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Florida—Recent Healthcare Reform Developments


Email Alert

By Rupa S. Lloyd*

November 25, 2008

In Florida, Governor Charlie Crist set the "health of our people" as one of his top three priorities for 2008. Working together with the Florida Legislature, many of the healthcare reform initiatives set forth by Crist as a part of his "Health Care Package" were accomplished in the past year, including the passage of the Cover Florida Health Care Access Program Act (the Cover Florida Act), a comprehensive market-based approach to help uninsured Floridians, which was unanimously passed by the Florida Legislature and signed into law by Crist on May 21, 2008. In setting forth his healthcare priorities for 2008, Crist directly addressed a fundamental problem with the current healthcare system in this country, noting that "[a] county health department visit costs on average $153 for primary care services, versus an average cost of $1015 in an emergency room, for a cost savings of $862 per visit."

I. Overview, Cover Florida Act (Section 408.9091, F.S.)

The intent of the Legislature in passing the Cover Florida Act was "to expand the availability of healthcare options for uninsured residents by developing an affordable health care product that emphasizes coverage for basic and preventative care services; provides inpatient hospital, urgent, and emergency care services; and is offered statewide by approved health insurers, HMOs, health-care-provider-sponsored organizations, or health care districts." The strategy behind effectuating such reform is to have the state program (Cover Florida) partner with private insurance companies to develop innovative health insurance products. There are no individual or employer mandates for participation and no tax dollars are required. A study by the Kaiser Family Foundation in 2006 found the average individual cost for small group health insurance was $354 per month and $957 per month for family coverage (see for more information).

The Cover Florida Act puts the state in the driver's seat to negotiate with insurers to offer similar coverage to the state's residents at a more affordable rate of $150 per month or less. Once the insurers who will provide coverage under the Cover Florida program (Cover Florida Plan Entities) have been selected and proposed plans implemented, the program will be open to all state residents ages 19-64 who have been uninsured for six months or more, are not covered by a private insurance policy, and are not eligible for coverage through another public health insurance program.

Cover Florida Plan Entities will be required to offer at least two alternative benefit option plans having different cost and benefit levels, one plan with catastrophic coverage, and one plan without. Plans without catastrophic coverage will provide the following coverage options, including but not limited to: preventative health services (i.e. immunizations; annual health assessments; well-woman and well-care services; and preventative screenings such as mammograms, cervical cancer, and noninvasive colorectal or prostrate screenings); incentives for routing preventative care; office visits for the diagnosis and treatment of illness or injury; office surgery, including anesthesia, behavioral health services, durable medical equipment and prosthetics, and diabetic supplies; and offer either a prescription drug benefit, use a prescription drug manager, or offer a discount drug program. Plans with catastrophic coverage will provide the same coverage noted above, plus: inpatient hospital stays; hospital emergency care services; urgent care services; and outpatient facility, surgery, and diagnostic services.

All Covered Florida Plan Entities are required to provide benefit plan, enrollment, and marketing materials in plain language—in English and in Spanish. Plans are portable such that the enrollee remains covered regardless of employment status or the cost-sharing of premiums. Plans that are offered through a qualified employer must meet the requirements of section 125 of the Internal Revenue Code.

Finally, although Plans are to be offered on a guaranteed-issue basis to enrollees, subject to any exclusions for certain pre-existing conditions as may be approved by the Agency for Health Care Administration. The Cover Florida Act includes additional measures that place upon the Agency for Health Care Administration, in coordination with either the Executive Office of the Governor or the Office of Insurance Regulation of the Financial Services Commission, to ensure that certain minimum standards of quality of care and access to care are maintained, and to ensure public awareness of the availability of the Cover Florida Plans.

II. Progress since Passage of the Cover Florida Act in May 2008

On July 2, 2008, Crist opened the competitive negotiation process for insurance companies to design competitive plans which will provide affordable coverage to Florida's uninsured citizens. The application to become an approved carrier required any plan proposal to 1) offer at least two plans, one with catastrophic and hospital coverage, and one without; and 2) offer comprehensive coverage, including coverage for preventative services, screenings, office visits, outpatient and inpatient surgery, urgent care, prescription drugs, durable medical equipment, and diabetic supplies.

On October 16, 2008, Crist announced the state's selection of six health insurance companies to provide Cover Florida program coverage beginning in early 2009. Two of the companies will provide statewide coverage (Blue Cross and Blue Shield of Florida and United Healthcare); the other four companies will offer regional coverage (for Broward and Miami-Dade counties: JMH Health Plan, Total Health Choice, and Medica Health Plans of Florida; for Volusia and Flagler counties: Florida Health Care Plans).

III. Highlights, Some Other Healthcare Reform Laws Recently Passed

A brief summary follows of some of the other reform measures, which were a part of the same bill which included the Cover Florida Act (Chapter 2008-32 (SB2534)):

Florida Health Choices Program. Established by Section 408.910, F.S. as "a single, centralized market for the sale and purchase of various products that enable individuals to pay for health care. These products include, but are not limited to, health insurance plans, health maintenance organization plans, prepaid services, service contracts, and flexible spending accounts."

Florida Healthy Kids Program. Section 409.814, F.S. is amended to remove the cap on full-pay enrollment for the Florida Healthy Kids program. Removing this cap means all children in Florida are eligible to purchase health insurance through the KidCare program. For more information about the program, see

Florida Health Flex Plans. Section 408.909, F.S. is amended to remove sunset provisions for Florida Health Flex Plans and increase eligibility to include those with a family income equal to or less than 300% of federal poverty level (previously was 200% of FPL).

Dependent Children Under 30. Section 627.6562, F.S. is amended to require group health insurance policies that provide dependent coverage to provide the policyholder with the option of insuring a child until the age of thirty, under certain circumstances (i.e. unmarried, no dependants, state resident, and part-time or full-time student).

A few other recent reform actions that also deserve mention are:

Chapter 2007-331 (SB 12-C): Charges the Agency for Persons with Disabilities to develop a comprehensive redesign of the current services delivery system for persons with developmental disabilities.

Chapter 2008-47 (SB 1488): Known as the "Health Care Consumer's Right to Information Act," amends Sections 381.026, 395.301, and 408.05, F.S. to require healthcare providers, licensed facilities, and the Agency for Health Care Administration to provide certain patient charge data and reasonable estimates of charges, as will generally increase the transparency to uninsured patients of the cost of the healthcare services received.

Chapter 2008-243 (HB 1429): Amends Section 394.9082, F.S to recognize that "untreated behavioral health disorders constitute major health problems for residents of the state, are a major economic burden to the citizens of this state, and substantially increase demands on the state's juvenile and adult criminal justice systems, the child welfare systems, and health care systems." To address this concern the amendment creates community-based systems of care, implements managing entities by the Department of Children and Family Services, and provides for a monitoring process.

Executive Order 08-36, March 7, 2008: Establishes the Governor's Task Force on Autism Spectrum Disorders created to "advance public policy for the research, screening, education, and treatment of autism, to assess the availability of insurance coverage for appropriate treatment of autism, and to recommend a unified and coordinated agenda for addressing autism in Florida."

IV. Existing Healthcare Programs in the State of Florida

Florida has many other healthcare programs in place, a few of which are briefly mentioned here by name, and with links to additional information.

Please also reference if interested in additional information about any of these programs.

*We would like to thank Rupa S. Lloyd, Esquire (University of Florida, HSC, Contracts & Related Services, Gainesville, FL) for providing this email alert.

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