nine years after the clause was approved, justices on the high court cited it when blocking an abortion law — a precedent that has remained in place since.

The Legislature passed and Gov. Ron DeSantis signed into law the 15-week ban last year shortly before the U.S. Supreme Court rescinded Roe v. Wade. A circuit court judge moved to block the law, but that decision was appealed and the 15-week restriction has remained in effect.

Attorney General Ashley Moody has asked the court to overturn the 1989 ruling, contending that it is as “egregiously wrong” as the Roe decision and that the privacy clause was never intended to include abortion.

“Far from a hidden thought whispered in the confines of the home, the effects of abortion ripple throughout society, from the women who endure it to the medical staff who perform it, to the unborn lives extinguished by it,” states the brief from Moody and her legal team.

But attorneys representing the abortion clinics and the physician challenging the 15-week law pointed out that voters in 2012 rejected a constitutional amendment proposed by the Legislature that would have wiped out the 1989 ruling.

“The state asks this court to override the will of the people and do with the stroke of a pen precisely what the people rejected at the ballot box,” states the brief filed by the American Civil Liberties Union and other groups.

The outcome of the court challenge to the 15-week ban is vital because Florida legislators passed a bill in the spring that would restrict abortions after six weeks of pregnancy. But that measure, also signed into law by DeSantis, does not take effect until 30 days after the court rules in the 15-week case.

The makeup of Florida’s highest court has completely shifted over the last several years due to several appointments made by DeSantis. The Republican Governor placed five of the seven justices sitting on the court.

— Medicaid, KidCare are ‘critical’ —

Florida’s major health care programs are among the drivers that will play a role in the state’s financial health over the next several years, according to the latest three-year long-range financial outlook that the state Legislative Budget Commission will adopt on Friday.

The outlook analyzes revenue and spending needs between the 2024-25 fiscal year and 2026-27.

Medicaid provides health care coverage to low-income children, elderly, disabled or families with dependent children. Medicaid is jointly funded by the state and federal government and is the most extensive single program in the state budget, representing 29.1% of the total. It is also the largest source of federal funding for the state.

Medicaid enrollment and costs are flagged as one of 14 budgetary “critical needs” in the outlook that, absent significant law or structural changes, must be funded for government services to work.

As the state resumes redeterminations, Medicaid enrollment in FY 2023-24 is expected to decrease by 10% from the previous year. The state began redetermining people for Medicaid in April after the public. Enrollment is still expected to hover around 5 million people but is projected to decrease by an additional 6% over the three years to 4.7 million people. That is still significantly higher than pre-pandemic enrollment levels. In FY 2018-2019, for instance, there were 3.8 million people enrolled in Medicaid.

Medicaid is projected to cost $35 billion in the current fiscal year and increase to $35.4 billion in the state fiscal year (FY) 2024-25; that’s $916 million more than what’s in the recurring base budget to fund the program. According to the outlook, the general revenue needed for FY 24-25 is $242.2 million.

Economists also flagged KidCare enrollment and expenditures as a “critical need” in the outlook. According to the document, $79 million is needed for KidCare enrollment, which is expected to total 249,708 in FY 2024-25.

— DCF tops ‘high priority’ needs. —

In addition to flagging “critical needs,” the long-range outlook identifies 28 other program areas and services that are “high priority” or have been funded in most, if not all, recent budgets.

“The most significant budget driver in this policy area is Children and Family Services,” economists noted in the outlook, adding that DCF is projected to need $222.7 million in state funding in FY 2024-25 and more than $668 million over the three-year outlook.

“This driver includes funding for community-based care lead agencies core services operations to keep families together and safe; child welfare initiatives aimed at reducing the number of children in out-of-home care; adoption maintenance subsidies to families that adopt a child from the child welfare system; resources for foster families to support the care of foster children; and funding needs resulting from recent federal changes,” the outlook reads.

“Funding is also included for mental health and substance abuse services provided through community providers with a focus on opioid crisis response; mental health treatment facility needs and operating contracts; and forensic treatment beds.”

The Department of Health (DOH) has $50 million in “critical needs” funding required in FY 2024-25 and $150 million over the three years covered by the outlook. The money would be used for the Early Steps program, the Office of Medical Marijuana Use, Florida Poison Control Centers, child protection teams, medical quality assurance services, minority health Initiatives, biomedical research and health care loan repayment programs.

