Medicaid waitlist, nursing shortages among Florida budget requests

The Florida House Health Care Appropriations Subcommittee kicked off its first interim meeting before the 2022 legislative session on Tuesday, reviewing budget requests from the Agency for Persons with Disabilities (APD), Department of Elder Affairs (DOEA), and the Florida Department of Veterans’ Affairs (FDVA). 

 

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Agency for Persons with Disabilities

Rose Salinas, APD deputy director of budget planning and administration, provided the committee members with a breakdown of the agency’s $61.5 million request. A majority of the funding would support home and community-based services (HCBS)  throughout the state. Approximately $25.5 million would expand waiver services and take individuals off a lengthy waiting list — approximately 22,000 people. 

Salinas said APD accepts around 100 individuals a month. This year, the agency has offered APD enrollment to 621 individuals, with an additional 252 offers coming on Oct. 8. The agency aims for a total of 1,900 offers this year. 

Approximately $28.5 million would increase hourly reimbursement rates for behavioral analysis services at HCBS. These would put reimbursement rates in line with those implemented under the state Medicaid plan. 

Other budget requests under APD include $1.47 million to complete the implementation of iConnect, the agency’s electronic client data system. APD also requested $1.2 million to contract out-of-house medical case managers for 2,250 APD licensed group homes. Salinas reiterated the workforce shortage that most facilities have faced during the pandemic.

“Like any other health care [facility] that employs nurses, we are having issues with hiring and retaining nurses … we have found that we have had some good success with contracting for those, but overall we have, especially during this time, had shortages.”

Department of Elder Affairs

Secretary Richard Prudom presented budget requests from DOEA, which serves one of the largest state elderly populations in the country (5.5 million). According to Prudom, Florida houses approximately 150,000 individuals in long-term care facilities, although up to 900,000 others rely on community care services, such as nutrition programs.

Prudom said a large amount of federal funding from the American Rescue Plan (ARP) translated into a “modest request” from state funds. Prudom applauded the federal funds, especially that the agency had received a virtually unlimited timeline to spend them.

 

Image: Florida Department of Elder Affairs

 

“We have taken the time to ask our [Area Agencies on Aging] to ask their agencies, ask their providers, ‘What do you think that you need in your communities to support the needs of your older adults that we can invest in?’ … What we want to do is invest in a service, invest in a program that is sustainable.” 

DOEA requested the state to transfer its Program of All-Inclusive Care for the Elderly (PACE) to the Agency for Health Care Administration (AHCA), as the program serves Medicaid and Medicare beneficiaries. This would cause an estimated reduction of $33.8 million in general revenue.

DOEA also requested $2.3 million from the state to upgrade its 30-year-old client tracking system. The agency also requests one additional FTE transfer for a position that would focus on community outreach. 

Department of Veterans’ Affairs

FDVA currently serves 1.5 million veterans across the state. During the pandemic, FDVA reported serving 78,000 first-time veterans. Major General James Hartsell, FDVA director, said his agency’s main budget priorities include trust fund recovery, addressing workforce shortages, and improving veterans’ “quality of life” services.

FDVA requested $41.2 million to replenish its general trust fund for staffing veteran nursing homes, after losing revenue during the pandemic. Since February 2020, FDVA saw staff vacancies increase from 11 to 110.

FDVA also estimated it would need $19.4 million to support veteran’s “quality of life” services, which include more contract staff, suicide prevention outreach, and workforce training grants. 

 

Image: Florida Department of Veteran Affairs

 

The subcommittee has not yet set a date for its next meeting. However, Rep. Kamia Brown (D – Orlando) requested to reserve a slot for a presentation from the Department of Health on the reinstatement of the Florida Center for Nursing (FCN). Rep. Brown helped sponsor a bill for the reinstatement earlier this year, and is working with the Department of Health to navigate the necessary contracts needed to implement the FCN.