Access to affordable and timely health care can prevent disease, lead to healthier children and families and lower expenses in emergency care and chronic disease treatment. In a state like Florida, which has a growing population of both young and old residents, health care is one of the backbones of the state’s economy. A healthy workforce is key to attracting investors and ensuring sustainable development in the state. Florida’s current health system is not sufficient to keep residents healthy and able to work and it will not support Florida’s aging population.
On November 6, Florida voters will decide on Amendment 5, which would — at best — lock the state into its already inequitable health care system that keeps thousands from accessing needed care. At worst, it could increase disparities, shutting out access for thousands more. The measure would require a two-thirds (supermajority) vote of the state Legislature to approve any new state revenue, taxes and fees, or to eliminate tax incentives, loopholes and other such expenditures.
Florida currently has the wrong priorities, giving special tax breaks to big corporations while putting up barriers to accessing health care services. Amendment 5 locks in these failed priorities before the state has a chance to recover from deep cuts following the Great Recession and a supermajority requirement would likely require huge funding cuts in the wake of another fiscal crisis. Amendment 5 would unnecessarily restrict investments in Florida’s future.
Florida’s current standing on multiple national health care rankings is already alarmingly low, as illustrated in Table 1. Florida’s uninsured rate continues to creep up, while waitlists for vital programs keep services out of reach for many. For example, the waitlist for Medicaid funded home- and community-based services (HCBS) in Florida is more than 50,000, which is, along with Texas, the longest in the nation. The waitlist for Medicaid-funded developmental disabilities services is more than 21,000. Some have been on the waitlist for more than 10 years.
The health and well-being of African-American and Hispanic Floridians is persistently worse than their white counterparts. Florida communities of color are disproportionately hurt by the abysmal trends reflected in these national rankings.
Florida has more than 20 million residents, making it the third most populous state in the nation, and it’s also among the fastest growing states, with projected annual population growth of roughly 320,000. Notably, the state is experiencing significant growth in the most medically expensive populations: people with disabilities and the elderly.
These unique demographics ensure even greater future demands on the state’s health care delivery systems and safety nets. To meet the needs of Florida’s residents, the state will need to make investments in its health care programs. However, Amendment 5 will significantly restrict the Legislature’s ability to raise revenue, making an improvement in Florida’s health measures unlikely and leaving Floridians to suffer with inadequate care.
Nearly 4 million of Florida’s low-income residents rely on Medicaid to cover essential health care services. Over half are low-income children. The remainder are mostly people with disabilities, the elderly and pregnant women. They include:
Medicaid is a great financial deal for the state. While the total amount appropriated for the program in Fiscal Year (FY) 2019 is substantial — more than $28 billion — federal funds cover about 61 percent of the cost (See Figure 1).
Florida already has one of the most limited Medicaid programs in the country. State investment per enrollee, as well as provider reimbursement rates, are among the lowest in the nation. Low reimbursement causes low provider participation rates and significant challenges for beneficiaries in accessing care. Additionally, thousands of low-income Floridians are completely shut out of Medicaid coverage because of very stringent income and eligibility requirements and state lawmakers’ failure to expand the Medicaid program.
Historically, the Medicaid program has been a bullseye for cuts when the Florida Legislature is looking for dollars. A supermajority requirement, like that in Amendment 5, would significantly ramp up these fiscal pressures. Medicaid coverage and services that could be in the line of fire include:
Florida already faces the high costs associated with having more than 2.8 million uninsured residents. There are about 400,000 living below the poverty line who cannot qualify for Medicaid because Florida leadership has opted not to expand Medicaid. Further cuts to Medicaid would add to these numbers. While the uninsured are more likely to delay care due to cost, their health care needs don’t go away. When left unattended, such health care needs become more complicated to treat and people are likely to end up in costlier settings, such as emergency rooms.
