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Medicaid eats up 20 billion state dollars every year. That�s about a third of the state�s total budget. As Whitney Ray tells us, lawmakers are looking for ways to lower the cost without drastically cutting services.

Four disabled Medicaid recipients greeted lawmakers, lobbyist and health care administrators with a sign Wednesday as they made their way to talk about Medicaid reform. Inside a caseworker assisted Patrick Wells as he told state senators how Medicaid helps him out of a group home and living on his own.

Caregiver: Do you need help to live there?
Patrick: Yes
Caregiver; Does somebody come in everyday and help you?
Patrick: James.

Lawmakers want to move Medicaid recipients into private managed care providers like HMOs to help cut the 20 billion dollar cost to the state. Aaron Nangle runs a company helping disabled people find caregivers. He says the move would leave his customers without vital services.

�Are they really going to put through the care, the effort? Are they going to advocate for the individuals with disabilities,� asks Nangle.

Besides privatizing parts of the entitlement program, lawmakers also want to cut down on rampant Medicaid fraud, and protect doctors from malpractice lawsuits.

Federally funded health clinics, like Bond Community Health Center in Tallahassee, already enjoy protection from lawsuits. Dr. Temple Robinson, the center�s medical director, says eliminating the threat of being sued lets doctors practice more freely.

�That was the physicians, the providers here do not pay malpractice premiums out of pocket,� said Robinson.

Whatever decisions are made by lawmakers will be met with criticism, but if the cost aren�t lowered, economist say over the next decade the state will go broke trying to pay them. Medicaid reform died in the legislative process last year, but with a newly elected Republican supermajority legislative leaders are more confident they�ll be able to make changes.

Medicaid costs the state of Florida 20 billion dollars a year; that�s nearly a third of the state budget. Incoming Senate President Mike Haridopolos is on a mission to bring those costs down. Haridopolos is touring the state, talking to doctors, administrators and today some students at FSU Med School in hopes of building support and gaining ideas to help solve the problem. Haridopolos says strict bureaucratic guidelines are keeping costs high.

�Right now doctors feel constrained, hospitals feel constrained by the one size fits all scenarios and with the additions of 1.4 million Floridians going on Medicaid because of what they did in Washington DC is making things more difficult,� said Haridopolos.

Nurse Practitioner Mai Kung has a few ideas to bring down the cost. Kung is asking state lawmakers to allow nurse practitioners to write prescriptions for controlled drugs, so patients don�t have to waste more time and money waiting for a doctor to do what the nurse practitioner tells them.

�Studies have show repeatedly that we can provide high quality cost effective patient centered care at a much reduced cost and we can practice to our full scope of practice and we can save Medicaid cost,� said Kung.

Florida and Alabama are the only states that don�t allow nurse practitioners to write prescriptions for controlled substances. Legislation allowing the 15-thousand Florida NPs to write the prescriptions has died 15 years in a row. If passed it�s estimated to save the state hundreds of millions of dollars.

Attorney General Bill McCollum is asking the federal government for more authority to fight Medicaid fraud. The state Agency for Health Care Administration joined McCollum�s call, asking for a waiver from the federal government to increase the state�s investigative authority. Tom Arnold, AHCA Secretary, says allowing Florida to view electronic Medicaid files will increase the state�s ability to catch people scamming the system.

�The key for us is more eyes on the target. In the managed care area we are going to continue to enforce our contract which we think are strong, but we need to have some additional resources in term of monitoring those,� said Arnold.

Last year the state busted 200 million dollars worth of Medicaid fraud. There�s an estimated two billion more out there.

Legislation creating more financial oversight in the state�s 19 billion dollar Medicaid program passed a House committee today.

The plan would require most Medicaid patients to enroll in a Health Management Organization. The HMOs would be responsible for making sure 80 percent of all Medicaid dollars were spent on medicine and services. Representative Dean Cannon says the plan would be ushered in slowly.

�There�s always nervousness with any kind of change. What we tried to do is create a really transformational policy that eliminates the special interest advantages of one party over another and create a level playing field for competition between the different regions,� said Cannon.

Under the plan there would be six regions regulated by the Agency for Health Care Administration. The Senate passed similar legislation earlier this year, implementing the changes in five counties. The House version affects 24 counties, spreading to all 67 over the next few years.

Attorney General McCollum has reached a six point five million dollar settlement with drug supplier Dey over allegations of drug price manipulation.� About half of the money will go into the state treasury, while another million will go into a whistleblower fund and a pharmacist who blew the whistle on the company will take a share. McCollum says he has been recovering more with fewer people

“Since the 2007-2008 fiscal year, we have now returned, from Medicaid fraud division efforts like this, over 29 million dollars to the general revenue fund of the state of Florida, to the taxpayers,” McCollum said.

