|
Medicaid Reform Section 1115 Super Waiver.
Governor Bush has announced his intention for Florida to seek a Section 1115
“Super Waiver” from the federal Centers for Medicare and Medicaid (CMS) to
reform the state’s Medicaid program. Specific details of the proposed waiver
request have not been released for public review, and it is uncertain when
the request will be submitted by AHCA to CMS for approval. Although the
Governor has the authority to submit a waiver proposal to CMS without prior
legislative review and approval, and CMS has the authority to approve a
waiver proposal, sole approval from CMS does not give the state the full
authority to change the Medicaid program. The Florida Legislature also has
to grant approval of proposed program changes needed to implement the
recommendations outlined in the waiver proposal.
A Section 1115 Super Waiver would dramatically
reform the state’s Medicaid program: federal reimbursement levels would be
capped, with the potential for severe cuts in services and eligible
populations if five-year projections of costs and/or eligible recipients
proved faulty. All four states which have been granted Section 1115 Super
Waivers in recent years have since rescinded their actions.
Given the potential dire consequences for
individuals and families with low incomes and resources, the Community
Alliance opposes the submission of a Section 1115 Super Waiver proposal by
the state without public vetting of the proposal and review and approval of
the waiver request by the Florida Legislature.
As development of the Super Waiver proposal
proceeds, the Community Alliance urges that reform of the state’s current
Medicaid program 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.
Universal Pre-Kindergarten. The Universal Pre-Kindergarten
program, which must be implemented by the 2005-2006 school year, will be
addressed during the special legislative session in December. Statewide
advocates have agreed on the following key principles that will ensure that
quality will not be compromised:
Fully Qualified Teachers: Teachers must have a bachelors degree
in early childhood education or a related field by 2012, an associates
degree in early childhood by 2008, and a Child Development Associate (CDA)
or equivalency certificate (CDAE) by 2005 as a minimum. Other
instructional staff must have a minimum of a CDA or CDAE.
Sufficient Staff: UPK must have one teacher for every ten
students or fewer and classrooms of no more than 20 children.
Evidence-Based Curriculum: UPK must offer a choice of approved,
evidence-based curricula leading to learning outcomes for children.
Full Parent Choice: Parents must have access to resource and
referral services to ensure a choice of high quality accredited programs
in public, private and faith-based settings.
Adequate Time: UPK must offer a choice of a 6-hour full day
option or a three hour part day option.
Governance and Oversight: Governance must be unified at the
state level with local oversight of all school readiness programs
including UPK.
Adequate Funding: Dollars must be commensurate
with the costs of providing high quality UPK as mandated to ensure
optimal development and learning outcomes for children
(and should not diminish in any way the
existing 0-5 system).
The above statements are consistent with the
principles adopted by leaders in Sarasota County, including an emphasis on
quality, accountability and parental choice. One of the additional
key items in Sarasota’s position is the importance of local control
in the implementation of UPK. We believe that local control is essential to
any successful implementation. We also strongly believe that School
Readiness Coalitions across the state should not be forced to merge (as an
add-on to any UPK legislation), but rather should be allowed to do so on a
voluntary basis when it makes sense for their respective communities.
Mobile Crisis Response Unit.
An analysis of Sarasota County’s acute care system conducted by the
Community Alliance in 2003 determined that there is a chronic shortage of
crisis stabilization unit (CSU) beds in the county. The study confirmed that
the County’s designated Baker Act public receiving facility is running over
capacity virtually every day. As a result, indigent patients are being
diverted to private receiving facilities in both Sarasota and surrounding
counties. When beds are not available at these facilities, the overflow of
patients ends up in Sarasota Memorial Hospital’s emergency room or in the
county jail. The closing of G. Pierce Wood Memorial Hospital and Bon Secours
Hospital’s private receiving facility has exacerbated this situation. For
the past two legislative sessions, the Alliance has made additional CSU beds
for Sarasota County a legislative priority. However, the Legislature has not
approved funding for any additional beds, and is unlikely to do so in the
near future.
In order to relieve the pressure on the CSU
and the other components of the acute care system, the Community Alliance
supports the creation of a Mobile Crisis Response Unit for Sarasota County.
This unit would be operated in conjunction with Coastal Behavioral
Healthcare’s Family Emergency Treatment Center and offer immediate
intervention and treatment for individuals experiencing a crisis related to
mental health and/or substance abuse issues. Mental health professionals
will be able to respond to the site of an emergency to provide assistance
and, when necessary, assist law enforcement officers in determining whether
the individual in crisis should be admitted to the CSU facility for
inpatient crisis stabilization. Intensive intervention and post-crisis
follow-up services would be provided as needed. Based on similar models now
operating throughout the country, the annual budget for the Mobile Crisis
Response Unit is estimated to be $500,000.
