Christine Jordan Sexton
Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.
– 20K staff from 28 colleges on the way –
As many as 20,000 employees at Florida colleges are expected to switch to the state group health insurance program, which will likely drive up costs for a program that has needed cash infusions from state legislators to stay in the black.
State economists gathered Wednesday to draw new forecasts for the number of individuals and families participating in the program that provides health insurance coverage to state and retired state workers.
State legislators earlier this year signed off on allowing all 28 state colleges to shift their employees into the program. But Gov. Ron DeSantis vetoed $80 million to help colleges pay for the cover coverage.
Still, Department of Management Services officials told economists that all 28 colleges are planning to go ahead and make the shift. The colleges are expected to hold open enrollment later this year, and those employees will become part of the state group health insurance program in January.
Stephen Russell, DMS’s chief of financial management services, told economists that the state’s insurance coverage is expected to be fairly attractive to college faculty and staff.
“[The division] is offering much more robust coverage,” said Russell, who added that it is “much more affordable’ to college employees.
Adding college employees will significantly increase the program, which currently has roughly 171,000 subscribers and provides coverage to about 350,000 people overall.
Economists will use the new enrollment estimates in early August to finalize the state health insurance trust fund forecast.
The fund was projected to swing into a deficit by next summer, but legislators shored it up with tens of millions last Session.
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– Challenges coming –
Florida’s decision to award Medicaid-managed care contracts to health plans following a massive re-procurement that took over two years to complete is being challenged in state administrative court by three spurned providers.
Three managed care plans notified the Agency for Health Care Administration of their intent to challenge the July 18 decision.
Florida Politics has confirmed that Sentara, AmeriHealth Caritas and ImagineCare notified the AHCA of their intent to challenge the July 18 decision and another one from April.
The parties have 10 days from filing the Notice of Intent to file amended complaints, which means they are due Aug. 2. The AHCA will likely refer the cases to the state Division of Administrative Hearings on Aug. 5. A hearing should be held within 30 days.
In a release to Florida Politics, Sentara said the company was disappointed in the outcome of the ITN.
“Sentara has filed an intent to protest, as we remain dedicated to serving members in the communities that we support,” the release said.
The state wants to unfurl the new six-year Medicaid-managed care contracts with plans across the state beginning Sept. 1. The AHCA will likely start the work necessary to accomplish that, including ensuring plans have an adequate network of providers.
To prevent the AHCA from proceeding with implementation, AmeriHealth Caritas has also filed a suit in Leon County Circuit Court seeking an injunction banning the AHCA and its Secretary, Jason Weida, from proceeding with contracts until its (and others’) underlying administrative complaint has been resolved.
“Allowing (the) AHCA and Secretary Weida to proceed with executing and implementing contracts while these protests remain pending will greatly prejudice ImagineCare and other protesting parties, cause irreparable harm to the Medicaid enrollees of the state of Florida and will violate both Florida law and the express provisions of the ITN,” attorneys wrote, referring to the statewide Medicaid-Managed Care Invitation to Negotiate issued April 2023.
Circuit Judge Angela Dempsey has been assigned the case. Shutts and Bowen attorneys Joseph Goldstein, Daniel Nordby, and Amber Stoner Nunnally represent the AHCA.
ImagineCare is a type of health plan known as a provider service network. A joint venture of Spark Pediatrics and CareSource, it does not currently have a Medicaid-managed-care contract in Florida.
An ImagineCare representative told Florida Politics that the plan earned the highest scores for a PSN but was not chosen for a Medicaid contract.
“We are obviously extremely disappointed with the current outcome and confused as to how the highest scorer was not provided an opportunity to offer differentiating services to Floridians. We are in the process of determining the appropriate next steps while preserving our argument that we are the most qualified PSN in this ITN,” the company said in a statement.
Florida requires most Medicaid enrollees, from the young to the old, to receive health care through managed care plans. In 2023, the AHCA released its Medicaid-managed care ITN to renegotiate new multiyear contracts worth tens of billions to the winning bidders.
In April, the state announced its intent to award new contracts to Florida Community Care, Humana Medical Plan, Simply Healthcare Plans, South Florida Community Care Network (which does business as Community Care Plan), and Sunshine State Health Plan.
Following the announcement, seven plans notified the state of their plans to challenge the decision, some because they weren’t in the regions they were vying for, others because they weren’t awarded any contracts.
After more negotiations, the AHCA published a second decision on July 18 that squashed four of the seven complaints.
