Medicaid Reform Initiative. The 2005 Florida Legislature authorized the Agency for Health Care Administration to seek a federal waiver authorizing the State to conduct two Medicaid reform pilot projects, one in Duval County and one in Broward County. Implementation of these pilot projects has begun. The Community Alliance supports reforming Medicaid, but as implementation proceeds and the Legislature evaluates the pilot projects, we believe it is imperative that principles adopted by the Coalition for Responsible Health Care Reform be followed:

• Medicaid reform should be done in the sunshine. Changes to the Medicaid program affect the life and health of millions of Medicaid consumers and their families. A meaningful public process allowing for public review and comment on Medicaid reform proposals is essential to laying the groundwork for successful reform.

• Maintain the guarantee of Medicaid coverage for consumers. Today, Floridians who qualify for Medicaid and who need health care coverage receive it, regardless of where they live or when they apply for coverage. They can rely on the program to provide medically necessary services when they need them. Medicaid reform should maintain this important commitment.

• Ensure Medicaid consumers’ access to quality health care services and choice of providers.  People who rely on Medicaid have very low incomes and many have intensive needs for services due to special needs (developmental, physical, medical, mental, emotional, and behavioral). Therefore, the coverage consumers get through Medicaid must ensure that their wide-ranging vital health care needs are met. Further, inadequate access to and choice of Medicaid providers is a significant problem in many parts of the state. Medicaid reform must include initiatives such as rate adjustments to attract more Medicaid providers, particularly in rural communities. Moreover, Medicaid reform initiatives must focus on improving the quality of health care services provided to Medicaid consumers. This should include data compilation and publication to document improved outcomes, particularly for historically under served populations such as racial and ethnic minorities.

• Maintain the open-ended federal commitment to sharing the cost of Medicaid. Every dollar ($1) that the state of Florida spends on Medicaid services draws down $1.43 in federal funding. This federal match system gives Florida the flexibility to respond to downturns in the economy, increases in the number of uninsured, or public health or other emergencies that occur, knowing we will not shoulder those expenses on our own. Florida should not agree to any plan that weakens this federal-state partnership.

Fetal Alcohol Spectrum Disorder (FASD) Initiative. The 2005 Florida Legislature appropriated $280,000 to establish Florida’s first FASD Diagnostic/Intervention Center at The Florida Center for Child and Family Development in Sarasota. The 2006 Legislature appropriated an additional $100,000 to increase total funding to $380,000 of recurring funds. Additional funding is requested for FY 2007-08 to continue expansion of the diagnostic/intervention clinics statewide and support expansion of services for pregnant, substance-abusing women at First Step Of Sarasota. The mission of this initiative 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.

Additional funding ($750,000) is requested in FY 2007-08 to build upon the FASD initiative started two years ago. 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 support development of a FASD clinic in Jacksonville, develop one additional clinic site in West Palm Beach or Ft. Lauderdale, and provide clinic services in Monroe County. The Diagnostic/Intervention Center in Sarasota will serve as a training site to train the other core teams at the new centers.

A portion of this funding ($225,000) would expand outreach services to pregnant women through First Step of Sarasota, support residential treatment for pregnant women who are abusing substances through the Mothers and Infants Program, and provide after-care services for women discharged from the Mothers and Infants Program and Transitional Living Program. These are high risk infants and mothers who require immediate and continuous comprehensive, coordinated services.

Through the efforts of Sarasota County Government and the Florida Center for Child and Family Development, along with First Step of Sarasota and many other local agencies, Sarasota has stepped out in the nation as a leader in infant mental health, FASD, and substance abuse services to young children and their families. These efforts will lead to best practice protocols that are likely to be duplicated throughout the country.

Florida 2-1-1 Network. The Community Alliance supports legislation and an appropriation of $5 million in General Revenue to the Agency for Health Care Administration that would fund the statewide expansion of the Florida 2-1-1 Network to cover all counties in Florida (currently 15 million Floridians are covered in 49 counties, including Sarasota County) and enhance the operations of existing 2-1-1 providers. Passage of this legislation 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.

Voluntary Prekindergarten Program Implementation. In November 2002, Florida voters overwhelmingly approved an amendment to the Florida Constitution requiring implementation of a high quality Voluntary Prekindergarten Program (VPK) by the 2005 school year for all four year olds whose parents want them to participate. During a special session in December 2004, the Legislature passed legislation requiring implementation of the new VPK program in August 2005.

Following the referendum, the 2003 Legislature created the Universal Prekindergarten Council to make recommendations regarding VPK program implementation. The Council’s recommendations fully embrace the concept of a high quality VPK program, addressing accountability, assessment, community partnership, costs/resources, service delivery design and parental involvement, including curriculum, child and program outcomes, programmatic requirements, coordination with existing programs, best practices, and cost estimates.

