Issues in health care

• Access to healthcare. Florida ranks 50th among the states when it comes to children’s access to health care.  Three in 10 of Miami-Dade’s residents under age 65 have no insurance. Policies to increase access to care are critical for a healthy community.
• Care for Older Adults. Florida is home to over 4.3 million people over the age of 60. In Miami-Dade, there are over 460,000 aged 60 and above. According to research, Miami-Dade elders are among the poorest, most in need of assistance, least healthy, and least informed elders in Florida. Lack of sufficient financial resources, proper nutrition, adequate social support, affordable housing, and transportation make living in our community more difficult for older adults.
• Child Welfare. When a child has been abused or neglected, the state steps in to protect them from future harm. An investigation takes place in order to determine the safety of the child. In the event the court system determines that the child is not safe in their home, the child can be removed and placed in a safer environment. In Miami-Dade approximately 3,600 children are currently in state custody.  
• Risk Prevention for Youth. (under constructrion)

Access to health care

Care for older adults

Child welfare

Risk prevention for youth

POLICY ISSUE

Access to Health Care

BACKGROUND

Access to primary and preventive health care is essential to maintain a healthy life. Without the available and appropriate resources, people are at a higher risk of health complications.
One of the barriers to accessing health care for low-income individuals is the lack of health insurance. Over 46 million Americans are uninsured. Other barriers to accessing health care may be geographic (inconveniently located clinics), economic (prohibitive costs for preventive, mental, and oral health services) or cultural (lack of programs that are sensitive to language, racial or gender differences). 
 
Why does insurance matter? People without insurance are more likely to go without preventive care, to delay or forgo medical care, and to die prematurely. When sick, the uninsured may turn to emergency rooms for care, where oftentimes they are charged more for services than insured patients. And when uninsured patients can’t afford their medical bills, the cost of this care is passed on to the insured in the form of higher premiums.
 
In Florida, 21% of the population (about 3.7 million) is uninsured. In Miami-Dade over 580,000 residents, or 30% of the population under age 65, are uninsured. There are health consequences to this high level of un-insurance. The 2007 Miami-Dade Health Report Card notes several indicators: overall hospital admission rates for elders are higher than the national average; the trend toward low birth weight babies is worsening; and fewer women in Miami-Dade are screened for breast and cervical cancer than the national average.
Medicaid and KidCare (the State Children's Health Insurance Program or SCHIP) help fill the gaps in health coverage for some low-income children and their parents, but the reach of these programs is limited.

POLICY ISSUES

Cover Florida

The Cover Florida Health Access Program is the Governor’s health initiative designed to provide affordable health care options for uninsured Florida residents between the ages of 19 to 64 who meet eligibility criteria. No tax dollars are required to fund the program. Cover Florida partners with private
insurance companies to bid on health insurance products. The cost to recipients will be $150 per month or less and will be available to Floridians who have been without insurance for at least six months.

Medicaid

Medicaid provides health insurance for low-income pregnant women, families with children, and aged, blind, and disabled individuals.

Florida KidCare

Florida KidCare is our State Children’s Health Insurance Program (SCHIP) for uninsured children under age 19 who meet income and eligibility requirements.

RELATED LINKS

Florida CHAIN
Cover the Uninsured
Families USA 
The Henry J. Kaiser Family Foundation

POLICY ISSUE

Medicaid / Medicaid Reform

BACKGROUND

Medicaid provides health insurance for low-income pregnant women; families with children; and aged, blind and disabled individuals who meet eligibility criteria. 

Medicaid is funded by a combination of federal and state dollars. In the 2007-2008 fiscal year, $16.3 billion was spent on Medicaid in Florida. From that amount $11.4 billion (about 70%) came from federal dollars. 

As an entitlement program, those who are eligible for Medicaid are automatically qualified to receive the benefit. Over 2.1 million people are served by Florida’s Medicaid program. The largest number of Medicaid-eligibles, 445,268 people, lives in Miami-Dade County.