Florida’s health care system subsequently faces the ongoing pressures of more than $2.4 billion annually in uncompensated care. An already overstrained safety net patchwork, including state and local programs and local charity health providers, struggles to meet the needs of the uninsured. But these resources are insufficient and uncertain, and easy victims of political funding decisions at both the state and local levels. With a supermajority requirement, fiscal pressures on local government and taxpayers would be even greater. The decreasing resources at the state level available to invest in Floridians’ health care would only make these circumstances more dire.
Simply stated, the need for health services far outpaces the current funding allocated by the Florida Legislature. Moreover, health funding in Florida will require significant additional resources to meet the state’s growing needs. Lawmakers must have capacity to rapidly respond to unexpected public health emergencies, such as the opioid crisis or the next mosquito borne virus like Zika or yellow fever.
Amendment 5 would lock in current health disparities and put future economic growth at risk. Health coverage and comprehensive care is critical to growing the state’s economy, since a population in good physical and mental health will be much more productive than one in poor health. But additional resources would be even more difficult to come by if Florida is unable to raise revenue, and lawmakers would be forced to make deep cuts to programs and services following the next economic crisis.
*Table 1 Sources: (1) Radley, D., McCarthy,D., Hayes, S., 2018 Scorecard on State Health System Performance, the Commonwealth Fund. (2) Swerlick, A., A Disturbing Trend-Uninsured Rates Rising in Florida and Nationally, Florida Policy Institute, June 2018. (3) Reinhard,S., et al., Picking Up the Pace of Change, 2017, A State Scorecard on Long TermServices and Supports for Older Adults and People with Physical Disabilities and Family Caregivers, AARP, The Commonwealth Fund & The SCAN Foundation,June 2017. (4) Florida DD Waitlist Campaign, Florida Center for InclusiveCommunities, University of South Florida. (5) Mental Health Funding Tied toFlorida's Controversial Gun Legislation, WUSF News, March 7, 2017.
 Florida Minority Health Profiles, Florida Department of Health, Office of Minority Health and Health Equity. Accessed via: http://www.floridahealth.gov/programs-and-services/minority-health/index.html
 Swerlick, A and Dadi, E. Federal Medicaid Per Capita Caps Would Trigger Significant Cuts to Health Services for Low-Income Children, Women, Seniors and Persons with Disabilities and Shift Billions in Costs to Florida, pp. 2-3, August 2017.
 Swerlick, A. Debunking the Myths in House Memorial 7033, An Unjustified Requiem, the Florida Policy Institute, March 2017.
 Fiscal Year 2018-19 Budget Summary: Once Again Florida Lags in Long Term Investments that Drive Economic Growth, Florida Policy Institute, March 2018; Florida Office of Economic and Demographic Research, Official FMAP estimate. Accessed via: http://edr.state.fl.us/Content/conferences/medicaid/index.cfm
 Swerlick, A. Code Red for Medicaid: What the House Proposal Means for Florida, Florida Policy Institute, March 2017.
 Supra at n. 3, p. 14
 Dept of Elder Affairs Waitlist Reports for Services, August 2018. Accessed via: http://fcoa.org/Advocacy
 Pre-Natal Care, National Association of State Legislatures, Feb. 2013. Accessed via: http://www.ncsl.org/research/health/prenatal-care-postcard.aspx
 Radley, D., McCarthy, D., Hayes, S., 2018 Scorecard on State Health System Performance, the Commonwealth Fund. Accessed via: https://interactives.commonwealthfund.org/2018/state-scorecard/
 Rivero, D. State Cuts Hit Palm Beach County’s Largest Public Substance Abuse Program, Health News Florida, July 2, 2018. Accessed via: http://health.wusf.usf.edu/post/state-cuts-hit-palm-beach-countys-largest-public-substance-abuse-program#stream/0
 The State of Mental Health in America, 2018, Adults with AMI who are uninsured, Access to Care Data. Accessed via: http://www.mentalhealthamerica.net/issues/mental-health-america-adult-data
 Florida Hospital Association, Facts and Stats, Community Hospital Finances 2015. Accessed via: http://www.fha.org/Reports-and-Resources/Facts-and-Stats.aspx
 Colombini, S. Yellow Fever Outbreak in Brazil Possible Threat to Florida, WUSF News, June 21, 2018. Accessed via: http://wusfnews.wusf.usf.edu/post/yellow-fever-outbreak-brazil-possible-threat-florida
American Rescue Plan Act Changes. The American Rescue Plan Act of 2021 extended PEUC and PUA benefits through the week ending September 6, 2021. It also increased the maximum duration of PEUC benefits ($300 a week) to 53 weeks and the maximum duration of PUA to 79 weeks. Although PEUC and PUA did not end until September 6, 2021, Florida withdrew from the Federal Pandemic Unemployment Compensation Program (FPUC) effective June 26, 2021. FPUC provided persons who were out of work due to COVID-19 with an additional $300 a week in unemployment insurance.
