Christine Jordan Sexton
Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.
— Red ink rising —
There’s a ballooning deficit in the health insurance program for 170,00 state workers, retirees and their families over the next several years, Florida’s top economists agree.
The $3.9 billion program is expected to finish the current fiscal year in the black, with a projected $471 million in the trust fund by the beginning of July 2025 according to results posted this month by the Office of Economic and Demographic Research (EDR). Most of the funding comes from premiums paid by state agencies while about $186 million comes from premiums paid by state employees.
But over the next few years the analysts and economists who work for the Legislature and EDR are forecasting an ever-growing deficit. The forecast projects the trust fund will have a $421 million deficit by July 2026 and that the deficit will eventually increase to $1.5 billion by July 2029.
The price pressures in the program include the addition in January of an estimated 19,000 Florida college system faculty and staff. State legislators did set aside money to cover the cost of adding college employees, but Gov. Ron DeSantis vetoed the $80 million appropriation.
The forecasts also predict a continued rise in pharmaceutical costs which state officials who run the program attribute to increased usage of diabetes-related drugs.
Over the past two years, state legislators have transferred $550 million to shore up the state health insurance trust fund instead of passing on the increased costs to employees through insurance premium hikes. Insurance premiums have remained flat for state workers for many years.
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— Navigators —
The University of South Florida/Florida Covering Kids & Families nabbed nearly $13.8 million in federal funds to help people obtain health care coverage through the traditional Medicaid program, the Florida KidCare program, or the federal health insurance exchange.
While the grant was awarded to Florida Covering Kids and Families, the group contracts with ten organizations across the state to accomplish its goal: Big Bend Area Health Education Center; Florida Alliance of Community Health Centers; Family Healthcare Foundation; Health Planning Council of Northeast Florida; Health Planning Council of Southeast Florida; Health Planning Council of Southwest Florida; Primary Care Access Network; Suwannee River Area Health Education Center; University of Miami Health System (UHealth); and the West Florida Area Health Education Center.
Navigators will make it a priority to assist Floridians impacted by Medicaid redeterminations; rural populations; Black, indigenous and people of color; the LGBTQ+ community; individuals with substance use disorders; refugees; asylum seekers and migrants; women and pregnant individuals; and people with disabilities.
According to information distributed by the Biden administration, only Texas received more money ($22,056,499) for navigation services than Florida.
Florida currently leads the nation in people getting health insurance through the marketplace established by Obamacare. More than 4.2 million signed up for coverage during the most recent open enrollment period, which ended in January. However, Florida Republicans have also resisted expanding Medicaid eligibility, which was also allowed under the Affordable Care Act.
—Get ready to roll up that sleeve—
September brings the return of school and the start of football season, but it’s also the ideal time to get a flu shot.
The Advisory Committee on Immunization Practices recommends that influenza vaccines for the season be offered during September or October. Although vaccination by the end of October is recommended, a vaccine administered in December or later — even if influenza activity has already begun — might be beneficial in most flu seasons.
Providers should offer flu shots to unvaccinated persons who have already become ill with influenza during the season because the vaccine could protect them against other influenza viruses that are in circulation.
The CDC recommends vaccination for all persons aged six months and older who do not have contraindications.
However, vaccination should continue after October and throughout the flu season as long as influenza viruses are circulating and an unexpired vaccine is available.
The ACIP develops recommendations for U.S. immunizations for the civilian population, including the ages at which vaccines should be given, the number of doses, the time between doses, and precautions and contraindications.
The ACIP comprises medical and public health experts. No ACIP members or ex officio members are from Florida. Florida Atlantic University Affiliate Assistant Professor of Clinical Biomedical Science and private physician Jason Goldman is a liaison representative for the American College of Physicians.
— Good news from AARP—
An estimated 200,000 Floridians on Medicare prescription drug plans will see savings beginning Jan. 1, when a new $2,000 out-of-pocket cap kicks in.
“AARP fought hard for the prescription drug law of 2022 because we knew it would provide crucial relief for Medicare enrollees here in Florida and across the country by lowering drug prices and out-of-pocket costs,” said Jeff Johnson, AARP Florida State Director, which serves more than 2.8 million members age 50 and older in the state.
