Medicaid Reform Initiative   The Centers for Medicare and Medicaid Services (CMS) has approved the Florida Medicaid Waiver. The Florida Legislature must still approve the Waiver before implementation can occur. The Medicaid Waiver appears to be driven almost exclusively by the intent to reduce future growth in the state’s Medicaid expenditures. While that itself may be a desirable objective, achieving it at the expense of cutting services, diminishing access to care, and/or reducing federal investments in Florida’s healthcare system may create unintended consequences which should be carefully considered.

The Medicaid Reform initiative should be reviewed by the Legislature in the broader context of setting state policy regarding indigent health care and delineating the respective roles of AHCA, the Department of Health and local government in that system. Medicaid Reform can be the venue for establishing these policies, and the Legislature needs to ensure that all affected parties have a voice in these discussions.

The current changes proposed in a Medicaid Reform Waiver will continue to erode services while capping federal reimbursement levels. There is a potential for severe cuts in services. The Community Alliance supports reforming Medicaid, but urges any reform be guided by the following principles:

• Oppose changes to the funding formula for the Medicaid Program between the federal and state government that would reduce the federal share to Florida;

• Oppose any legislation that would eliminate statewide application of mandatory or optional Medicaid services for eligible recipients;

• Support legislation that fully maintains and preserves critical mandatory and optional Medicaid services such as prenatal health care benefits and the Medically Needy program;

• Support legislation that allows the state to finance and promote the objectives of the Medicaid Program without shifting additional costs to county government;

• Support legislation that provides flexibility at the local level for counties to actively participate in the state’s efforts to reduce unnecessary nursing home placement by allowing counties to redirect their required Medicaid match to fund local health services or community-based care programs;

• Support legislative efforts to use intergovernmental transfers to help draw down additional federal funding without supplanting the state’s share with local funds that have been certified to be federally matched, in addition to the state’s contribution; and

• Oppose any legislative efforts to divert county funding for mental health services to managed care programs.

Funding of Senior Services   Support state funding of a complete, community-based array of comprehensive and quality services for senior recipients which includes:

• elder, long-term care services

• directing existing funding from institutional care to community-based care programs such as Community Care for the Elderly, Home Care for the Elderly, Medicaid Waiver, Alzheimer’s Disease Initiative and senior centers.

• effective community based systems that ensure elders receive the level and intensity of services that meet their needs and promote their wellness.

• quality assurance monitoring and measures that hold providers accountable for appropriate care including community based providers that respond to local needs, managed care and health maintenance organizations and other plans

Approval of this item should result in increased funding for senior services in Sarasota County. There is also the potential to reduce the County’s financial obligation for the Medicaid Nursing Home expenditures as one purpose of additional funding is to reduce unnecessary institutionalization of frail elders and support in-home services instead. Through support of this recommendation the community should realize an increase in the quality of life among elders. Additional support services will promote aging in place, and decrease the morbidity and mortality rate among frail elders.


Equitable Funding for Community-Based Care Lead Agencies   The Legislative request statewide for $21 million for community based care organizations will bring the average state reimbursement per child to $10,100. In this process, those communities above the average of $10,000 should be held harmless from any reductions. In Sarasota and Manatee counties, the reimbursement rate is $17,000 per child. This outcome has been accomplished through proviso language in each of the last three years. If this does not pass, Sarasota County could lose up to $2.8 million in community based care, depending upon the final amount of reimbursement. This would be a dramatic impact on Sarasota’s ability to provide services to its child welfare population.


Foster Family Care Rate Increase   Foster parents have not received a rate increase since 2000. Data systems show that the base rate being paid per child is $369 per month. Forty-five percent of foster parents report spending between $500 to $1,500 of their own personal income to supplement board rates each year. The Community Alliance supports the rate increases of 17 to 23% which have been proposed.

Passage of this bill would not only increase the foster home rate but also the placement stability, as required by federal law, and recruitment and retention of family foster homes.