Reemployment Assistance weeks reverted to 12 effective January 1, 2022. DEO determines the maximum number of weeks available to RA claimants based on a statutory formula that looks at the average unemployment rate for the most recent third calendar year quarter (i.e., July, August, and September). Based on the downturn in unemployment, the maximum number of weeks for RA reverted to 12 effective January 1, 2022.
RA work-search and work registration requirements reinstated on May 30, 2021. Persons filing an application for RA benefits beginning March 15, 2020, are not required to complete work registration in Employ Florida through May 29, 2021. In addition, work search requirements for individuals requesting benefits for the weeks beginning March 15, 2020, were also reinstated on May 30, 2021.
Mobile app deployed. DEO has deployed a mobile app for RA applications.
DEO announces extended benefits. DEO announced implementation of Extended Benefits (EB).
Resources and guidance. For a list of resources and guidance from the United States Department of Labor on unemployment insurance and COVID-19, go here.
For DEO’s “Reemployment Assistance Frequently Asked Questions and Additional Resources,” updated 12/30/2020, go here.
For DEO’s latest claims data, go here.
DCF opens offices. DCF has reopened its brick-and-mortar storefronts, which were previously closed due to coronavirus.
DCF adds call center numbers. DCF has added a call center number for Monday through Friday, from 7 a.m. to 6 p.m. Call center numbers now include 850-300-4323, 866-762-2237, or TTY 1-800-955-8771.
Certification periods extended by 6 months only through August 2020. Certification periods for cash, food and medical assistance were extended by 6 months for individuals and families scheduled to recertify in April through August 2020. FNS’ approval of the SNAP extension for August is here. However, effective September 1, 2020, SNAP, TANF and Medicaid recertifications have been reinstated, although DCF says that no one will lose Medicaid due to recertification.
DCF allows phone interviews. Phone interviews are now being used for TANF cash and SNAP food assistance.
Mandatory work requirements suspended only through May 2021. Under a directive from Governor DeSantis to waive work requirements for safety net programs, DCF waived work requirements for individuals participating in the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) through May 2021. To do this, DCF explains that it partnered with the Department of Economic Opportunity to apply “good cause” statewide for TANF and SNAP recipients who would otherwise be subject to participation in mandatory work requirements as a condition of receiving those benefits. Through May 2021, persons who were sanctioned in the past due to work requirements will be able to reapply and participate in SNAP or TANF again.
Work requirements were reinstated effective June 1, 2021.
Emergency allotments (EA) ended. DCF automatically supplemented SNAP allotments of current recipients up to the maximum for a household’s size for July 2021. However, EA was discontinued beginning August 1, 2021.
The SNAP benefits increase by 15 percent ended in October 2021. Floridians who participate in SNAP to put food on the table will receive a temporary 15 percent supplement to SNAP under COVID relief passed by Congress and extended by the American Rescue Plan Act through September 2021.
FNS permanently increases SNAP through revamp of the Thrifty Food Plan. Effective October 2021, FNS has mandated a permanent increase to SNAP through a revamp of the Thrifty Food Plan. DCF says that the increase amounts to about 6% for Floridians.