Economists also included in the Outlook funds to the Agency for Persons with Disabilities (APD) to eliminate waiting lists for Medicaid waiver services for people with intellectual and developmental disabilities and the Department of Elder Affairs (DOEA) to reduce the waitlist for the Community Care for the Elderly program and the Home Care for the Elderly program. The outlook includes $36.7 million in state funds for APD in FY 2024-25 and $110.1 million over the three years and $18.5 million to DOEA in FY 2024-25 and $55.5 million over the three years.

Economists also included $4.9 million for the state Department of Veterans’ Affairs next fiscal year and $14.7 million over the three-year outlook. The money is for repairs and maintenance at state veteran nursing homes and to fund veteran-friendly initiatives in the state.

The outlook also includes continued investment in information technology, including $21.1 million in FY 2024-25 and $63.5 million in general revenue funds for information technology advancements, including AHCA’s continuation of the Florida Health Care Connections (FX) system.

— Expanding 988 —

In addition to adopting the financial outlook, members of the LBC on Friday will also discuss a few legislative budget amendments, including one that gives the state the green light to spend an additional $8 million on its 988 Suicide and Crisis Lifeline.

According to a DCF budget amendment, Florida handled nearly 74,000 calls to its 988 Lifeline between July 2022 through May 2023. During the same period, 34,022 chats and 28,566 texts were sent to the number from Florida.

And the calls are expected to increase by as much as 50%.

The 988 Lifeline serves as a universal telephone number for national suicide prevention and mental health crisis lines and was created as part of the National Suicide Hotline Designation Act of 2020. The federal law requires states to be responsible for building and maintaining the new 988 Lifeline but provides states with funding opportunities for build-out and startup efforts.

While telephone calls to the national 988 Lifeline are routed to the state of origin, text and chat encounters are handled at the national level.

The budget amendment gives DCF the authority to spend $8 million between now and Sept. 30, 2024, including providing DCF the authority to spend nearly $6 million more on community substance abuse and mental health services to increase the capacity of the 988 Suicide and Crisis Lifeline.

According to the budget amendment, the $8 million is the first installment in a three-year grant.

— 3Q —

At least five people in Florida have died this year from a deadly flesh-eating bacterium in warm ocean waters called Vibrio vulnificus and the bacteria also has been responsible for deaths in Connecticut, New York and North Carolina. With Idalia bringing storm surge to the Big Bend area, there are worries that the brackish water can bring a new round of infections in the Sunshine State. Norman L. Beatty, M.D., an assistant professor of medicine in the UF College of Medicine’s Division of Infectious Diseases and Global Medicine, spoke with Florida Politics Wednesday about the bacteria and the public health concern of Floridians. Below is an edited transcript of the interview.

Q: With Hurricane Idalia making landfall, is there concern that more people could be at risk?

This is a very important and timely matter because of Hurricane Idalia, which hit the Big Bend area, where several coastal towns did have a significant amount of storm surge. And we are monitoring at this time for an increase in these Vibrio infections in these communities which are rebuilding. And these communities which are rebuilding. We have been trying to bring awareness in the small communities to help community members understand the importance of staying out of the water and keeping their wounds free from exposure to the saltwater. And we, you know, recently last year with Hurricane Ian in Southwest Florida, there was a significant increase in the cases of Vibrio vulnificus infections, which some of them were fatal after the hurricane. So, at this time, our team, the University of Florida, is monitoring these infections to present to our hospital as well as we have collected water samples from several of these communities that have been impacted to assess the presence of Vibrio species in the water.

Q: In a post-hurricane environment, people can get cut if they’re working to remove debris, among other things. If I have cuts, how can I keep myself safe?

The most important factor would be to protect your skin from the water. So, wearing appropriate footwear, wearing boots that will protect you from direct exposure to the water, wearing long pants, keeping your extremities clean from the muck and debris and wearing gloves. If you do acquire a wound, cleanse it immediately and try to free it from any contaminated water or soil. And have access to clean water. And wrap it if you have an existing wound.

Q: People understand that eating raw oysters exposes themselves to these bacteria. Do people know they can get this in the aftermath of a hurricane?