Fetal Alcohol Spectrum Disorder (FASD)
Diagnostic and Treatment Center.
The Community Alliance supports funding for the development of a FASD
Diagnostic and Treatment Center for young children and their families in
Sarasota County. Many children with prenatal exposure to alcohol experience
growth deficiencies, cognitive and behavioral problems, and developmental
delays and eventually become involved with the juvenile delinquency system
as they age. When compared with other drugs-including heroin, cocaine and
marijuana-alcohol produces by far the most serious long-term neurobehavioral
effects in the fetus. In fact, FASD is now the leading cause of mental
retardation in children-and it is 100 percent preventable. The cost to American
taxpayers for fetal alcohol syndrome is enormous-an estimated $5 million per
day. In Florida alone, the state spends an estimated $79 million each year
to provide special education and juvenile justice services to children aged
5-18 who are affected by FASD. An extraordinarily high number of young
children in Sarasota County are at high risk for developmental and
behavioral disorders due to FASD; a recent study reported that 42 percent of
mothers in Sarasota reported use of alcohol during their pregnancy, compared
with only 26 percent in Pensacola and 22 percent in Miami.
One of the key protective factors identified
for children with FASD is early identification and intervention. However,
diagnosing FASD is difficult and requires a team of skilled professionals
trained in the areas of speech therapy, occupational therapy, mental health
and medicine. The proposed FASD Diagnostic and Treatment Center would be
developed by the Florida Center for Child and Family Development and will
provide assessment and intervention services to children with FASD and their
families, with the goal being to reduce disabilities and increase
functioning. The target population will be young children involved in the
child welfare system and mothers and infants in First Step of Sarasota’s
residential substance abuse treatment program. The FASD Center will also
serve as a training site to train other core teams in the state to expand
the program statewide. A minimum of 40 children and their families will be
served each year and an additional 200-300 community professionals will
receive training on FASD. The budget for this pilot project is estimated to
be $200,000 per year for three years. In addition, the Florida Center has
submitted a proposal to Northrop Grumman through the FASD Center for
Excellence to obtain federal funding to support this project.
Continuation Funding for Mothers and Infants
Program. First Step of Sarasota’s
Mothers and Infants Program was created in 1995 to address the growing issue
of drug-exposed newborns. Funded initially through the Department of
Children and Families, the program provides residential treatment in a safe,
secure environment for pregnant, substance abusing women with a goal of
healthy, live births with no drug presence in the newborns. While awaiting
the birth of their babies, women in the program receive intensive treatment
for their addiction as well as vocational training and classes in parenting
and daily living skills designed to ensure a successful reentry into the
community with stable housing and employment. The program has been
remarkably successful, with 100 percent of the babies born to program participants
being drug-free at delivery. The program’s annual operating budget is
approximately $600,000, serving 18-20 clients with an average length of stay
of eight months.
Despite its documented success, funding for
the Mothers and Infants Program has been unstable in recent years. DCF
funding for the program was lost in FY 2002 when Sarasota County was shifted
from DCF’s District 8 to the SunCoast Region. The program was able to secure
continuation funding that year as a special project funded through the
Department of Health. The following year, the Department of Health
determined that the program was not consistent with the agency’s core
mission and reduced it’s funding by 50 percent. Sarasota County Government and the DCF Suncoast Region stepped in and awarded “one-time” contracts to First
Step of Sarasota to enable the organization to continue the program. In FY
2004, DCF resumed funding of the Mothers and Infants Program; however, only
one-half of the current funding for the program comes from recurring funds,
while the other half is non-recurring funds.
Given the demonstrated results of the Mothers
and Infants Program and its strong benefit/cost ratio, the Community
Alliance believes that this program should have a stable funding base and
supports legislation through which DCF would fund the program entirely with
recurring funds.
Foster Parent Automobile Insurance Pilot
Project. The Community Alliance
supports a pilot project which would provide $50,000 in state General
Revenue funds to the Department of Children and Families for the purpose of
reimbursing foster parents, residential facilities, or foster children who
live independently for one-half of the increase in cost incurred when a
foster child is added to an motor vehicle insurance policy. The pilot
project would be limited to the DCF’s SunCoast Region in FY 2005.
The increased cost of motor vehicle insurance
for a foster child after that child attains a driver’s license is currently
borne by foster parents (or by the authorized representative of a
residential facility, if that is where the foster child lives). This
increase in the cost of insurance creates an additional barrier for the
foster child in gaining independence and may limit the child’s opportunities
for obtaining employment. Under this proposal, the foster child would be
encouraged to pay the other half of the increase in insurance costs.
Legislation supporting this pilot project was introduced in the FY 2004
legislative session (CS for CS for SB 1058) and had strong support, but the
bill died without final action at the end of the session. |