McCollum says the state could be collecting even more if he had more staff. One estimate is that the state is losing over three billion dollars in Medicaid fraud each year.

The race for Governor is heating up over who is or isn�t fighting fraud in the Medicaid program. CFO Alex Sink is suggesting her likely GOP opponent, Attorney General Bill McCollum, isn�t doing his job. McCollum says he is.

“Well, it’s estimated that we have as much as three billion dollars in Medicaid fraud, right here in Florida,� CFO Sink said. �And it’s about time that the Attorney General step up and do his job and go after this fraud.”

“I just reported $198 million in recoveries just this past year,� McCollum said. �That’s the record high number of dollar amounts that have been recovered and we’ve had steady increasing convictions, so those kinds of reports were highly inaccurate.”

Today the Agency for Health Care Administration launched the Florida Medicaid Health Information Network, becoming the first state in the country to make the move toward a paperless system. As Whitney Ray tells us, the move is expected to save money and improve quality, but concerns about security surround the new system.

The Florida Medicaid Health Information Network will give 2.6 million Floridians a chance to access their medical data online. Medicaid patients who sign up will have 18 months worth of checkups, prescriptions, and surgeries available to their doctors with just a few mouse clicks.

�They can look at the benefits that that person is eligibility for. They can submit claims to us and other payers through this portal,� said AHCA Secretary Tom Arnold.

For Medicaid patients who sign up for the program, they can have their medical records accessed immediately, even if they are in an accident away from home.

The network will allow doctors to better serve patients who are incapacitated, but the instant access comes at a price. Larry Spalding, an attorney for the ACLU says there isn�t an online network that can�t be hacked.

�This is not a panacea. With all the good that will hopefully come from these types of systems, there are real personal dangers lurking out there,� said Spalding.

Russ Thomas, the president of the company overseeing the network says his company has a flawless record.

�We have not had a release or exposure of date in the eight years that we have been in business, but if it is exposed, it is our duty to report that,� said Thomas.

Sign up for the network is voluntary. The state will evaluate the success of the program after two years and consider an expansion. To sign up for the Florida Medicaid Health Information network go to www.floridahealthfinder.gov

A state hotline, for low income families try to change their Medicaid coverage is flooded with calls. People dialing into the call center are often greeted with a busy signal. As Whitney Ray tells us, staff and hours have been added, but right now the demand is exceeding the state�s resources.

Hear it Here: Medicaid Hotline Flooded with Calls

Once a month 82 year-old Frances Hyatt visits her senior center for a free medical check up.

�For people who can�t afford to pay for having it done they can come here and it won�t cost them,� said Frances.

Frances has her medical expenses covered through Medicare and the Capital Health Plan, but around the corner at the center Pearl Fuller relies solely on Medicaid.

�I would really be in trouble without it because it helps a lot,� said Pearl.

The number of Floridians relying on Medicaid for health care coverage has skyrocketed. 100,000 people were added to the state�s Medicaid rolls this year alone. The increase is bogging down the state hotline for people trying to change their plan. We called the hotline five times, and five times we received a busy signal.

The Agency for Health Care Administration has added operators and extended hours to keep up with the demand.

�Please be patient. Continue trying the line and at various times through out the day and if at some point say they�ve tried continuously in the morning and that�s unsuccessful try in the afternoon or maybe even try on a Saturday,� said Fernando Senro, a spokesman for AHCA.

People who can�t get through to the call center are assigned a plan; it just may not be the coverage they want. People automatically enrolled in a Medicaid plan have 90 days to switch their coverage.

Florida Democrats today unveiled a plan to put more accountability behind the four bill the state sends to nursing homes each year. The legislation would require that 75 percent of the cash would be required to do to direct patient care. Zayne Smith of AARP praised the effort.

“This legislation would guarantee that seventy-five percent of Medicaid funding would go to direct patient care.  It’s a win for the residents. Its a win for the most vulnerable residents in Florida, It’s a win for the workforce, and frankly, its a win for the nursing homes to do the right thing, and place the emphasis on care.”

The legislation also seeks to stop nursing homes from using inflated staff leasing companies that are often owned by the parent companies of the homes. 

30 years ago Florida ranked third in the nation for the highest infant mortality rate, but thanks in large part to the work of Healthy Start, the state now ranks 28th.

The program, which offers free services to all pregnant women in Florida celebrated its 30th anniversary Wednesday.