While some of the Council’s recommendations have been incorporated into the design of the new VPK Program, other key recommendations have not been implemented. The Community Alliance urges the 2007 Florida Legislature to adopt the following recommendations of the Universal Prekindergarten Council to strengthen the VPK Program:

• include ongoing assessments used to inform instruction

• require each program/provider to establish referral processes for children who need support

• embrace strong parental involvement

• require age-appropriate, literacy-focused, individually-directed, and research-based curriculum that instills a love of learning in each child

• institute ongoing staff development combined with multi-level reimbursement and career ladder opportunities

• contain a five-year target of at least one staff member in each VPK class with an associates degree and, after eight years, at least one staff member in each class with a BA degree

• require a school year of 1080 hours with 720 contact hours

• place all School Readiness programs and VPK in the Department of Education under a Chancellor of Early Education

• maintain modified local school readiness coalitions to administer the programs locally

In addition to these recommendations, the Community Alliance supports a change in the fiscal requirements of the VPK Program. Currently, a 5 percent cap is imposed on administrative costs for the program at the local level. That 5 percent cap includes the enrollment and monitoring functions for VPK. For School Readiness programs, the 5 percent cap does not include these functions, which are funded as a separate line-item in the budget. The Sarasota County Early Learning Coalition, like many of its counterparts across the state, is struggling to meet the 5 percent cap requirement for VPK. Either the administrative cap rate should be raised, or the enrollment and monitoring functions should be removed from the cap.

Affordable Housing.  The average cost of a home in Florida has risen almost 90 percent since 2001, while average wages have risen only about 10 percent. As a result, many Florida families cannot afford safe, decent, and affordable rental and single family housing. In addition to the long-standing needs of very low and low income families, steep increases in real estate prices have also effectively priced moderate income families out of the homeownership market in many communities, including most of Sarasota County. The result is a widening of the “gap” in the ability of many working families to access affordable rental and owner housing.

The Florida Legislature has taken steps over the years to address the affordable housing problem. In 1992, the Legislature adopted the Sadowski Affordable Housing Act, establishing a dedicated revenue source for affordable housing by phasing in two 10 cent increases in the documentary stamp tax paid on the transfer of real estate, the first in August 1992 and the second in July 1995.

Sadowski Act monies are statutorily dedicated to state and local housing trust funds, with 70 percent of the revenue dedicated to local governments through the State Housing Initiatives Partnership program (SHIP) and 30 percent dedicated to the state to fund programs such as the State Apartment Incentives Loan Program (SAIL). Annual revenues to the Sadowski Trust Fund have increased significantly in recent years as Florida’s real estate market has experienced steady growth. Like last year, this year the Trust Fund will total more than $900 million, with about $500 million attributable to annual intangibles tax revenues and about $400 million carried over from the previous year.

The 2006 Legislature passed far-reaching affordable housing legislation designed to stimulate the construction of home ownership and rental housing in high cost and high growth areas to meet the needs of extremely-low, very-low, low, moderate and middle-income families along this continuum and in particular, essential services personnel who are facing tremendous difficulties living in the communities in which they work. Approximately $520 million was appropriated to support the bill. However, the Legislature appropriated only that $520 million of the $900+ million in the Affordable Housing Trust Fund, leaving about $400 million remaining unspent.

In many parts of Florida—and especially in Sarasota County--affordable housing shortages are reaching crisis proportions. While the 2006 legislation may have an impact, the bottom line is that more funding is needed. The SAIL and SHIP programs, already in place in statute, offer a reliable, quick and accountable vehicle for targeting the funds to areas of the state that need them and can best use them.

In addition, the 2005 Legislature placed a cap of $243 million on the amount of funds that can be appropriated out of the Affordable Housing Trust Fund, effective July 1, 2007. This is less than half the $500 million to $600 million available. The Community Alliance urges that the Sadowski Affordable Housing Trust Fund cap be removed so the Legislature can maximize appropriations for affordable housing.

Additional Funding for HIPPY Program. The Home Instruction for Parents of Preschool Youngsters (HIPPY) Program has consistently produced the best kindergarten test results, better than those achieved by Head Start, subsidized child care, and VPK programs in the past. The Community Alliance supports an increase in the University of South Florida’s statewide contract to $2 million. This would be sufficient to give each program in the state a $100,000 funding base and create a consistent basis for each program to plan for the future. The remainder of all program costs would be financed through local match contributions. The $100,000 investment would cost approximately $1000/child in state funding, compared with approximately $2500/child in the VPK Program.

Additional funding will provide for program expansion which would allow additional children in Sarasota County to receive services, especially in our black and Hispanic minority communities.

Foster Parent Automobile Insurance Pilot Project. When a foster child obtains a driver’s license, the child’s foster parents, the residential facility in which the child lives, or the foster child himself (if living independently) is faced with a significant increase in the premium cost of motor vehicle insurance. Many of the foster parents, facilities, and foster children in independent living are unable to pay this increase, thereby limiting the child’s opportunities for obtaining employment and independence.

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 a motor vehicle insurance policy. Under this proposal, the foster child would be encouraged to pay the other half of the increase in insurance costs. The pilot project would be limited to the DCF’s Suncoast Region in FY 2007.

This program would remove one more barrier that sets foster children apart from the other children in Sarasota County. The legislation would allow foster children to live more normal teenage lives by providing them with a valuable life skill, the opportunity to obtain employment, and would also normalize their socialization.