Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.
— Trans care battle coming to medical board? —
Gov Ron DeSantis wants to ensure no taxpayer dollars are spent on supplying gender-affirming care through the Florida Medicaid program.
But some worry that the administration will use the Florida Board of Medicine to prevent Florida physicians from providing gender-affirming care regardless of who’s paying. While the issue doesn’t appear on the agenda for the upcoming Aug. 5 Board of Medicine (BOM) meeting in Ft. Lauderdale, documents affirm the Governor’s position to block or curtail the care included in the 4,000-plus page “public book.” The massive public book generally contains information the board will discuss at the meeting.
University of Florida professor Michael Haller, M.D., worries that the board will move to adopt its standard of care for gender medicine outside of what already exists. The state hasn’t floated any specific rule language for consideration, and Haller says he doesn’t know how far the state is willing to take it.
Florida Board of Medicine members know the DeSantis administration’s interest in the issue. State Surgeon General Joseph Ladapo sent a letter to BOM members June 2 requesting that the issue be considered highlighting the recommendations he made earlier in the month that specific pharmaceutical, non-pharmaceutical, and surgical treatments for gender dysphoria not be used.
The board did not publicly discuss the issue.
But there have been new board members since that meeting, including Dr. Patrick Hunter, a Pensacola pediatrician. Hunter actively posts about trans care on his Twitter account, and among his followers are Chloe Cole, a 17-year-old from California who spoke at the state’s Medicaid meeting, and Partners for Ethical Care, which, according to its website, has the goal of raising awareness and supporting efforts to “stop the unethical treatment of children under the duplicitous banner of gender identity.”
Dr. Hunter is a general pediatrician and a clinical professor at Florida State University’s College of Medicine. He is also a veteran of the United States Army and a fellow of the American Academy of Pediatrics.
DeSantis announced four appointees to the BOM on June 17.
If the BOM agrees to tackle the issue, it will be the third high-profile rule it’s proposing to change. The BOM is changing the rules for prescribing weight loss drugs. It also is defending its emergency rule on Brazilian Butt lifts.
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— FMA PAC shows mostly Republicans the money —
The Florida Medical Association’s campaign arm, the FMA Political Action Committee, was formed nearly 50 years ago to help elect candidates who advocate the agenda of the group that works on behalf of the state’s physicians.
For years, the FMA had a stellar record in the Legislature; but the last few years, especially under then-House Speaker José Oliva, have resulted in legislation that the FMA did not support getting passed and signed into law.
Heading into the 2022 elections, the FMA has handed out campaign contributions worth more than $1.33 million during the current cycle, with a large portion going to Republicans.
The group’s largest single donation in April — $100,000 — went to the political committee backing DeSantis’ re-election.
But an analysis of campaign records shows the FMA has donated $300,000 to the Florida Republican Senatorial Campaign Committee, which is the committee controlled by Senate Republican leaders whose aim is to protect the GOP majority in the state Senate.
The FMA has also contributed $175,000 to the Republican Party of Florida, although $75,000 given in late April and May is on campaign records listed as intended for House Majority, an effort to help House Republicans keep control of the state House.
The Association has given $25,000 to the Florida Democratic Party over the last two years.
The Association has also made donations directly to political committees controlled by Republican legislative leaders, including those in the line of succession. Over the last two years, the FMA has given $72,500 to a political committee controlled by Sen. Ben Albritton, who is slated to become Senate president after the 2024 elections. Last year the FMA donated $40,000 to a political committee run by House Speaker Chris Sprowls.
The political committee controlled by Sen. Lori Berman, a Palm Beach County Democrat whose husband, Dr. Jeffrey Ganeles, is a periodontist and dental impact surgeon, has received a total of $25,000 in 2021 and 2022 from the FMA political action committee. The FMA has begun endorsing what it calls “pro-medicine” candidates and has chosen 16 legislators to support.
Campaign records show that some of the endorsed candidates have gotten financial support for their campaign accounts in recent weeks, although the committee has also given donations to legislative candidates it has not endorsed as of now, including a $1,000 contribution to the House campaign of Jennifer Canady, the wife of Supreme Court Justice Charles Canady.
— FHA PAC shows more money —
Another major health care group — the Florida Hospital Association — has made slightly more than $566,000 in campaign contributions through its political committee during the current election cycle.
The largest share of those donations — $185,000 — has gone to the Florida Republican Senatorial Campaign Committee, the central political committee that helps get GOP state Senators elected. Sen. Kathleen Passidomo leads the committee. She took over the organization last October from Senate President Wilton Simpson after the Senate GOP caucus designated her as the next President.
The FHA political committee, led by current FHA president and CEO Mary Mayhew, donated $40,000 in January to a separate political committee — Working Together for Florida — affiliated with Passidomo.
The hospital political committee has also contributed $110,000 to the Florida House Republican Campaign Committee led by Rep. Paul Renner, who is lined up to become Speaker later this year.
The FHA has contributed to campaign accounts of dozens of individual legislators and political committees run by top legislators. The FHA political committee has donated $35,000 to Conservatives for a Better Florida, the committee run by Rep. Daniel Perez, the Miami Republican in line to lead the Florida House after the 2024 elections.