Florida’s infant mortality rate has dropped by 32 percent since Healthy Start was created.

That equates to 638 lives saved last year alone.

“That’s approximately 30 kindergarten classes,” said CEO for the Florida Association of Healthy Start Coalitions Cathy Timuta.

Timuta at an event celebrating the program’s 30th birthday, said the program served more 129,000 pregnant women and 84,000 babies in 2020.

“We’re talking about real people and real families who have been impacted,” said Timuta.

Babies born to mothers who received Healthy Start services has an infant mortality rate of less than three per 1,000 births.

That’s more than 50 percent lower than the statewide average of six per 1,000 births.

The program got its start in 1991 under Governor Lawton Chiles.

“Who had a low birthweight grandchild himself,” said Jack Levine, founder of 4Generations Institute.

Levine has been a child advocated for four decades.

He said Healthy Start’s impact on the state has been undeniable.

“No state in the nation has had better achievement over these three decades,” said Levine.

One of Healthy Starts main missions to reduce racial disparities in infant and maternal mortality rates.

It was an issue given special attention in the last legislative session.

“It is our biggest challenge as a state and as a Healthy Start program,” said Timuta.

As part of the Legislature’s response, it extended postpartum Medicaid coverage from two to 12 months earlier this year.

It’s a $240 million endeavor Timuta believes will have a major impact.

“More families are going to be able to get services this year through Healthy Start, which is very exciting,” said Timuta.

And Healthy Start advocates said there’s an economic benefit to providing pre and postpartum services.

They claim for every $1 spent, the state saves $10 down the road.

The State of Florida has been dealt an initial blow in its battle to block a federal rule requiring health care workers to get vaccinated.

The federal policy conflicts with the state law banning vaccine mandates and could result in facilities facing stiff fines, but health care groups are most concerned about how the mandate will affect staffing levels.

Health care workers will have to be vaccinated by December 6th or billions of Medicaid dollars could be withheld from facilities.

Kristen Knapp with the Florida Health Care Association told us nursing homes have no choice but to comply.

“That December 6th deadline is fast approaching and we’re all working really hard to make sure that we’re in compliance,” said Knapp.

And with only about six of ten nursing home staff vaccinated to date, Knapp worries how staffing could be affected.

“There’s a possibility if we have limited staffing that we have to shut down wings, limit admissions,” said Knapp.

Compliance with the federal rule would also mean facilities could face ten to $50,000 fines from the state for every employee fired.

Mary Mayhew with the Florida Hospital Association said health care facilities are in desperate need of resolution.

“Where there is confusion there’s a lack of clarity and that’s where we are right now between the state law that has recently been passed and the federal rule,” said Mayhew.

So far the state’s efforts to block the federal vaccine mandate for health care workers in the courts has been unsuccessful.

The Governor has vowed to continue fighting the rule, despite a US District Judge refusing to block it in an initial ruling.

“I don’t want to see anyone get thrown out of a job based on getting a shot or not getting a shot,” said Governor Ron DeSantis.

The Governor said he plans to take the state’s lawsuit against the rule to the 11th Circuit Court of Appeal, but there’s no guarantee a ruling will come before the December 6th deadline.

Attorney General Ashley Moody’s office issued this statement about the loss in the lower court.

“Attorney General Moody will continue to fight back on President Biden’s unlawful vaccine mandates. We strongly disagree with this order and will pursue further action in court to protect the livelihoods and rights of all Floridians,” said Moody’s Director of Public Affairs Lauren Schenone Cassedy.

The health care industry in Florida says it is in crisis and is pleading for lawmakers’ help in the upcoming legislative session to address chronic staffing shortages.

The lack of employees is already resulting in people having to wait longer for care.

Florida Hospitals saw one out of four nurses leave their job last year, the highest turnover rate the state has ever seen.

“We just saw during the Delta surge what happens when you can bring beds in but you can’t staff them,” said Florida Hospital Association President Mary Mayhew.

Additionally, 92 percent of long term care facilities say they’re facing staffing challenges.

“And for 75 percent of them it is the number one concern,” said Nick Van Der Linden with LeadingAge Florida.

Mayhew and Van Der Linden were among a diverse group of health care representatives who met Monday to raise the alarm in hopes of catching the the ears of lawmakers.

For the long term care facilities, additional Medicaid funding is the biggest ask, as the industry has seen costs increase by $600 million.

“And it doesn’t have to be strictly dollars. There can be other creative ways to do that, whether it’s looking at how we do staffing. Are there more creative ways to safely take care of our residents that will reduce costs?” said Emmett Reed with the Florida Health Care Association.