We are currently investigating and have been surveying the communities, especially the community aid workers, on the risk of Vibrio vulnificus. After a storm such as this, we are finding in our preliminary results that there is a general awareness of Vibrio vulnificus but a lack of understanding on how to protect yourself from the wound infection that you could get, and as well as just how serious this infection could be if you were to have it. So, we’ve been trying to educate community members on the signs and symptoms of what a wound infection would look like. If that were to happen and, you know, ways to seek medical attention quickly if you have concerns for Vibrio vulnificus infection.

—RULES —

AHCA is amending proposed Rules 59E-4.101, 59E-4.102 and 59E-4.103 regarding Prior Year Report Revisions, Ownership Change and Fiscal Year End Change. More here.

AHCA is amending proposed Rule 59E-4.102 regarding the Florida Nursing Home Uniform Reporting System. More here.

The Board of Dentistry is amending proposed amendments to Rule 64B5-17.002 regarding written dental records. More here.

—LOBBYISTS —

Christopher Dawson, GrayRobinson: Association for Responsible Alternatives to Workers’ Compensation

— ETC —

— AHCA approved a $240,000 project to allow Allarian Rehabilitation & Senior Living to add 12 community nursing home beds to its facility that operates as Susanna Wesley Health Center in Miami-Dade County.

— The MolinaCares Accord, in collaboration with Molina Healthcare of Florida, is donating $250,000 to the Florida Disaster Fund, the state’s official fund that supports response and recovery activities in times of emergency or disaster. Molina members who evacuated their homes and residents can access their prescriptions at a location other than their local pharmacy. More here.

— Centene Corporation has been named to Fortune’s “Best Workplaces in Health Care” large company list for the second year in a row. Centene operates in Florida under the Sunshine Health moniker offering Medicaid long-term care and specialty plans. Under the WellCare name, Centene sells Medicare Advantage Prescription Drug Plans and Medicare stand-alone prescription drug plans. Centene also provides managed care to medically complex children through the DOH Children’s Medical Services Health Plan. Centene ranked 13 best places to work on the list of large health care company categories. “We are pleased to be recognized by Fortune and Great Place to Work® for creating a work environment that fosters collaboration, innovative thinking and inclusivity,” said Centene CEO Sarah London. “Our mission-driven culture has allowed our employees, from Gen Z to the Silent Generation and everyone in between, to be stewards for change in transforming the health of the communities we serve.” Centene ranked 27 on Fortune’s 2022 list of Best Workplaces in Health Care.

— The Centers for Medicare & Medicaid Services (CMS) has hit UF Health North in Jacksonville with a $979,000 fine for not complying with federal price transparency requirements. CMS determined that the hospital has been out of compliance since Feb. 27 and has hit the facility with a $5,000-per-day fine. According to the Aug. 23 letter sent to UF Health North CEO Russ Armistead, the hospital can request that CMS hold a hearing on the penalty.

— ROSTER —

— Samantha Silverberg has been named CFO of HCA Florida Palms West Hospital. Silverberg joins Palms West Hospital after serving as CFO of HCA Florida Raulerson Hospital for the past year and a half.

— Brandon Wolf has been named Press Secretary for the Human Rights Campaign in Washington. Brandon leaves his post as representative for Equality Florida.

— LeadingAge Florida named Rep. Jenna Persons-Mulicka Legislator of the Year. She was recognized for helping pass new continuing care retirement community (CCRC) legislation. CCRCs serve more than 30,000 older adults in Florida.

— ICYMI —

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

Failure to communicate: During the latest court hearing in an ongoing legal fight over Florida’s restrictions on types of medical treatment for transgender individuals, U.S. District Judge Robert Hinkle is slamming the state’s two medical boards for adopting informed consent forms for transgender care that he said are confusing and misleading. “You would be hard-pressed to do a worse job drafting a form that is intended to have a layperson understand it and give informed consent. This form is just abysmally drafted,” Hinkle said. “There’s a lot of misinformation, a lot of information that doesn’t deal with what a particular patient may be getting.”

