Florida lawmakers expand doctor training but again shun Medicaid expansion
ORLANDO, Fla. — Health care was one of the biggest issues of the 2024 legislative session, culminating in the passage of the Live Healthy initiative aimed at addressing the state’s health care worker shortage and increasing innovation.
Gov. Ron DeSantis signed components of the package into law on Thursday at a Bonita Springs press conference. He signed five bills, the most prominent being SB 7016, which will invest $716 million in developing and retaining the state’s health care workforce.
“We are taking action to bolster our health care workforce to keep pace with our state’s unprecedented growth,” DeSantis said. “I applaud Senate President Passidomo for her dedication to this cause, which contributes to positioning Florida as the freest and healthiest state in the nation.”
Bills passed this session make it easier to license out-of-state doctors, pay doctors’ student loans and treat HIV, among other things.
Reforms passed this year still leave an estimated 789,800 Floridians without health insurance, however. Many Democrats pushed to address this by making Medicaid expansion part of the Live Healthy package.
Florida is one of 10 states that has chosen not to accept federal dollars to expand Medicaid eligibility to low-income, childless adults. Before the pandemic, an estimated 415,000 Floridians were in a coverage gap because they made too much to qualify for Medicaid but too little to qualify for subsidized care.
A review of 151 studies by policy analysis group KFF found expansion reduced uninsured patients and improved hospital profits, particularly at small or rural hospitals. Studies also suggest expansion saves states enough money to break even or even completely offset the cost of expansion.
But for Passidomo, it was a non-starter.
“Expanding Medicaid does nothing,” she told reporters earlier this month, going on to say that Florida doesn’t have enough providers to treat more Medicaid patients.
Here are some of the most impactful changes taking place this year – and proposed changes that didn’t make it.
More doctors, training
Florida’s shortage of doctors and nurses has become a major problem with older doctors retiring and younger ones leaving the state. Passidomo said her main priority was to resolve it.
Live Healthy allocates $150 million to increase the Graduate Medical Education Statewide Medical Residency Program and expand the Slots for Doctors Program. The goal is to pay for 500 new physician residency slots, along with offering doctors and dentists incentives to stay in Florida after completing their training.
The bill also removes barriers for foreign-trained physicians to practice in Florida and teach at medical schools, among other measures to attract more doctors to the state.
In addition, SB 7018 creates the Health Care Innovation Council within the Florida Department of Health, which will provide loans to projects that aim to improve Florida’s health care and fill gaps created by shortages.
The 15-member council will get $50 million of non-recurring funds each year, for $500 million over 10 years.
Nursing unions including National Nurses United have long argued that while increasing education is important to add to the state’s supply of medical providers, better working conditions are necessary to keep nurses from getting burnt out and leaving the profession.
A bill proposed by Sen. Ileana Garcia, R-Miami-Dade, would have created minimum staffing levels for registered nurses in Florida and provided whistle-blower protections. Her bill, SB 376: Delivery of Patient Protection, died without a reading.
Mental health issues
The nonprofit Mental Health America ranks Florida 46th in the nation for access to mental health care, a measure that includes access to insurance, treatment, access to special education and workforce availability.
The state needs 587 more mental health providers to meet needs, according to U.S. Department of Health & Human Services calculations.
One of the Live Healthy package’s biggest investments, SB 330, allocates $321 million to create a new care and education model for Florida’s behavioral health system by establishing “behavioral health teaching hospitals.”
Existing teaching hospitals can earn the designation by partnering with a university, developing a workforce development program and offering specific behavioral health education programs. Florida officials will give out $300 million in grants over the next three years to these hospitals.
The Live Healthy package also reduces barriers for psychologists and psychiatric nurses to work in Baker Act facilities and devotes $11.5 million in recurring general revenue to expand mobile response teams to every county in order to reduce Baker Acts and unnecessary emergency hospitalizations for mental health crises.
An additional $8.2 million is marked for reimbursing health care models that integrate physical and behavioral health care. Integration is an approach endorsed by the American Psychological Association and backed by dozens of studies.