– What’s what –
Under the tandem of agency decisions, the AHCA will enter new six-year contracts with eight plans: Aetna Better Health of Florida, Florida Community Care (FCC), Humana Medical Plan, Molina Healthcare of Florida, Simply Healthcare Plans, Community Care Plan (CCP), Sunshine State Health Plan and UnitedHealthcare of Florida.
All eight have existing Medicaid-managed care contracts set to expire at the end of the year. AmeriHealth Caritas, which is currently under contract, wasn’t offered a new contract.
Two of the eight plans, FCC and CCP, are PSNs. The latter is owned and operated by the North Broward Hospital District, commonly known as Broward Health and the South Broward Hospital District. Shane Strum, DeSantis’ former Chief of Staff, runs Broward Health.
AHCA is signing statewide contracts with FCC, Humana Medical Plan, Simply Healthcare Plans and Sunshine State Health Plans. This expands Simply’s current program.
Aetna and United will continue to operate in the same areas of the state they currently do.
Molina Healthcare, blanked in the initial agency decision, was offered a contract in one region, which pares back its presence in the Medicaid market. Nevertheless, the company issued a statement following the announcement.
“Under the contract award in Miami-Dade and Monroe counties, Molina expects to serve approximately 90,000 Medicaid beneficiaries. The contract term is expected to commence on Jan. 1, 2025, and run through Dec. 31, 2030,” the letter read.
While CCP’s footprint is limited to Broward County, it was offered Medicaid contracts in five of the nine Medicaid Regions across the state.
– Dramatic decline –
New estimates for Florida KidCare project a dramatic decline in the number of children covered under the umbrella program, which provides subsidized health coverage for many enrolled families.
Economists, using data provided by Florida Healthy Kids and others involved in KidCare, this month forecast nearly 137,000 fewer children would be covered by the program than they had forecast last December.
The breakout shows that most of that drop – 94,000 – is due to a decline in Florida Healthy Kids enrollment. Economists had previously anticipated that there would be a bump in Florida KidCare as families transitioned off Florida Medicaid due to changes in how that program was administered following the end of the COVID-19 public health emergency. State officials could not remove someone from Medicaid during the emergency.
Previous enrollment estimates also assumed an influx of new children into the program due to HB 121, which expanded income eligibility so families who earn more can qualify for the program. But that expansion has not happened yet. Florida had been waiting for federal approval, but now the state is objecting to requirements that they provide 12 months of continuous eligibility to subsidized coverage recipients even if the family cannot pay Healthy Kids’ required premiums. Florida is challenging the requirement in federal court.
Healthy Kids officials told economists earlier this month they were continuing to drop families that failed to pay premiums as the litigation continues.
Florida KidCare is an optional Medicaid expansion created in 1998 for children aged 5-18 living in families earning too much to qualify for traditional Medicaid – which is free – but no more than 200% of the federal poverty level. Families pay monthly premiums and copayments toward coverage costs. State and federal Medicaid dollars subsidize the remainder.
During a Wednesday meeting, Florida economists discussed the program for the current and upcoming fiscal year.
– Another dip –
According to new estimates released this month by state economists, the number of Floridians enrolled in the state’s safety net program is expected to dip by more than 8% in the coming year.
Florida Medicaid enrollment is expected to slide to 4.4 million by the end of the current fiscal year. That’s 1 million people since program enrollment peaked during the COVID-19 public emergency.
States were not allowed to trim Medicaid rolls during the pandemic in exchange for receiving more federal aid. But Congress last year allowed states to resume checking enrollee’s coverage, a process called “unwinding.”
Working in tandem with the AHCA, state economists this month drew up new caseload estimates for Medicaid.
While the forecast shows a continued decline over the next 12 months, economists expect the number to rise slightly in the out years. Economists projected that the number of Medicaid enrollees will increase to nearly 4.45 million in the 2025-26 fiscal year and almost 4.46 million in the year after. The number will continue to climb slowly toward about 5 million by the decade’s end. According to the Social Service Estimating Conference, economists will meet on Thursday to discuss program costs and hear initial presentations on Medicaid-managed care and long-term care rates.
– RULES –
The Board of Osteopathic Medicine proposes amending Rule 64B15-13.001 regarding continuing education for biennial renewal to add another provider for the controlled prescribing course. More here.
The Board of Medicine proposes amending Rule 64B8-13.005 regarding continuing education for biennial renewal to add an additional provider for the controlled prescribing course. More here.
