Florida Medicaid, DOH, present FY 2022 budget requests

Three agencies — the Agency for Health Care Administration (AHCA), the Florida Department of Health, and the Department of Children and Families — presented their legislative budget requests (LBR) for fiscal year (FY) 2022 to the House Health Care Appropriations Subcommittee for consideration on Monday. 

Recurring requests among the agencies included health care workforce support to address high turnover rates, replacing outdated IT systems, and health quality assurance (MQA) measures. 

 

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See a list of notable items from each agency below: 

Agency for Health Care Administration

Total legislative budget request (federal and state): $36.5 billion

  • Medicaid rate adjustments: $277.47 million in general revenue

Florida has seen 1.1 million more enrollments in Medicaid during the COVID-19 pandemic, leading to the state’s largest Medicaid population (4.9 million) in history. Rate increases to fit these new parameters were determined at the August 2021 Social Services Estimating Conference (SSEC). 

  • Florida KidCare adjustments: $53.9 million in general revenue
  • Institutional and Prescribed Drug Providers: $1.16 billion

This reflects cost adjustments for prescribed drug provider operations, such as over-the-counter prescriptions and drugs administered in outpatient settings.

  • Statewide Medicaid Managed Care Procurement Activities: $2.3 million in general revenue

This will support legal and actuary expenses to respond to protests of contract awards as during procurement negotiations. AHCA is required to reprocure contract awards every six years.

  • Medicaid Hospital Direct Provider Payment (DPP) Program: $154,000/2 FTE in general revenue

AHCA will create two positions to oversee this new program, which is expected to bring $1.8 billion in direct payments to hospitals and other providers in its first year. CMS approved this program earlier this year.

  • Florida Medicaid Management Information System: $117.8 million in general revenue

AHCA is set to replace its 20-year-old Florida Medicaid Management Information System.

  • Transfer of PACE from DOEA to AHCA: $37.7 million in general revenue/2 FTE

Revenue, administration, and authority over the Program for All-Inclusive Care for the Elderly, previously under the Department of Elder Affairs, will move to AHCA. AHCA Secretary Simone Marstiller said the move would streamline administrative processes and that AHCA was better suited to oversee PACE, as it is a health care program.

 

Department of Children and Families (DCF)

Total legislative budget request (federal and state): $3.8 billion

  • Replacing federal foster care funds: $32.5 million in general revenue

Due to changes in eligibility, Florida may not receive federal matching funds for Title IV-E foster care services and would need to use general revenue instead.

  • Stabilizing Children’s Legal Services Workforce: $4.8 million 

DCF would use funds to increase pay for 600 legal staff that manage court child welfare cases across the state. Staff turnover in this field has increased from 21% in 2017 to 49% this past year, according to Tony Lloyd, DCF assistant secretary for administration.

  • Comprehensive Behavioral Health Services: $109.7 million in trust fund authority

Federal funds from the American Rescue Plan, COVID-19 Relief, and the Substance Abuse and Mental Health Block Grant will expand behavioral health and substance use disorder services within the department, which have waiting lists of 2,000 and 1,000 people, respectively. 

  • State Opioid Response (SOR) Grant Budget Authority: $24.6 million in trust fund authority

Continued funding for this program has provided substance use disorder services for over 15,000 individuals in the last three years.

 

Department of Health (DOH)

State legislative budget request (general revenue and trust fund authority): $49.3 million

  • Infant Mortality and Prevention: $2.8 million in general revenue

Services would address the top two causes of infant mortality: sleep-related infant death and drowning. 

  • Office of General Counsel – Litigation: $2 million in general revenue

DOH will contract outside legal counsel due to “additional lawsuits arising from enactment of new laws and adoption of new rules governing the Department.” This request raised concern from Rep. Carlos Guillermo Smith (D – Orange), who filed a lawsuit in August over the department’s refusal to release daily COVID-19 data.

  • Group Care Program (GCP) Services: $3.8 million in general revenue

State funds would cover gaps between funding from county health departments and the GCP’s actual expenditures for group homes, schools, and other care services. 

  • Workload Medical Quality Assurance: $1.1 million in trust fund authority/19 FTE

DOH requests 19 positions due to an increase in applicants and high staff turnover rate for the Board of Nursing and the Board of Pharmacy.

  • Office of Medical Marijuana: $24.8 million in trust fund authority

This includes the creation of 85 positions within the department to serve additional patients and licensed Medical Marijuana Treatment Centers, accounting for nearly half of DOH’s budget request. 

Rep. Kelly Skidmore (D – Palm Beach), also expressed concern over DOH’s LBR, and asked why no COVID mitigation requests were included. DOH Deputy Secretary for Operations, Michele Tallent, responded that this was due to the department receiving over $3 billion in federal COVID support funds.