Time limits suspended. SNAP time limits are suspended during the COVID-19 public health emergency. No one in Florida should be barred from SNAP due to time limits, even if they exhausted their time limit in the past.
Florida granted waiver to allow families to purchase groceries online. DCF has been granted a federal waiver to permit the State of Florida to launch a pilot project statewide effective April 21, 2020, that allows families to purchase groceries online with their Electronic Benefit Transfer (EBT) card instead of going into stores.
No Medicaid terminations from March 2020 through the end of the federal public health emergency. The national public health emergency has existed since January 27, 2020 and has been renewed by the Secretary of the U.S. Department of Health & Human Services in 90-day increments since that time. The most recent renewal is effective January 16, 2022.
Redetermination/recertification times are reinstated. As of October 1, 2020 AHCA's website is alerting recipients that the Department of Children and Families is now mailing letters for case reviews to check if a household is still eligible for Medicaid and/or Medically Needy. AHCA is urging people receiving these letters to take steps now to re-apply. But note, Medicaid coverage will not end during the COVID-19 Public Health Emergency. In January 2021 DCF conducted one-year “automated renewals” for people whose sole income is social security and SSI and are enrolled in an SSI-related Medicaid program (e.g., MEDS/AD, Medically Needy and Medicare Savings Programs). People getting VA income were not included in the automated renewal.
Extended application time. Effective with applications filed in February 2020, the time for submitting documentation required to process an application is extended for 120 days from the date of the application and eligibility will still be effective the first day of the month the application was received. Effective July 1, 2021, this policy has been rescinded. Medicaid applications submitted on or after July 1, 2021 may be denied on the 30th day after application or the day after verification information is due. Applications filed prior to July 1, will be allowed 120 days to provide requested verification to establish Medicaid eligibility.
Exclusion of additional unemployment payments in determining eligibility. The $600/week of additional unemployment insurance payments under the CARES Act will not be counted as income in determining Medicaid eligibility. (However, these payments will be counted as income in determining marketplace subsidy calculations.)
Coverage of Medicaid services during the state of emergency
COVID-19 Vaccines for Medicaid Enrollees. In an executive order published March 16, 2021 Governor DeSantis revised the vaccine distribution plan, which applies to the general public including Medicaid enrollees, to lower the age requirement to 40 effective March 29, 2021 and then effective April 5, 2021 all Floridians are eligible to receive any COVID-19 vaccination approved by the Food and Drug Administration.
Medicaid enrollees eligible to receive the vaccine may visit myvaccine.fl.gov to find a location distributing the vaccine and to schedule an appointment.
On March 12, 2021, AHCA published instructions for Medicaid enrollees on how to obtain Medicaid transportation once they have scheduled an appointment for a vaccine. AHCA states: "Florida Medicaid will take you to get the COVID-19 vaccine at no cost. All you need to do is set up a time to get your vaccine. Next, let your Medicaid plan know you need a ride and they will take care of the rest. If you are not enrolled in a plan, call the Medicaid Helpline at 1-877-254-1055 to find out the name and phone number for a transportation service."
The state has also recently launched a new email system to help bring COVID-19 vaccines to homebound seniors. Seniors will be able to sign up to have the vaccine come to them by emailing a request to HomeboundVaccine@em.myflorida.com.
AHCA has posted Medicaid Alerts and FAQs providing more detail on Medicaid service changes in response to COVID-19. They address a wide range of topics including, but not limited to: telemedicine guidance for medical, behavioral health, and early intervention services providers; long-term care provider network flexibilities allowing more types of providers to deliver specified long term care services; and continuity of care for adult day care center enrollees during the time these centers are closed.
AHCA is loosening coverage restrictions for behavioral health services. Effective May 5, 2020, all prior authorization requirements for mental health or substance use disorder treatment are waived and service limitations (frequency and duration) are lifted. For behavioral analysis services, current authorizations will be extended through an "administrative approval process" which does not require providers to reassess beneficiaries currently getting services. Effective July 1, 2021 service limits will be reinstated for behavioral health services and effective July 15, 2021 Medicaid prior authorization requirements will be reinstated for behavioral health services.