– LOBBYISTS –
Jeff Johnston, Amanda Stewart; Johnston & Stewart Government Strategies: Brightstone Therapy.
– ETC –
According to a university news release, UF Health’s transplant programs are among the best in the state and the top five nationwide.
Every six months, the Scientific Registry of Transplant Recipients, or SRTR, evaluates transplant centers across the United States through a comprehensive, five-tier assessment focused on crucial transplant metrics: survival while on the waiting list, the time it takes a patient to get a transplant, and one-year organ survival after surgery. UF Health Shands ranked No. 1 nationally for liver transplants, No. 2 in kidney transplants, and No. 4 in lung transplants.
UF Health’s transplants held its No. 1 national ranking among 152 programs for three SRTR rating periods, or 18 months. UF Health’s program has held its position at No. 2 in the country among 256 programs for the past 18 months. The program’s rate is 98%, with the highest survival rate among centers performing more than 100 transplants annually.
UF Health’s transplants stand out for its exceptional patient care and surgical expertise, ranking first in Florida and fourth in the nation. According to SRTR, patients at UF Health are far less likely to die before their transplant compared with the national average.
– ROSTER –
– Tara Beth Anderson was named President of Baptist Medical Center Nassau. She most recently served as chief nursing officer at HCA Florida Capital Hospital in Tallahassee and had clinical and operational oversight across multiple service lines. Anderson served in leadership roles at HCA Frankfort Regional Medical Center in Kentucky and HCA Tulane Health System in Louisiana. Anderson holds certifications as a Nurse Executive, Board Certified (NE-BC), and is a candidate to become a fellow of the American College of Healthcare Executives (FACHE).
– Dr. Jeffrey Ottley was sworn in as the 2024-2025 President of the Florida Dental Association. He has held leadership positions in organized dentistry at the local, state and national levels. He has served as president of the Escambia-Santa Rosa County Dental Association and on the FDA Leadership Development and Governmental Action Committees. Ottley, who practices in Milton, has served on the FDA Board of Trustees since 2012 and is currently a delegate to the American Dental Association.
– LeadingAge Southeast recognized eight senior living leaders and volunteers and two longtime staff members at its annual conference. Awards went to Florida advocates as well as people from Mississippi and Louisiana. The association named Barie Hamilton of Traceway Retirement Community as Caregiver of the Year. Minilik Belay of John Knox Village was named Emerging Leader. Louvenia Morgan of Poydras Home, was awarded Employee of the Year. Executive of the Year was awarded to Pam Petsopoulos of Solaris Healthcare. The Innovation Award was bestowed upon Elvis Burrows and Patrick Tramontana of The Mayflower. Service Coordinator of the Year was awarded to Patricia Walker of Robert Sharp Towers. Volunteer of the Year was awarded to Helga Howard of Air Force Enlisted Village. The Distinguished Service and Lifetime Achievement awards were bestowed upon Rich Scanlon and LeadingAge Southeast’s Mary Ellen Early.
— ICYMI –
In case you missed them, here is a recap of other critical health care policy stories covered in Florida Politics this past week.
“Group backing recreational pot amendment raises another $314K as Ron DeSantis ramps up attack messaging” via Christine Jordan Sexton of Florida Politics – The political committee sponsoring a ballot initiative allowing recreational marijuana collected nearly $314,000 in new donations. The report, which covered the second week of July, showed that most new contributions to Smart & Safe Florida, supporting Amendment 3, came from two companies involved in the marijuana business. Verano Holdings, which is based in Chicago, donated $250,000. Oregon-based Dutchie gave $50,000. Verano already has 77 medical marijuana dispensaries in Florida and recently just opened new locations in Miami-Dade and Pasco counties. Verano gave $2.25 million to Smart & Safe Florida in late March. The company website describes Verano as an “active supporter” of the effort to pass Amendment 3.
“Tampa General Hospital climbs to No. 2 in the Sunshine State” via Peter Schorsch of Florida Politics – In recent years, Floridians have witnessed Tampa General take a leading role in transforming health care through innovation and technology. National rankings, released this week, show Tampa General’s climb to center stage in Florida and nationally. Tampa General jumped to the second-highest-ranked hospital in Florida. The region’s leading academic health system is up from the fourth-highest ranked in the state last year. The hospital was also counted as one of the nation’s top 50 hospitals in eight medical specialties and ranked among the top 10% in three additional medical specialties. “This significant national recognition is further evidence that Tampa General is truly an innovative, academic health system that delivers world-class care across the enterprise,” said John Couris, president and CEO of Tampa General.