Flawless victory: Tampa General Hospital didn’t miss a beat when Hurricane Idalia passed through the Tampa Bay area, despite rumors circulating on social media that the storm flooded the facility and cut off power. While torrents of water did flood many other buildings in the region, TGH deployed its “AquaFence.” The water-impermeable barrier, which TGH purchased five years ago, takes about 48 hours to set up and can hold back 7 feet of storm surge. TGH sits about 8 feet above sea level at its lowest point, so with the barrier up, the Level 1 Trauma Center is prepped for as much as 15 feet of surge. TGH Security Director Tony Venezia told Florida Politics that the hospital easily withstood everything Idalia threw at it: “We could have taken an additional 5 feet of surge if we needed to.”

— FOR YOUR RADAR —

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

“A huge threat to the U.S. budget has receded. And no one is sure why.” via Margot Sanger-Katz, Alicia Parlapiano and Josh Katz of The New York Times — Something strange has been happening in this giant federal program. Instead of growing and growing, as it always had before, spending per Medicare beneficiary has nearly leveled off over a decade. The trend can be hard to see because the number of people using Medicare has grown as baby boomers have aged. But it has had enormous consequences for federal spending. Budget news often sounds apocalyptic, but the Medicare trend has been unexpectedly good for federal spending, saving taxpayers a huge amount relative to projections. The reason for the per-person slowdown is a bit of a mystery. Scholars have argued about it for years, but no one seems sure enough to confidently predict whether it will likely stick around for much longer.

“Crowdfunding saves Florida abortion clinic with $193,000 in fines” via Timothy Bella of The Washington Post — An Orlando abortion clinic facing $193,000 in state fines has raised more than $200,000 in a crowdfunding effort that will keep one of the city’s last clinics open. Florida health regulators announced last month that the Center of Orlando for Women repeatedly violated a law that requires women to wait 24 hours before having an abortion in the days after the law took effect. The Florida Agency for Health Care Administration (AHCA) ordered the clinic to pay $1,000 for each of the 193 violations, a total of $193,000, nearly three times more than a judge’s recommendation.

“DeSantis was decisive, not divisive, at first. Then COVID-19 pandemic hit” via the Miami Herald editorial board — By now, many Floridians may have a dim memory of the man they elected Governor in 2018 — the little-known conservative congressman who grew up in the Gulf Coast town of Dunedin, population 36,000. That early-model DeSantis, who defeated his Democratic opponent Andrew Gillum by just 37,000 votes in this then-swing state, campaigned on America First principles and Trump-lite issues. But what a difference a pandemic and White House ambitions can make. They gave birth to the divisive tactics — his dismissal of COVID mandates and his attacks on immigrants, LGBTQ+ issues, education, Black history and “wokeness” — that he would exploit to advance his political career. DeSantis initially acted like most Governors: He shut down public schools and prohibited visitors in nursing homes. He expanded testing capacity, closed public parks, and told us to stay home. But then DeSantis got political, exploiting the health crisis rather than managing it.

“You thought your kids could sleep in? Broward schools to ask for exemption to new law” via Lisa J. Huriash of the South Florida Sun-Sentinel — Don’t turn the alarm clock off quite yet. Broward schools will ask state legislators for an exemption to a new Florida law that would move back start times for many schools by the 2026-27 school year. Florida’s bill, signed into law in May, allows “middle and high school students in Florida to achieve optimal levels of sleep, to improve their physical and mental health, safety, academic performance and quality of life.” That means by the 2026-27 academic year, the instructional day for all public and charter middle schools must begin no earlier than 8 a.m. and no earlier than 8:30 a.m. for high schools.

— PENCIL IT IN —

Thursday

2 p.m. — AHCA hosts a meeting on proposed Rule 59A-35.125 regarding the standards for the appropriate use of facial coverings for infection control. AHCA, 2727 Mahan Dr. Building #3, Conference Room A, Tallahassee. Or call (888) 585-9008; participant code: 998518088#.

Friday

Happy birthday to Rep. Thad Altman.

Tuesday

10 a.m. — AHCA hosts a meeting on proposed Rule 59G-4.085 regarding Medicaid early intervention services. AHCA, 2727 Mahan Dr. Tallahassee.

Wednesday

1 p.m. — AHCA hosts a workshop on proposed amendments to Rule 59G-4.150 regarding inpatient hospital services. AHCA, 2727 Mahan Dr. Building 3, Tallahassee.

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