Per a May 29, 2020 provider alert, during the state of emergency AHCA will be reimbursing providers for telemedicine well-child visits provided to children older than 24 months through age 20. Providers are directed to actively work to schedule follow-up in-person visits to administer immunizations and other physical components of the exam which cannot be accomplished through telemedicine.
Coverage of home and community-based waiver services (HCBS) - In response to the public emergency, Florida obtained approval from the federal government to make changes in HCBS waiver programs, including the Long Term Care and Developmental Disabilities programs. The changes are effective retroactively from January 27, 2020 to January 26, 2021. Details can be found here. They include, but are not limited to:
Note on COVID-19 testing, treatment, and vaccines for the uninsured. Florida has not opted to receive 100 percent federal Medicaid funding for COVID-19 testing of people without health insurance. Under the 2021 American Rescue Plan Act this option has been expanded to cover COVID-19 treatment and vaccines for the uninsured as well. Since the state has not taken up this option Floridians must look to an uneven patchwork of free testing, treatment, and vaccine resources scattered around the state. AHCA advises that uninsured people may receive free testing from their county health department or a federally qualified health center and that “many communities provide testing for free for individuals who do not have insurance. Please [click here] to find a test site in your area. Uninsured individuals should ask before the test whether testing is free of charge." There are no state agency instructions on where uninsured people can receive free treatment. However, more information on possible sources for free treatment is available here.
Residency proof no longer required at some vaccine sites, “paving the way for migrants.” - On April 29, 2021 Surgeon General Rivkees issued a new public health advisory specifying that COVID-19 vaccines are available to “a Florida resident” or someone “who is present in Florida for the purpose of providing goods or services for the benefits of residents and visitors of the State of Florida.” This new policy applies to all state-run and federally supported vaccination sites. It rescinds an advisory issued in January that had restricted vaccinations to people who could show proof of Florida residency
2021 unemployment compensation claimants can access free or reduced cost health insurance through the ACA marketplace. The Affordable Care Act (ACA) Marketplace was re-opened in February 2021 to give people who need health insurance a new “special enrollment" opportunity to get covered. The 2021 American Rescue Plan eliminated or vastly reduced premiums for many people with low or moderate incomes.
Starting July 1, 2021, people who received or have been approved for unemployment compensation for any week beginning in 2021 can access free or reduced cost comprehensive health insurance plans through the ACA marketplace. This benefit is available regardless of someone's current income. To get this benefit, people must enroll in the marketplace no later than August 15, 2021. For help with enrollment, contact Covering Florida at 877-813-9115.
School children in distance learning still eligible for free or reduced cost meals. Students in distance learning for 2020-21 can still receive school meals through the National School Lunch Program if they are eligible. The student or parent/guardian may pick up meals at the school but should contact their school for more information.
For a list of current child nutrition program waivers for Florida from USDA, go here.
Congress allows increased fruit and vegetable benefits. At present, WIC provides $9 for children and $11 for women monthly for fruits and vegetables. The American Rescue Plan Act makes funding available for a four-month increase in the benefit of up to $35 monthly, if a state chooses to do so.
DOH attains waiver allowing remote issuance: Department of Health (DOH) obtained a waiver of the requirement that participants pick up their EBT cards in person at recertification or during nutritional education appointments.
WIC participants allowed to substitute certain food. Under a waiver from USDA, WIC participants in Florida are allowed to substitute milk of any available fat content and whole wheat or whole grain bread in package sizes up to 24 oz. when 16 oz. packages are unavailable.
USDA waived physical presence requirements: Although the scope and logistics are unclear at this time, USDA has given DOH permission to waive the requirement that persons be physically present at each certification or recertification determination in order to determine eligibility under the program through May 31, 2020.
USDA extends certification periods through May 31, 2020, for some participants.
For a list of current WIC waivers for Florida from USDA, go here.
HHS provides guidance. HHS has issued guidance on the flexibilities in TANF to respond to COVID-19.