In 2005, Florida obtained a waiver from the federal government to implement a “Medicaid Reform” five-year pilot program. The pilot program currently serves residents in Broward, Duval, Baker, Clay, and Nassau counties.

Medicaid Reform allows qualified private managed care entities (HMOs and Provider Service Networks) to develop and market health care plans to Medicaid beneficiaries. The managed care entities determine the scope, amount and duration of services for plan members. All Medicaid beneficiaries in the pilot counties (with a few exceptions such as children in foster care) are required to participate in one of the Medicaid Reform managed care plans. 
 
Medicaid Reform plans have customized their service offerings somewhat for different beneficiary groups, although this customization has been limited by federal and state requirement. Some Reform plans offer higher limits on some medical services and provide additional extra services to aged and disabled beneficiaries. Medicaid Reform benefits packages have generally remained similar over the first two years of the initiative, with a few plans offering higher benefit levels, additional extra services, and fewer co-payments in the second year.

POLICY ISSUES

Key questions addressing Medicaid Reform policy include:

Medicaid Reform is slated to be expanded state-wide in 2010.

Florida Legislature has agreed to evaluate the Medicaid Reform Pilot Program before it is expanded. Governmental agencies, including the Florida Agency for Health Care Administration and the Office of Program Policy Analysis & Government Accountability, as well as private entities, including the University of Florida and Georgetown University are conducting studies monitoring Medicaid Reform.
 
Preliminary findings show that preferred drug lists and specific drug coverage information is not easily accessible, there is limited access to specialists, and there is an increase in administrative burdens to Medicaid providers.

Currently there is not enough data to determine the effectiveness of Medicaid Reform.

RELATED LINKS

AHCA: Medicaid Services 
Florida CHAIN – Medicaid 
Georgetown University Health Policy Institute

POLICY ISSUE
Children’s Health Insurance – Florida KidCare Program

BACKGROUND

Florida KidCare is our State Children’s Health Insurance Program (SCHIP) for uninsured children under age 19 who meet income and eligibility requirements. KidCare is made up of four parts: Healthy Kids, MediKids, Children’s Medical Services (CMS) Network for Children with special health care needs, and Medicaid for children.  It is funded by state and federal dollars at a federal match rate of 71.2%. Florida KidCare was created in
1998 and currently serves 230,567 children.

Approximately 700,000 Florida children are uninsured. Of these, 465,000 (65%) are eligible but not enrolled in Medicaid or Florida KidCare. Currently in Miami-Dade, over 110,000 children lack health insurance.

Florida KidCare it is currently underfunded (it cannot accommodate the large number of eligible, uninsured children); it lacks resources for outreach; and its four components are uncoordinated, each with its own eligibility determination and enrollment process. The result is that many eligible children are not enrolled, or become un-enrolled when they shift from one program to another as their eligibility status changes.

POLICY ISSUES

The Florida KidCare Coordinating Council made the following program recommendations to the Governor and Legislature:

In 2008 the Florida Legislature increased the KidCare budget by $13.6 million, increasing coverage for an additional 38,000 children. However, outreach funds were eliminated when bills to streamline KidCare enrollment failed.

RELATED LINKS

Florida KidCare Website 
Florida Agency for Health Care Administration
Florida KidCare Fact Sheet 
Florida Healthcare Myths

POLICY ISSUE

Care for Older Adults

BACKGROUND

Florida is home to over 4.3 million people over the age of 60. In Miami-Dade, there are over 460,000 aged 60 and above. According to research, Miami-Dade elders are among the poorest, most in need of assistance, least healthy, and least informed elders in Florida. Lack of sufficient financial resources, proper nutrition, adequate social support, affordable housing, and transportation make living in our community more difficult for
older adults.

The Florida Department of Elder Affairs (DOEA) is the state’s primary agency responsible for administering services to older adults and developing policy recommendations for long-term care. DOEA funds are allocated to local communities through a network of Area Agencies on Aging (AAAs).
 
