5 Things Florida: Medicaid step therapy coverage, FL hospitals’ economic impact, Medicaid redeterminations


Eli Kirshbaum


This edition includes coverage of a bill to prohibit Medicaid coverage of step therapy, a report showing the significant contribution Florida hospitals make to the state’s economy, and information about upcoming Medicaid redeterminations.

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Eli Kirshbaum
State of Reform


1. Legislature looks to eliminate step therapy in Medicaid

We’re monitoring the progress of a bill that would prohibit the use of step therapy in Medicaid-covered prescriptions. It aims to increase patient access to appropriate medications by removing the requirement that patients try less costly (and often less efficient) medications before being prescribed certain high-cost medications. Despite being intended as a cost-control tool, step therapy can also lead to higher costs for the healthcare system.

Practicing OBGYN Dr. Sujatha Prabhakaran spoke with State of Reform about the intent of the bill and how step therapy can delay patient treatment. “[This bill] just takes away some of that delay that we know is both harmful to the patient themselves, and then also just costs the healthcare system more money too,” she said. The bill received unanimous support from lawmakers during its first committee hearing last month.


2. Report shows hospitals’ significant contribution to Florida’s economy

A recent report from the Florida Hospital Association details the significant financial impact that hospitals have on the state’s economy. In 2021, Florida had 321 private and public hospitals, 70,444 hospital beds, and 315,497 full-time equivalent employees. During that year, Florida hospitals had a total economic output of $177.8 billion. They employed more than 322,000 Floridians and spent over $28 billion on their compensation.

The report says that every $1 spent by hospitals supports $1.25 in business activity, and that each hospital job supports an additional 1.73 jobs in the state. The Orlando area saw the highest rate of hospital employment at 358,396 jobs, followed by Miami-Ft. Lauderdale (315,739) and Tampa-St. Petersburg (238,336).


3. Healthcare leaders working to minimize impact of Medicaid redeterminations

With a recent survey showing that the majority of Medicaid beneficiaries in the country aren’t aware of the upcoming redeterminations, DCF is conducting thorough outreach to individuals who might be taken off the program. The department is reaching out via MyAccess accounts and physical mail, and will connect newly ineligible beneficiaries to alternative coverage options like Florida KidCare and the Medically Needy Program.

The Florida Hospital Association is also working to minimize gaps in coverage. FHA has been conducting webinars with stakeholders since last year to offer guidance on assisting enrollees with their coverage. “FHA is working with our member hospitals, state agency partners, and community-based organizations to ensure that all individuals are aware of the impending changes to Medicaid eligibility redeterminations,” CEO Mary C. Mayhew told State of Reform.


4. DeSantis, first lady release funding to address opioid addiction

Gov. DeSantis and First Lady Casey DeSantis recently announced the dispersal of $205.7 million in opioid settlement funds to address substance abuse in the state. “Opioid addiction is plaguing our state and nation, and we are seeing more fatalities related to overdose than ever before with fentanyl being trafficked through the southern border. We will use funds from the opioid settlement in the most efficient and effective way possible to end addiction in Florida,” DeSantis said.

The funding will be broken down into various different projects, including $92.5 million for deploying a mobile treatment program to expand medication-assisted treatment to more individuals. The funding also includes $39.4 million to conduct education campaigns to prevent substance abuse, $26.8 million to expand the state’s Coordinated Opioid Recovery (CORE) network to 17 additional counties, and $10.2 million to establish an Office of Opioid Recovery within DCF.


5. Updates on reproductive health policy

The Florida High School Athletic Association has eliminated questions relating to students’ menstrual cycles on athletic participation forms after receiving backlash from community members and some state leaders. “The concerns of student-athletes, parents, SMAC, and other stakeholders have been carefully and respectfully heard,” FHSAA said. “The FHSAA shares in the concern and belief that our student-athletes deserve privacy through their health, safety, and well-being.”

In other reproductive health news, we’re monitoring the status of several bills including the Reproductive Health Care Rights initiative (HB 1033 and SB 1076). These identical bills would statutorily guarantee reproductive healthcare rights for Floridians, and outlines guidance for when abortions can be performed during the third trimester of pregnancy.