Florida lawmakers expand doctor training, but again shy away from Medicaid expansion

Health care was one of the top issues in the 2024 legislative session, which culminated in the passage of the Live Healthy initiative aimed at addressing state health worker shortages and increasing innovation.

Gov. Ron DeSantis signed components of the package into law Thursday at a news conference in Bonita Springs. He signed five bills into law, the most notable being SB 7016, which will invest $716 million in developing and retaining the state’s health care workforce.

We are taking steps to strengthen our health care workforce to keep pace with our states unprecedented growth, DeSantis said. I applaud Senate President Passidomo for her dedication to this cause, which helps position Florida as the freest and healthiest state in the nation.

Bills passed this session make it easier for out-of-state doctors to be licensed, to pay off medical student loans and for HIV treatment, among other things.

However, the reforms passed this year still leave about 789,800 Floridians without health insurance. 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 earned too much to qualify for Medicaid but too little to qualify for subsidized care.

A review of 151 studies by the policy analysis group KFF found that the expansion reduced uninsured patients and improved hospital benefits, particularly at small or rural hospitals. Studies also suggest that expansion saves states enough money to offset or even completely offset the cost of expansion.

But for Passidomo, it was a non-starter.

Medicaid expansion doesn’t do anything, he told reporters earlier this month, saying Florida doesn’t have enough providers to treat more Medicaid patients.

Here are some of the most impactful changes that happened this year and the proposed changes that didn’t.

More doctors, training

The shortage of doctors and nurses in Florida has become a major problem with older doctors retiring and younger ones leaving the state. Passidomo said his top priority was getting it resolved.

Live Healthy allocates $150 million to increase the state’s graduate medical education residency program and expand the physician slots program. The goal is to pay for 500 new physician residency positions, as well as provide incentives for doctors and dentists to stay in Florida after completing their training.

The bill also removes barriers to foreign-trained doctors being able to practice in Florida and teach at medical schools, among other measures to attract more doctors to the state.

Additionally, SB 7018 creates the Health Care Innovation Council within the Florida Department of Health, which will provide loans to projects that aim to improve health care in Florida and fill gaps created by shortages .

The 15-member board will receive $50 million in non-recurring funds each year, for $500 million over 10 years.

Nurses unions, including National Nurses United, have long argued that while increased education is important to add to the state’s supply of medical providers, better working conditions are needed to prevent that nurses burn out and leave 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 whistleblower protections. His bill, SB 376: Patient Protection Surrender, died without a reading.

Mental health problems

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 education special and the availability of labor.

The state needs 587 more mental health providers to meet the need, according to calculations by the US Department of Health and Human Services.

One of the largest investments in the Live Healthy package, SB 330, allocates $321 million to create a new model of care and education 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 $300 million in grants over the next three years to these hospitals.

The Live Healthy package also lowers barriers for psychologists and psychiatric nurses to work in Baker Act facilities and allocates $11.5 million in recurring general revenue to expand mobile response teams to all counties to to reduce Baker events and unnecessary emergency hospitalizations for mental health crises.

An additional $8.2 million is earmarked to reimburse health care models that integrate physical and behavioral health care. Integration is an approach endorsed by the American Psychological Association and supported by dozens of studies.

HIV prevention

Florida has one of the highest HIV rates in the country, with about 5,000 new cases diagnosed each year over the past decade, and the state hasn’t seen a big decline, even as the U.S. saw a decline of 8 % in the last 10 years. Thousands more are believed to be living with HIV and don’t know it.

HB 159/SB 1320 aims to help prevent more people from contracting the sexually transmitted disease by authorizing certain pharmacists to screen for exposure to HIV and to prescribe and dispense post-exposure prophylaxis, or PEP, a drug that can prevent an HIV infection HIV after exposure if taken. in 72 hours.

Currently, a person would have to go to a primary care doctor, emergency room, or urgent care to get PEP. The bill is pending the governor’s signature.

The original bill would have allowed pharmacists to prescribe pre-exposure prophylaxis (PrEP), a drug taken before exposure that would reduce the chance of contracting HIV by 99%, but that part was removed.

Cancer research

This year’s budget tripled the states’ investment in the Florida Cancer Innovation Fund, set for 2023, to $60 million. Projects previously funded by this fund include research on biomarkers to detect pancreatic cancer and an initiative to increase early detection of breast cancer 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 uninsured women whose incomes are below 200% of the poverty line.

Meanwhile, the 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 breast cancer follow-up 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 Exams, would have eliminated cost-sharing for state employees only. It passed unanimously in the Senate but died in the House.

People with disabilities

The CDC estimates that 4.5 million adults in Florida 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 for applying for government services and shortens the time frame for determining eligibility.

One major change is that people with disabilities will be able to use an allocated monthly budget to buy long-term care services that fit their needs.

Maternal health care

SB 7016 provided $23 million to expand a telehealth minority maternity care pilot program in Florida’s 67 counties. The program was successfully piloted in Duval and Orange counties in 2022. In 2023, the program received more than $12 million to expand to 18 additional counties.

SB 7016 would also allow advanced birth centers to perform C-sections for women with low-risk pregnancies. Currently, birth centers cannot perform caesarean 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 an emergency.

The Live Healthy package also invests $134 million to increase hospital Medicaid reimbursement rates for labor and delivery services. Maternity hospitals are often considered money losers for hospitals. In recent years in Florida, 20 hospitals have closed their labor and delivery rooms, 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 women and parents. The bill has passed but has not yet been signed by DeSantis. Democrats tried and failed to pass amendments that would have required 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 Floridians can search for these services in their area. It also has the help of county health departments to promote the portal.

Nonprofits can get a grant to start new tests or health care services or clinics or mobile units to expand their health care capabilities.

Biomarker testing

HB 885 would require Florida Medicaid and state employee health insurance plans to cover biomarker testing, an initiative promoted by groups such as the American Cancer Society Cancer Action Network and the Alzheimer’s Association. The requirement does not extend to private insurance.

Biomarker tests measure biological changes that show whether someone has a disease or is at risk for 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 provide information about which treatments may work best for cancer patients.

The bill has been approved by the Legislature and sent to DeSantis for his signature.

Ccatherman@orlandosentinel.com; cgoodman@sunsentinel.com

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