HIV prevention
Florida has among the highest HIV rates in the nation, with about 5,000 new cases diagnosed each year over the past decade, and the state hasn’t seen much of a decline even as the U.S. saw an 8% decrease over the past 10 years. Thousands more are thought to be living with HIV and not know it.
HB 159/SB 1320 aims to help prevent more people from catching the sexually transmitted disease by authorizing certain pharmacists to screen for HIV exposure and prescribe and distribute post-exposure prophylaxis, or PEP, a medicine that can prevent an HIV infection after exposure if taken within 72 hours.
Currently, a person would have to go to a primary care physician, emergency room or urgent care to get PEP. The bill is awaiting the governor’s signature.
The original bill would have allowed pharmacists to prescribe preexposure prophylaxis (PrEP) a drug taken before exposure that would reduce the chance of catching HIV by 99%, but that part was dropped.
Cancer research
This year’s budget tripled the state’s investment in the Florida Cancer Innovation Fund, established in 2023, to $60 million. Projects previously financed by this fund include research on biomarkers to detect pancreatic cancer and an initiative to increase early breast cancer detection among rural women.
The budget also added $1.2 million to the Mary Brogan Breast and Cervical Cancer Early Detection Program, bringing the program’s total funding to $3 million. The program funds breast and cervical cancer screening for women without insurance whose incomes are below 200% of the poverty line.
Meanwhile, an attempt to make breast cancer diagnoses more affordable for women with insurance fell short. HB 773, sponsored by Rep. Marie Paul Woodson, D-Hollywood, would have required insurance to cover follow-up breast cancer exams for free, without cost-sharing. Follow-up diagnostic scans can cost anywhere from $234 to more than $1,000 out-of-pocket according to Susan G. Komen.
A related bill, SB 932, Coverage for Diagnostic and Supplemental Breast Examinations, would have eliminated cost-sharing for state employees alone. It unanimously passed the Senate but died in the House.
People with disabilities
The CDC estimates 4.5 million Florida adults have some form of disability. A bill signed into law Thursday, SB 1758, will expand services for many of these Floridians.
The bill adds an online application process to apply for government services and shortens the time frame to determine eligibility.
A major change is that people with disabilities will be able to use an allotted monthly budget to buy long-term care services that fit their needs.
Maternal health care
SB 7016 gave $23 million to expand a telehealth minority maternity care pilot program to all 67 Florida counties. The program was successfully piloted in Duval and Orange counties in 2022. In 2023, the program received over $12 million to expand to 18 more counties.
SB 7016 will also allow “advanced birth centers” to do Cesarean-section deliveries for women with low-risk pregnancies. Birth centers are not currently allowed to perform C-sections. It will also allow these birth centers to serve Medicaid recipients. However, these centers must have a written transfer agreement with a nearby hospital to accept their patients in case of an emergency.
The Live Healthy package also invests $134 million to increase hospital Medicaid reimbursement rates for labor and delivery services. Maternity wards often are considered money losers for hospitals. In the past few years in Florida, 20 hospitals have closed their labor and delivery wards, creating maternity care deserts in some counties.
Another bill, HB 415, gives the Florida Department of Health $466,200 to develop a website to share public and private resources for pregnant people and parents. The bill has passed but has not yet been signed by DeSantis. Democrats tried and failed to pass amendments that would require the website to include medically accurate information about abortion and contraception.
Health screenings
Live Healthy creates an online portal for health care providers to advertise free or low cost screenings and services so that Floridians can search for those services in their area. It also enlists the help of county health departments to promote the portal.
Nonprofit entities can get a grant to start new health care screening or services or mobile clinics or units to expand their healthcare delivery capabilities.
Biomarker testing
HB 885 would require Florida Medicaid and state employee health insurance plans to cover biomarker testing, an initiative championed by groups including the American Cancer Society Cancer Action Network and the Alzheimer’s Association. The requirement does not extend to private insurance.
Biomarker testing measures biological changes that show whether someone has a disease, or whether they are at risk of getting certain diseases. Research is underway to establish biomarkers for many of Florida’s leading causes of death, including Alzheimer’s and most types of cancer. Biomarker testing can also give insights about which treatments might work best for cancer patients.
The bill has been passed by the Legislature and sent to DeSantis for this signature.
_____