Hospitals are pushing for more faculty in nursing programs at universities.

They’re also hoping lawmakers will create incentives to increase graduation rates.

“We’ve got to replace what we’ve lost and then grow it even more for our growing population,” said Justin Senior with the Safety Net Hospital Alliance of Florida.

If something isn’t done soon, the Florida Hospital Association estimates the state could be short nearly 60,000 nurses by 2035.

That will make it harder than it already is to find openings at nursing homes and it could also mean further delays for elective procedures.

“So it’s a dangerous situation for Floridians,” said Reed.

And with an 11 percent vacancy rate, Florida has been hit harder by nursing shortages than the nation as a whole, which has a vacancy rate of 9.9 percent.

All of the health care representatives at the round table agreed the staffing shortages have been exacerbated by the pandemic.

The turnover rate in nursing homes nearly doubled between 2017 to 2021.

Florida will face a severe nursing shortage by the year 2035 according to a report by the Florida Hospital Association and Safety Net Hospitals.

The problem is compounded by too few entering the profession and too many leaving.

The report found Florida will be short more than 59,000 nurses by 2035.

The pandemic has made an already bad situation worse.

“We have a crisis today because of what our hospitals, staff have experienced throughout the pandemic, the stress and strain,” said Florida Hospital Association CEO Mary Mayhew.

Over the next 14 years Florida’s population will increase by more than four million.

The fastest growing segment is those over 65.

“That population is the one most likely to use inpatient services, out patient services, emergency room services,” said Justin Senior, CEO of Safety Net Hospitals.

Quality healthcare is a big draw for both people and companies who want to move to Florida.

Ultimately, not having enough nurses could impact the state’s economic and population growth.

The study recommends the state adds at least 4,000 new nurses every year.

There are now more than 18 nursing schools in Florida.

Senior said there are plenty of applicants, but not enough seats or faculty.

“The number of applicants to nursing schools has actually increased, but if the number of seats doesn’t increase, the number of faculty members doesn’t increase, then all you have is more applicants,” said Senior.

Willa Fuller is the Executive Director of the Florida Nurses Association.

“More forms you have to fill out, more things we have to document. And you know, one of the things now is that even satisfaction is measured by a survey,” said Fuller.

The report also found if barriers to health care are lifted, such as expanding medicaid, the need for nurses could increase by a third, to almost a 100,000.

Recommendations include using Florida’s strengths to recruit, expanding training in non-metro areas and increasing the faculty Senior said is lacking.

The problem is also made worse by nursing staffing companies that hire nurses, then lease them back to hospitals at a premium.

State Lawmakers have wrapped up their work for the 2021 legislative session agreeing on a historic $101.5 billion budget.

Both parties say they’re happy with where the budget landed, after initially fearing drastic cuts.

This is the first time in state history the budget has topped $100 billion.

Legislative leaders say the spending plan this year was crafted with the future in mind.

“I believe this session we have created a framework that will benefit our state for generations to come,” said Senate President Wilton Simpson.

The eye popping overall price tag seemed unimaginable at the start of session, when lawmakers were looking at massive cuts to health care, prisons and more.

But those cuts were avoided thanks to higher than expected state revenues and billions in federal stimulus.

“I think every time we came back the estimates got better and better about revenue coming back in the state, which wasn’t happening, which made our budget choices a lot easier,” said House Speaker Chris Sprowls.

Even Democrats are happy with the overall product, despite not seeing the direct relief to Floridians they had hoped the extra federal cash would go towards.

“$10 billion goes a long way into any budget and it’ll make it a lot better,” said House Democratic Co-Leader Bobby DuBose.

Some highlights of the budget include half a billion for coastal resiliency projects, a ten month expansion of postpartum Medicaid coverage, a raise for minimum wage state employees to $13 an hour and one time teacher and principle bonuses of $1,000.

One area seeing a huge boost from the feds, the $20 billion k-12 budget.

“We now have more money than they can even consider what to do with. We’re awash in funding. COVID turned out to be the greatest stimulus for education spending in public education history,” said House K-12 Appropriations Chair Randy Fine.

The budget is now in the hands of the Governor, but the Senate President isn’t fearing the veto pen this year.

“Wildlife corridors, the environment, sea level rise. All of the things that are in this budget, I believe the Governor will fair in his application of the veto pen,” said Simpson.

Facing the uncertainty around the pandemic, the Governor vetoed a billion from the budget last year.

He has a month to decide what stay and what goes for this year.