The Alliance for Aging, Inc., Miami-Dade’s Area Agency on Aging, is responsible for a wide range of services provided locally to older people in Miami-Dade and Monroe Counties. The Alliance is a private not-for-profit agency, part of a nationwide network of more than 650 Area Agencies on Aging. A volunteer Board of Directors governs the Alliance. Operating funds, in addition to the DOEA funds, are received through federal, state and local grants, as well as private donations from individuals, corporations and special initiatives. 
 

POLICY ISSUES

Long Term Care

Research shows that community based care is more cost effective and beneficial to older adults than institutional care. According to the Alliance for Aging, for every dollar invested in community based care, society saves $3.61. Funding for community care is a critical issue. Community Care for the Elderly (CCE) is a statewide program administered by the DOEA that enables impaired elders to live dignified and reasonably independent lives in their homes or in the homes of relatives or caregivers. Programs operate on federal and state dollars through the CCE and Older American’s Act. Due to escalating
costs and static funding, community-based agencies have cut back on services in the 07-08 and 08-09 fiscal years.

Florida Senior Care – (Medicaid Reform)

Florida Senior Care (FSC) is a Medicaid managed care program serving seniors 60 and older, which integrates all Medicaid services and provides care coordination for each enrollee. By 2010, FSC will be expanded to Miami-Dade and Monroe counties as a voluntary program.

RELATED LINKS

Florida Department of Elder Affairs 
Florida AARP
Alliance for Aging

POLICY ISSUE

Child Welfare

BACKGROUND

When a child has been abused or neglected, the state steps in to protect them from future harm.
An investigation takes place in order to determine the safety of the child. In the event the court
system determines that the child is not safe in their home, the child can be removed and placed in
a safer environment. In Miami-Dade approximately 3,600 children are currently in state custody. 
 

POLICY ISSUES

Community Based Care

In 1996, the Florida Legislature passed the Community Based Care (CBC) system, which was
expanded statewide in 1998.
 
Community Based Care is a comprehensive redesign of Florida's child welfare system. It combines
the outsourcing of foster care and related services with an increased local community ownership of
service delivery and design. Under this system, the government continues to retain custody of child
abuse investigations and certain financial services, while private entities provide one or more
services including foster care services, adoption services, case management, and intensive in-home
services.
 
In Miami-Dade and Monroe counties, the community-based care lead agency is a non-profit
organization called Our Kids, Inc., which is the only model which has service providers under
contract. The system of care includes family preservation services, case management, clinical
services, shelter and residential group care, crisis intervention, and independent living services.
 
Additionally, Florida Law mandated that the Department of Children and Families establish the CBC
Alliance Advisory Board in order to provide a focal point for community participation and
governance of community-based services. This entity engages the child welfare community, system
stakeholders and community partners to identify and address system challenges and barriers that
impact outcomes for children and families in Miami-Dade.

Foster Care Review / Guardian Ad Litem 

Foster Care Review Inc. (FCR) helps the Juvenile Court provide oversight for the welfare of Miami-
Dade children who have been removed from their homes because of abuse and neglect and are under the jurisdiction of the Juvenile Court. FCR volunteers conduct review hearings to monitor the
safety, wellbeing and progress to permanency of these children. The Foster Care Review provides
the court additional information that may help decide how a child’s case may be handled. 
 
The Florida Guardian Ad Litem Program is a partnership of community advocates and professional
staff acting on behalf of Florida’s abused and neglected children. A Guardian Ad
Litem (GAL) is “a volunteer appointed by the court to protect the rights and advocate for the best
interests of a child involved in a child welfare court proceeding.” As of September 14, 2007, there
were 32,411 children represented by the Guardian ad Litem Program. There are currently 5,687
certified volunteers in the Guardian ad Litem Program.
 

RELATED LINKS

Department of Children and Families
Our Kids, Inc.