State’s crisis services infrastructure will be put to the test with July 16 rollout of national 988 suicide prevention hotline
Investment in mobile response teams already made under the Marjory Stoneman Douglas High School Public Safety Act could be used as a state Medicaid match to draw down millions more in federal funding
ORLANDO, Fla. - In advance of this weekend’s rollout of a national 988 suicide prevention hotline, 36 organizations from across the state have signed on to a letter urging Gov. Ron DeSantis and state policymakers to take action and draw down millions in additional federal dollars to help ensure a more robust behavioral health care infrastructure.
Signatories include Florida Policy Institute (FPI), Disability Rights Florida, United Way of Florida, Florida Association of School Psychologists, Hillsborough County Public Schools, Hillsborough County Clerk of Court and Comptroller Cindy Stuart, and Hillsborough County Public Defender Julie Holt.
Specifically, the American Rescue Plan Act (ARPA), enacted on March 11, 2021, establishes a new option for states to cover mobile response team services (MRTs) through their Medicaid programs for a five-year period beginning April 2022. It also provides an enhanced federal match, which covers 85% of the cost of these services for the first three years.
The 988 hotline was established “to improve access to crisis services in a way that meets our country’s growing suicide and mental health related crisis care needs,” according to the Substance Abuse and Mental Health Services Administration. As groups point out in the sign-on letter, MRTs, which provide 24/7, on-demand crisis intervention services in homes, schools, emergency departments, and other settings, are a critical piece of behavioral health crisis care. These services will be crucial as Florida callers are routed to local centers for help.
A recent FPI analysis makes the case for using ARPA funds to supplement current state and local funding for MRTs. Notably, the state's current $18.3 million annual investment in mobile response teams, which was made pursuant to the Marjory Stoneman Douglas High School Public Safety Act, could be used as a state Medicaid match to draw down over $100 million new federal dollars for the first three years and more than $28 million in subsequent years. Additional state matching dollars could be available through annual mental health allocations provided to local school districts.
Sadaf Knight, CEO of FPI, said: “For years Florida has been behind the curve when it comes to investing in behavioral health care to meet the needs of its growing population. The toll of the pandemic on top of the rollout of 988 will shine a light on the holes in our crisis services. These Medicaid MRT funds provide an invaluable opportunity to bolster these services for Floridians in desperate need of help.”
Peter Sleasman, executive director of Disability Rights Florida, said: “Disability Rights Florida joins Florida Policy Institute in urging the state to take advantage of federal dollars allocated in the American Rescue Plan Act to fund mobile response team services in Florida. There is a greater need for crisis intervention services through the state’s mental health system than ever before. This federal funding is vitally important to persons in the disability community with behavior disorders, mental illness, and substance use disorders who might otherwise be imprisoned, involuntarily committed, or killed if not provided access to appropriately-prepared and trained mental health professionals while in crisis.”
Hillsborough County Schools Superintendent Addison Davis said: “Hillsborough County Public Schools supports any opportunity to further fund critical mental health supports for our students. Our district's Mobile Response Team, in concert with our local health partners, has already made tremendous impacts on 1,200 students in the first year of operation. Further demonstrating the positive impact on students and families, just over 10% of the calls for service resulted in a Baker Act. It is our hope to continue to bolster these resources, offering families immediate assistance when they need it most.”
Hillsborough County Clerk of Court and Comptroller Cindy Stuart said: “As a member of the Safe and Sound Board for many years, I’ve witnessed the newly introduced MRT or Mobile Response Team in Hillsborough County Schools reduce the number of Baker Acts and divert those students to mental health treatment alternatives. It’s been a community-wide effort to get here, to see this crisis through a lens of prevention and implement lasting changes.”
Hillsborough County Public Defender Julie Holt said: “As the Public Defender for the 13th Judicial Circuit of Florida for 30 years, I am extremely aware of the unprecedented mental health crisis in our country and the local community. Mobile Response Teams (MRTs) are critical for real-time interventions when a mental crisis is occurring. Targeted treatment and healing can begin in real-time. MRTs can and do timely address trauma and reduce the ‘criminalization’ of mental illness, without compromising public safety.”
FPI is an independent, nonpartisan and nonprofit organization dedicated to advancing state policies and budgets that improve the economic mobility and quality of life for all Floridians.
Click here to read the letter.
Complete list of signatories:
Florida Policy Institute
Allegany Franciscan Ministries
Alliance for Public Schools Foundation
American Children's Campaign
Center for Children's Rights
Charles & Margery Barancik Foundation
Children's Board of Hillsborough County
Children’s Services Council of Broward County
Community Foundation of South Lake County, Inc.
Disability Rights Florida
Devereux Advanced Behavioral Health
FL National Organization for Women
Florida Association of School Psychologists
Florida NOW Education Fund
Florida Voices for Health
Forty Carrots Family Center
Gulf Coast Community Foundation
Haitian Neighborhood Center, Sant La Inc.
Hillsborough County Public Schools
iCommunity Multiservices llc
Julianne Holt, Hillsborough County Public Defender
League of Women Voters of Broward County
National Organization for Women, Jacksonville Chapter (Jax NOW)
Palm Health Foundation
Safe Children Coalition, Inc.
Dr. Harold Shinitzky, Psy.D.
Southeastern Behavioral Health
Cindy Stuart, Hillsborough County Clerk of Court and Comptroller
Suncoast Partnership To End Homelessness, Inc.
Tampa Bay Thrives
United Way of Broward County
United Way of Florida
Winter Park Health Foundation
Women's Foundation of 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.