Fetal Alcohol Spectrum Disorder (FASD)  The FY 05-06 Legislature appropriated $280,000 which established Florida’s first FASD Diagnostic/Intervention Center at The Florida Center for Child and Family Development in Sarasota. Funding is requested to continue this initiative whose mission is primary and secondary prevention of FASD through screening, diagnosis, intervention, training, education and research; and to reduce disabilities and increase functioning of persons with FASD to improve their quality of life. The primary target population of this project is young children, ages birth through eight years, and their families who are involved in the child welfare system, those at high risk for entering the child welfare system due to parental substance abuse and/or pre-natal exposure to alcohol and other substances, and those mothers and infants in a residential substance abuse treatment program.

This project provides 1) diagnostic services and training/education on a statewide basis; and 2) intervention services for children and families residing in Sarasota County. Family Navigators work with each child and family team to provide support and to assist the family with integration and coordination of services among the multiple systems and various service providers. Continuation funding in FY 06-07 will be used to provide assessment and intervention services (individual/family therapy, behavioral support services, respite, advocacy) to an additional 40 children. In addition, 200 to 300 community professionals will receive training on FASD.

Additional funding ($4,340,000) is requested in FY 06-07 to build upon the FASD initiative started in FY 05-06. Although Florida has made great strides in addressing the impact of FASD in a short period of time, much more needs to be done to accomplish the goals/objectives of Florida’s FASD State Strategic Plan. Additional funds will be used to establish three additional FASD Diagnostic and Intervention Centers in Florida. The Diagnostic/Intervention Center in Sarasota will serve as a training site to train the other core teams at the new centers. This funding will also allow development of a family resource center, modeled after the FASD Family Resource Institute in Seattle, WA, to provide families the intensive family support needed to care for these children. These intensive support services would reduce/eliminate children being removed from their biological families due to the family’s inability to cope with their multiple needs. These intensive support services would also prevent multiple foster care placements of children and/or failed adoptive placements.

This additional funding provided would also allow the Center to coordinate a community effort to develop a comprehensive service delivery system for substance exposed infants/children in our community. A portion of this funding ($300,000) would expand outreach services to pregnant women through First Step, support residential treatment for pregnant women who are abusing substances in the Mothers and Infants Program, and provide after-care services for women discharged from the Mothers and Infants or Transitional Living Programs. This comprehensive approach would include multiple service providers that would focus on prevention, intervention, and long term outcomes of infants with pre-natal exposure to alcohol and other substances. These are high risk infants and mothers who require immediate and continuous comprehensive, coordinated services. The additional funding will also create a statewide network which will provide mental health, behavioral support, developmental services; family support services, including training/education support, advocacy, and respite; cross discipline training with the Departments of Juvenile Justice, Health, Mental Health, Education, Agency for Persons with Developmental Disabilities; technical assistance and community support; and program evaluation.


Support SB 0156 for 2-1-1   This bill would amend s. 408.918, F.S. requiring the Florida 2-1-1 Network to provide services in each county and to coordinate services with county emergency management agencies during disasters. The bill calls for appropriation of $5,000,000 from the General revenue Fund to the Agency for Health Care Administration to fund the statewide expansion of the Florida 2-1-1 Network to all counties (currently 13 million Floridians covered in 36 counties, including Sarasota County ), and to enhance the operations of existing 211 providers. The Florida 211 Network is the coordinated system of 2-1-1 and information and referral providers sought to be achieved through the community/state partnership envisioned in SB 156.

Passage of this bill would:

• establish a comprehensive statewide information and referral system, linking hundreds of information and referral providers who currently answer more than 3 million calls annually.

• increase capacity of 2-1-1 providers so they can appropriately respond to disasters.

• expand 2-1-1 services to counties currently not covered.

• provide cell phone access to 2-1-1 statewide.

• establish and promote standards for data collection and for distributing information among state and local organizations to assist in identifying gaps and needs in health and human service programs.

The bill calls for a dollar for dollar local match. Local funding for the existing
2-1-1 system is already being provided by Sarasota County ($80,000 in current year) and United Way of Sarasota County ($100,000 in current year) and from other funding sources including United Way of Manatee County and Manatee County Government. We do not anticipate this bill to require additional local funding.