“Snubbed Medicaid plan sues state in Leon County court” via Christine Jordan Sexton of Florida Politics – After having its administrative challenge tossed by the Agency for Health Care Administration (AHCA), a Medicaid-managed long-term care provider is asking a Leon County circuit court to intervene and prevent the state from moving ahead with new multiyear contracts. Last week, attorneys for ImagineCare filed a lawsuit seeking a temporary injunction banning the AHCA and Secretary Weida from moving ahead with the new Medicaid-managed care contracts until its (and others) underlying administrative complaint has been resolved.
“Joe Gruters, Fiona McFarland endorse Sarah Lodge in Sarasota Hospital Board race” via Jacob Ogles of Florida Politics – Sen. Gruters and Rep. McFarland, both Sarasota Republicans, are endorsing Lodge for re-election to her Central District Seat 1 post on the Sarasota County Public Hospital Board. “Sarah’s dedication to ensuring those in our community receive the best possible medical care is unmatched,” Gruters said. “She has a proven track record of delivering results for Sarasota County and has my full endorsement.” A news release announcing the endorsements called the lawmakers “conservative stalwarts.” Gruters, Florida’s Republican National Committee member, gave one of the first televised speeches at this year’s Republican National Convention earlier this week. He’s a close ally of Trump and served as Florida Co-Chair for Trump’s successful 2016 campaign. McFarland, meanwhile, spoke at CPAC in 2021 and has earned the endorsement from the American Conservative Union in the past. She praised Lodge’s tenure as Chair of the Hospital Board.
– FOR YOUR RADAR –
Aside from coverage by Florida Politics, these stories are worth your time.
“VA warns Congress that benefits payments are at risk due to projected $15B budget shortfall” via Rebecca Kheel of Military.com – The Department of Veterans Affairs (VA) expects to be nearly $15 billion short of what it needs to pay for benefits and health care this year and next, in part because more veterans are using VA services than expected, officials told Congress this week. An increase in benefits claims driven by the PACT Act could leave VA benefits accounts $2.9 billion short this year. Meanwhile, health care accounts could be nearly $12 billion short next year because of higher-than-expected staffing and prescription drug costs, among other factors. In a statement, the VA said it is working with the White House and Congress to address the budget shortfalls in a way that doesn’t harm veterans.
“Florida never OK’d school plans for sex ed – so Orange County students went without” via Alissa Gary and Lauren Brensel of the Orlando Sentinel – Orange County students missed sex education classes last school year after the state failed to approve the School District’s plans that included lessons on contraception and sexually transmitted diseases. Orange County Public Schools (OCPS) decided to avoid the topic of reproductive health as district officials grappled with the mandates of a new state law that required them either to use state-authorized textbooks focusing on abstinence or to submit their lesson plans to the Florida Department of Education for review. OCPS and at least six other school districts that submitted their lessons said the state never responded.
“Ordered by Florida to clean up its act, Fort Myers works to fix its water pollution problem” via Amy Bennett Williams of the Fort Myers News-Press – With swelling demand straining its antique wastewater infrastructure, it’s no wonder Fort Myers has water pollution problems. Fecal bacteria in its creeks, fountains “of raw sewage,” dirty construction runoff and dangerous spills have plagued the city for years. It can be a big problem. Beyond the ick factor, the bacteria “can be an indication of fecal pollution, which may come from stormwater runoff, pets and wildlife, and human sewage,” according to the state health department. “If they are present in high concentrations in recreational waters and are ingested while swimming or enter the skin through a cut or sore, they may cause human disease, infections or rashes.”
– PENCIL IT IN –
Thursday
9 a.m. – The Social Services Estimating Conference meets. 117 Knott Building.
Friday
1:30 p.m. – The Self-Insurance Estimating Conference meets. 117 Knott Building.
Monday
1:30 p.m. – The AHCA is meeting on proposed changes to Rule 59G-4.252, to incorporate diabetic supply services coverage policy, including the Florida Medicaid Preferred Product List (PPL). Place: Agency for Health Care Administration, 2727 Mahan Dr. Bldg. 3, Tallahassee, 32308-5407.
Wednesday
1 p.m. – The AHCA is meeting on Rule 59G-4.130 regarding home health visit services. Place: Agency for Health Care Administration, 2727 Mahan Dr. Bldg. 3, Tallahassee, 32308-5407.
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Diagnosis is written by Christine Jordan Sexton and edited by Drew Wilson and Phil Ammann.
