October 15, 2018

Cuts Likely to Medicaid Services Like Substance Abuse Treatment, Home- and Community-Based Services and Mental Health Care Under Amendment 5

Florida already ranks near the bottom on measures of residents’ health

LAKE MARY, FLThe already fragmented health care landscape in Florida, which includes coverage gaps, underinvestment in mental health and substance abuse treatment and barriers to accessing life-saving services, would face even more challenges under Amendment 5. In its new policy brief, the Florida Policy Institute explores the shortcomings in the state’s health care system and cautions that enacting a revenue-restricting measure would put certain groups at risk, likely resulting in lawmakers cutting “optional” Medicaid services.

On November 6, Florida voters will decide on Amendment 5, which would make generating resources to meet the needs of Florida’s families, communities and economy much harder.  The measure would require a two-thirds (supermajority) vote of the state Legislature to approve any new state revenues, taxes and fees or to eliminate tax incentives and loopholes.

Florida has one of the lowest rates of residents with health care coverage in the nation, and ranks 50th in its per person investment in mental health care and 49th in fiscal investment in services for children and adults with developmental disabilities. The state already has some of the largest waiting lists in the country for people trying to access critical services.

The brief explains which Medicaid groups and services would be targeted for cuts if lawmakers failed to raise revenue under the supermajority requirement. They include:

  • Health coverage for low income people with severe disabilities and the medically needy. Currently, uninsured medically needy Floridians with income above the state’s income threshold for Medicaid can qualify if they face catastrophic medical costs from an unexpected illness or accident. This is an “optional” program, meaning it’s also likely to be on the chopping block when lawmakers target Medicaid for cuts.
  • Home- and community-based services that keep seniors and adults and children with disabilities out of nursing homes. Florida covers services like assistance with bathing, eating and dressing under optional Medicaid waiver programs.
  • Prenatal care. Florida covers prenatal care (and care 60 days after childbirth) for uninsured women up to 185 percent of the poverty threshold ($3,870 per month for family of four). Lawmakers could lower this threshold, however, when faced with a severe budget shortfall under a supermajority requirement.
  • Mental health, substance abuse and opioid treatment for adults. A supermajority requirement would inevitably trigger fiscal pressures on the Medicaid program, which in turn could reduce treatment services.

“Amendment 5 would force state legislators to make harrowing choices over which areas of the budget get cut following the next economic crisis, since raising revenue would not be an option,” said Sadaf Knight, co-interim executive director of the Institute. “Oklahoma, which enacted a similar measure in 1992, made deep cuts to pre-K-12 education, higher education and Medicaid. Florida’s health care accessibility issues would become even more severe if the amendment passes.”

“Florida, like other states, has seen a marked increase in opioid abuse and opioid-related deaths,” said Dr. Brent Schillinger, chair of the Palm Beach County Medical Society Opioids Task Force and Florida Policy Institute board member. “If Amendment 5 passes, much-needed funding for drug treatment and prevention programs, along with multiple other programs and services that assist Florida residents, would be at risk for cuts.”

“Our ability to respond to the health care challenges of the future will depend, in large part, on our flexibility to implement new solutions,” said Scott Darius, executive director of Florida Voices for Health. “Amendment 5 would give Florida less flexibility, ultimately threatening the most vulnerable families.”

The Florida Policy Institute’s mission is to advance state policies and budgets that improve the economic mobility and quality of life for all Floridians.

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