Florida lawmakers are considering legislation that would streamline services for medically complex kids provided by a state program. But critics are concerned the effort would harm families seeking care for their children with chronic conditions.
The measure (HB 1085) would streamline administrative operations of the Children's Medical Services program, a state- and federal-subsidized health insurance for low-income families who have children with physical, mental or emotional disabilities.
According to the Florida Department of Health, there were about 123,000 children enrolled in the insurance in 2024.
Among several changes, the bill would transfer oversight from the Florida Department of Health to the Agency for Health Care Administration.
Currently, AHCA receives funding for CMS through Title XXI of the Social Security Act. The health department is in charge of CMS administrative services, such as determining the income and medical eligibility of children. When services for a family are approved by the health department, it sends an invoice to AHCA.
The proposal would cut out the middleman, said state Rep. Vanessa Oliver, R-Punta Gorda, a bill sponsor.
"That back and forth is kind of pointless and just administrative for no reason. Just cut that out and make the government operate more efficiently so the program can be administered in a more efficient way," said Oliver. "If there are issues that come up, there is one department that is solely responsible for the administration of those plans. You don't have to wonder 'who do I complain to?' "
The bill would also expand home health services, also known as the Medicaid model waiver, so that it can serve all Medicaid-eligible children who receive skilled nursing services.
The measure would also reduce the administrative workforce from about 50 people at the health department to four people at AHCA, Oliver said.
In 2014, the Legislature passed the Statewide Medicaid Managed Care Act. The act required AHCA to manage contracts with Medicaid health plans, and rather than the state paying individual doctors for Medicaid services, it paid the plans to act as health insurers. At the time, the health department was already doing this for minors covered under CMS.
Oliver said she believes the move to AHCA would not only provide one agency for families to speak with regarding issues in care, but also give AHCA more bargaining power against managed care companies (private insurers) in contract with the state.
"AHCA can say, 'OK, well if you're not meeting the requirements under this particular contract, we have other sticks at our disposal that we can use to help encourage compliance,' " Oliver said.
There was talk of setting up this change in 2014, but it was rejected and left to the health department to avoid any disruption families might feel in a transfer, Oliver said.
"These children are so fragile, and any disruption to their care would be more detrimental than it would be to the rest of the population," Oliver said.
Oliver said a transfer could now occur more easily.
Not everyone is so sure.
"It's a false equivalency to say, well, (CMS) is just another managed care contract, because these are highly specialized services," said Steve Freedman, founding director of the University of Florida-based Institute for Child Health Policy.
"Medicaid admittedly has a terrific benefit structure, but managing networks for a presumably healthy population, a relatively healthy population of children, and managing a specialized population is really two different animals."
Freedman has a long career in child health insurance, including serving as the director of CMS twice. His concern comes from whether or not AHCA has the institutional knowledge and availability to handle the financial duties that come with a specialized population, such as Florida's most vulnerable.
"Adults could face five or six major diseases, right? And those are the things that are really the concerns of health insurance, but kids can be born with hundreds of different issues, and they're not acquired later in life. Some kids are born with a genetic anomaly, like some kids are born without fully formed diaphragms," Freedman said. "A design for kids has to accommodate a lot more variability than a design for adults."
Freedman said it would be like if a fast-food restaurant received the recipes for a fine dining experience.
"The needs of these kids are, the more complex menu, the ingredients for them are more complex, and we have to make them look like chicken nuggets," he said.
Additionally, he's concerned with splitting up the duties of determining eligibility. The bill would make it so AHCA would determine financial responsibility, but the health department would still determine medical eligibility.
"If you think about what happens as a parent, so you get a determination like, 'My kid is eligible medically, but not financially.' That's nuts," he said.
Oliver isn't convinced of the issue. She said the specialties of both agencies will improve the insurance experience.
"Let the Agency for Health Care Administration focus on its core goals now of administering the contracts while the Department of Health is able to focus more on that clinical aspect," she said.
Central Florida Public Media reached out to Sen. Gayle Harrell, sponsor of the Senate version (SB 1490), but her office did not respond. That bill had its first reading on Tuesday.
The House version is in a Health Care Bbudget Subcommittee, and Oliver is working to get the bill on the schedule for its second reading in the House.
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