“Knowing they won’t pay a dime over $2,000 next year — maximum — for prescription drugs they get at the pharmacy gives Florida seniors on Medicare drug plans some peace of mind as they struggle to keep up with rising costs for other everyday essentials like housing, groceries and utilities.”
Nationwide, between 3 and 4 million Medicare Part D plan enrollees are expected to benefit from the new law. More than three-quarters of Medicare drug plan enrollees who will benefit in 2025 are between the ages of 65 and 84.
AARP analyzed the number of enrollees who will benefit from the cap by state, age, gender, and race between 2025 and 2029. According to the analysis, Medicare drug plan enrollees who hit the maximum out-of-pocket cap will, on average, save about $1,500 in 2025.
“Limiting how much seniors on Medicare drug plans pay for prescription drugs every year builds on other new and important cost-saving measures, such as capping insulin co-pays at $35 a month and making many vaccines, such as shingles and pneumonia, free,” said Johnson.
— Suicide Prevention Month —
Sunday marks the start of suicide prevention month in Florida and across the nation.
In 2022, there were 3,446 suicide deaths in Florida, putting the Sunshine State’s death rate (14.1 per 100,000 people) toward the bottom nationwide.
Eleven states and the District of Columbia had lower death rates than Florida, with DC having the lowest death rate (6.1 per 100,000) in 2022.
Nationwide, more than 49,000 people died by suicide in 2022.
That statistic only captures part of the picture as millions more made plans to commit suicide.
“Nearly four million Americans made a plan to die by suicide and nearly two million attempted suicide in 2022,” said Natalie Kelly, CEO of the Florida Association of Managing Entities.
The seven managing entities across the state connect people experiencing a mental health crisis with behavioral health services and programs that meet their needs from mobile response teams of highly trained counselors who de-escalate situations, to hospital bridge programs that coordinate services after an individual is stabilized in the emergency department, to school mental health services.
In addition to a month-long prevention campaign, Sept. 10 is World Suicide Prevention Day. It’s a time to remember those affected by suicide, raise awareness, and to focus efforts on directing treatment to those who need it most.
Florida Behavioral Health Association President and CEO Melanie Brown-Woofter said preventing suicides is a top priority for her member organizations.
“Unfortunately, suicide rates increased slightly last year, indicating that Floridians are still struggling and that we must continue our efforts to inform and educate Floridians to recognize the signs, empower them to engage others in conversation, and know when to refer for help,” she said. “By working together, we can reduce the stigma and foster more supportive, resilient communities.”
For behavioral health concerns that do not involve an immediate risk to public or individual safety call 988 Suicide & Crisis Lifeline. 988 connects to the National Suicide Prevention Lifeline for free 24-hour support for people in suicidal crisis or emotional distress. #BeThe1To is the 988 Suicide & Crisis Lifeline’s message for National Suicide Prevention Month and beyond.
— RULES —
The Board of Osteopathic Medicine proposes amending Rule 64B15-6.003 to incorporate physician assistant applications for licensure by endorsement. More here.
AHCA proposes developing Rule 59G-4.125 to incorporate by reference the Florida Medicaid Behavior Analysis Services Coverage Policy. More here.
AHCA proposes amending Rule 59A-36.006 regarding admission and continued residency criteria for assisted living facilities regarding communicable diseases. More here.
The Board of Dentistry proposes amending Rule 64B5-2.0150 to create a method to address a hardship when the applicant fails to meet the full-time practice requirement. More here.
The Board of Optometry proposes amending Rule 64B13-18.002 to add an anti-glaucoma medication to its formulary of Topical Ocular Pharmaceutical Agents. More here.
— LOBBYISTS —
Patrick M Gillespie, MC Global Holdings: Medefy Health
Kamal I. Latham, GBM Global Solutions: KweHealth
Amy Bisceglia: Children’s Network of Hillsborough.
— ETC—
— Still no news on the invitation to negotiate the children’s medical services Medicaid managed care plan. The nearly $13 billion contract to provide health care services for medically complex children who are eligible for Medicaid or the state children’s health insurance program (CHIP) expires Jan. 31, 2025. A Medicaid official in the DeSantis administration told economists earlier this month that the ITN would be released shortly. DOH decided in May to extend its current contract with Sunshine Health Plan. Under the amended contract, Sunshine will be paid no more than $12.9 billion.
