The 2013 session

2013 Legislative Priority Talking Points

FRHA 2013 Legislative Priority Talking Points

Expanding FL Medicaid to 138% of the Federal Poverty Level.

·       Conservative estimate, 47,000 rural residents would be covered if FL Medicaid is expanded to cover those at or below 138% of the federal poverty level.

·       The Federal government will pay 100% of the cost for the first three years when you are most likely to see the pent-up demand experienced in the past by other states that expanded their programs.

·       The match rate does not drop for two years and then to 90% where it remains. 

·       In sum, it costs Florida nothing to expand coverage to its poorest residents for three years and as the demand for services drops it costs 10%.

·       Added to the discussion is the move to statewide Medicaid managed care for long term care (2013) and medical aid (2014) as efforts to control costs—hopefully while improving quality.

·       FRHA well understands the concern about funding liabilities however it also understands the responsibilities of a moral and ethical government to their citizens. 

·       In addition, expanding Medicaid to 138% FPL is good business, an investment when the costs to the state are low.

·       The mission of FRHA is to focus on the healthy state of our Rural Residents and would welcome the participation of our State Legislators in this effort.

Scholarship and Loan Repayment

·       A large number of currently uninsured rural Floridians, ~167,000, will have health insurance starting in 2014.  However, you need a workforce to provide the care.

o   13 of Florida’s 30 state defined “rural” counties are full county Health Provider Shortage Areas (HPSA); the remaining counties are HPSAs for low income populations (including Native Americans and migrants).

o   6 of Florida’s 30 rural counties do not have a hospital

·       The number of medical students pursuing a career in primary care has been declining due, among other things, to educational debt.

·       A study conducted by FSU College of Medicine found that 37 states had 75 programs providing some variant of loan forgiveness to encourage health professionals to provide primary care services in underserved areas. 

·       Florida has long recognized the “need to encourage medical professionals to practice in underserved locations where there are shortages of such personnel,” as evidenced by the continued existence in statute of the Medical Education Reimbursement and Loan Repayment Program (Title XLVIII Section 1009.65).  [See Statute Content below.]

·       Loan Forgiveness is an Investment in Florida’s Future.  We are losing far too many of our best and brightest to out-of-state opportunities. 

·       The program is on the books, we need to fund it!

The purpose of the Medical Education Reimbursement and Loan Repayment Program (Title XLVIII Section 1009.65)[1] is:

(1)  To encourage qualified medical professionals to practice in underserved locations where there are shortages of such personnel, there is established the Medical Education Reimbursement and Loan Repayment Program. The function of the program is to make payments that offset loans and educational expenses incurred by students for studies leading to a medical or nursing degree, medical or nursing licensure, or advanced registered nurse practitioner certification or physician assistant licensure. The following licensed or certified health care professionals are eligible to participate in this program: medical doctors with primary care specialties, doctors of osteopathic medicine with primary care specialties, physician’s assistants, licensed practical nurses and registered nurses, and advanced registered nurse practitioners with primary care specialties such as certified nurse midwives. Primary care medical specialties for physicians include obstetrics, gynecology, general and family practice, internal medicine, pediatrics, and other specialties which may be identified by the Department of Health.

(2)  From the funds available, the Department of Health shall make payments to selected medical professionals as follows:

(a)  Up to $4,000 per year for licensed practical nurses and registered nurses, up to $10,000 per year for advanced registered nurse practitioners and physician’s assistants, and up to $20,000 per year for physicians. Penalties for noncompliance shall be the same as those in the National Health Services Corps Loan Repayment Program. Educational expenses include costs for tuition, matriculation, registration, books, laboratory and other fees, other educational costs, and reasonable living expenses as determined by the Department of Health.

(b) All payments shall be contingent on continued proof of primary care practice in an area defined in s. 395.602(2)(e), or an underserved area designated by the Department of Health, provided the practitioner accepts Medicaid reimbursement if eligible for such reimbursement. Correctional facilities, state hospitals, and other state institutions that employ medical personnel shall be designated by the Department of Health as underserved locations. Locations with high incidences of infant mortality, high morbidity, or low Medicaid participation by health care professionals may be designated as underserved.

(c)  The Department of Health may use funds appropriated for the Medical Education Reimbursement and Loan Repayment Program as matching funds for federal loan repayment programs such as the National Health Service Corps State Loan Repayment Program.

(3)  The Department of Health may adopt any rules necessary for the administration of the Medical Education Reimbursement and Loan Repayment Program. The department may also solicit technical advice regarding conduct of the program from the Department of Education and Florida universities and Florida College System institutions. The Department of Health shall submit a budget request for an amount sufficient to fund medical education reimbursement, loan repayments, and program administration.

History.—s. 448, ch. 2002-387; s. 138, ch. 2011-5.

[1] http://www.flsenate.gov/laws/statutes/2010/1009.65

Proposed rule on the Affordable Care Act and the Children's Health Insurance Program

The link below will take you to the appropriate section of the Federal Register to read the entire announcement regarding the proposed regulations on the continued implementation of the Affordable Care Act (ACA), involving the 2014 Medicaid expansion and both flexibilities and safeguards being built into the Medicaid program.  These proposed regulations were announced on Monday, January 14, 2013, and are published in the Federal Register Jan. 22.  https://www.federalregister.gov/articles/2013/01/22/2013-00659/medicaid-childrens-health-insurance-programs-and-exchanges-essential-health-benefits-in-alternative

     

Gearing up for the 2013 session

We are working to get a head start on the 2013 Florida Legislative Session, which will start on March 5. Our first step was soliciting your input into the identification of priority issues and concerns for Florida's rural communities and rural providers with an online survey.

See next section for updates on issues FRHA identifited as important issues.

In addition, we wanted to let you know how the issues FRHA identified as important last session fared, starting with the good news:

— HB4057 Physical Education in Public Schools. This bill would have repealed a mandate that children in 6 - 8 grades take PE classes. Died in education.

— HB459/SB564 Office of Minority Health speak to programs that are sensitive to and address the needs of ethnically diverse groups in rural populations. Died in HHS access subcommittee.

The bad news:

—HB723/SB886 Community Health Workers. This bill would have established a task force to develop community health worker networks. Died in HHS subcommittee.

—SB788/HB261 Eye Health Care spoke to the efficient and effective use of health professionals and resources in rural areas. Died in HHS subcommittee.

—SB510/HB899 Florida Kidcare would have addressed flexibility in Medicare and Medicaid policies to offer new coverage and reduce unnecessary barriers to enrollment. Died in criminal justice.

—HB 1263/SB 1824 Department of Health was a very dense bill. Reorganizes DOH; revises duties of State Surgeon General; requires decentralization of public health system; allows department to delegate roles & responsibilities or use outside contractors to implement program & service activities; requires DOH to contract with each county to establish & maintain county health department; defines specific services to be provided by county health departments. Some provisions were successfully deleted, e.g., requiring decentralization of public health system. However, the bill passed with many negative provisions still in place and was signed by the Governor in April 2012. Finally, this year we want FRHA to be more engaged so we can be more effective.