— AHCA approved transferring a certificate of need (CON) from Pinellas SNF OPCO to Pinellas County SNF OPCO II to establish a new 120-bed community nursing home. AHCA also this week received an expedited application from Clermont SNF, operating as The Lakes of Clermont Health and Rehabilitation, to obtain a CON for 40 community nursing home beds from Innovative Medical Management Solutions. Florida manages the number of new nursing home beds through CON, which is a license of sorts to do business in the state.
— Americans will be able to get free COVID-19 test kits mailed to their homes starting in late September. U.S. households will be able to order up to four COVID-19 nasal swab tests starting late next month, according to information posted on COVIDtests.gov.
— ROSTER —
Corey Howard is the recipient of the 2024 Florida Medical Association (FMA) Award of Distinguished Service. It is the association’s highest award. Howard, a past FMA President, is a board-certified internal medicine physician who got started in organized medicine in 1992. He has written, co-written and collaborated with other physicians on many resolutions that are now American Medical Association policy.
The Governor removed Miami Beach physician Luz Marina Pages, and Miami physician Eleonor Pimentel from the Board of Medicine. There are 15 members on the Board of Medicine, including one consumer member. The consumer member is the only vacant position currently on the Board.
— ICYMI —
In case you missed them, here is a recap of other critical health care policy stories covered in Florida Politics this past week.
“Tourism adds significant dangers on Florida roads during peak visitation times” via Drew Dixon of Florida Politics — A five-year study of crash data on Florida roads from 2018 to 2023 indicates that there are more accidents in March than any other time of the year. During that month, the number of tourists visiting the state is at a peak. The study showed there was a 12% jump in serious car crashes in Florida in March compared to other times of the year.
”Endorsements keep rolling in for recreational pot initiative” via Christine Jordan Sexton of Florida Politics— One of the state’s largest unions is throwing its support behind legalizing marijuana for adults. The Florida chapter of the Service Employees International Union is supporting Amendment 3, the group said in a press release. Morgan Hill, spokesperson for Smart & Safe Florida, welcomed the endorsement.
“Trulieve keeps pumping millions into recreational pot initiative” via Christine Jordan Sexton of Florida Politics — Trulieve continues to surge money into the campaign to pass Amendment 3. The medical marijuana company donated another $5 million to Smart & Safe Florida, the political committee that is sponsoring the initiative that would legalize recreational pot.
— FOR YOUR RADAR —
Aside from coverage by Florida Politics, these stories are worth your time.
“Ashley Moody says execution shouldn’t be stayed for Parkinson’s symptoms” via the Associated Press — Attorneys for the state of Florida say the execution of a man with Parkinson’s symptoms should not be delayed, despite his appeal to the U.S. Supreme Court challenging the state’s lethal injection procedures. Florida Attorney General Moody argued that Loran Cole waited too long to raise his claims that the drug cocktail would “very likely cause him needless pain and suffering” due to symptoms caused by his Parkinson’s disease.
“Rise of Oropouche virus cases among Floridians traveling to Cuba prompts CDC response” via Jackie Llanos of the Florida Phoenix — The U.S. Centers for Disease Control and Prevention announced Tuesday that researchers are developing a detection plan to respond to a rise in cases of Oropouche virus, a mosquito-borne illness emerging among Floridians traveling to Cuba. The Florida Department of Health reported 10 cases of Oropouche virus in people who had traveled to Cuba, bringing the number of cases this year to 30, according to the agency’s latest arbovirus surveillance report. The department didn’t report any cases last year.
“Group of Florida doctors says leading Medicaid operator slow to pay” via Arek Sarkissian of POLITICO Florida — Hundreds of Florida’s most vulnerable children are stuck in the middle of a long-running financial dispute between doctors and the state’s largest Medicaid operator. A group of physicians affiliated with Privia Medical Group, a Virginia-based network of health care providers that has a branch in Florida serving doctors’ offices statewide, says it is owed $781,000 from Sunshine State Health Plan, a Medicaid managed care plan that oversees the most patients in the state.
— PENCIL IT IN —
Thursday
Happy birthday to Rep. Griff Griffitt!
Friday
Happy birthday to Rep. Lauren Melo!
Sunday
Start of Suicide Prevention Month.
Monday
Happy birthday to Rep. Spencer Roach!
Diagnosis is written by Christine Jordan Sexton and edited by Drew Wilson.