Not all of FHA’s donations have gone to Republicans. Earlier this year, the group’s political committee contributed $15,000 to the Florida Democratic Party and $25,000 to the Florida Democratic Legislative Campaign Committee.
— Ask, don’t tell —
The Florida Department of Health provided vendors little insight into its plans for a managed care program that supplies care to the state’s most medically complex children, including the number of vendors that may be awarded contracts.
The state posted the 5-page Request for Information (RFI) on June 30, seeking to learn ways to incorporate best practices for improving the managed care delivery system for children and youth with special health care needs.
But the DOH said the “details of the proposed procurement are not yet known” when asked whether it would be awarding one statewide or regional contract.
Moreover, when asked about the scope of the procurement would be compared to the traditional Medicaid managed care program, the state replied, “The purpose of this RFI is to obtain input on best practices and innovative ideas related to an effective and efficient service delivery model including care management, performance improvement, condition-specific services, and the overall improvement of health and plan experience of (enrollees).”
Responses to the RFI are due Aug. 2. Vendors had until July 12 to submit questions about the RFI. The state posted answers to the questions on July 20.
The post includes the questions and answers but does not include the names of the interested parties that asked the questions. But there are signs that at least one party may not have experience in Florida.
The DOH said it was “seeking feedback” in response to a part of the RFI that describes what the state is looking for in a vendor. “The RFI seeks to obtain information from respondents that have experience with or the ability to provide integrated managed care services for enrollees with a strong emphasis on provider network adequacy.”
A vendor asked”: Are you seeking specific experience in Florida versus experience in other States?”
The DOH responded: “The CMS Health Plan must meet all plan requirements for the Managed Medical Assistance (MMA) program. The Department is seeking feedback on experience in meeting provider network adequacy regardless of the state in which this experience was gained.”
The state’s latest enrollment data shows that 92,411 medically complex children and youth were enrolled in the managed care network.
The CMS Medicaid managed care plan provides courage to medically complex children and youth whether they are enrolled in the traditional Medicaid program or Florida KidCare.
— Medicaid, KidCare and PHE —
Nearly 5.35 million Florida residents were enrolled in Medicaid as of June 30. The enrollment for the month was a 1% increase over the previous month’s enrollment: the most significant expansion since August 2021.
State economists meet Friday to take a closer look at Florida’s Medicaid program to project the enrollment and costs for the state fiscal year 2022 and beyond.
The extension of the COVID-19 public health emergency through mid-October means that Florida will continue to receive an additional 6.2% federal Medicaid match through the end of the year, which is halfway through the state fiscal year 2022-2023 budget.
Economists met earlier this month to discuss enrollment in another health care program, the federal children’s health insurance program called Florida KidCare.
KidCare had more than 1.88 million enrollees as of June 30, which marked the end of the state’s 2021-2022 fiscal year. The enrollment is slightly higher than predicted when they last met in December.
But the good news ends there.
Economists lowered their projected enrollment projection in the Florida KidCare program in the current state budget year by nearly 623,000 children for a total enrollment of 1,776,313 by June 30, 2023.
States cannot drop people from the Medicaid program unless they request to be dropped, die, or move so long as the public health emergency still is in place. That means the state has not been able to switch children from Medicaid, which has no cost-sharing requirements, to KidCare, where enrollees are charged premiums.
Florida’s children are among the most at risk nationwide of losing health care coverage when the public health emergency expires, along with Georgia, Delaware, Missouri, Nevada, and Texas, according to a study produced by the Georgetown University Center for Children and Families.
Researchers reviewed five reasons children could face barriers, from the percentage of automated — or ex parte — redeterminations to coverage decisions. The report notes that children ages 5-19 (and certain adults) only qualify for six months of coverage which is an added hurdle. Additionally, Florida administers KidCare programs differently than Medicaid, so there isn’t a seamless transition from one program to another, another red flag for researchers.
— RULES —
The Florida Board of Dentistry proposes amending Rule 64B5-1.002 regarding unexcused absences of board members. More here.
The Florida Board of Dentistry proposes amending Rules 64B5-2.013 and 64B5-2.013 regarding the use of live patients for practical or clinical examination. More here.
The Florida Board of Dentistry proposes amending Rule 64B5-9.011 regarding dental assistants’ education and training history. More here.
— ROSTER —
LeadingAge Florida is honoring Harry Hobson, CEO of Plymouth Harbor on Sarasota Bay, with its Lifetime Achievement Award. “Harry has committed his life’s work to serving older adults, and his true passion for providing the highest quality care is second to none,” said LeadingAge Florida President and CEO Steve Bahmer. “He is a living example of excellence in leadership. During his two decades at Plymouth Harbor, he has earned a place among the most revered senior living leaders in Florida, and we are thrilled and honored to recognize him with this award.”
Former Florida Deputy Health Secretary Shamarial Roberson, a Florida A&M University (FAMU) alum, is delivering the commencement speech at FAMU summer graduation on July 29.
— ICYMI —
In case you missed them, here is a recap of other critical health care policy stories covered in Florida Politics this past week.
—Not before November: A Florida appeals court, in a split 2-1 split decision, is rejecting attempts to block the state’s new ban on abortions after 15 weeks and refusing to speed the case up to the state Supreme Court. The Thursday night decision by the 1st District Court of Appeal means it could be weeks, if not months, before the legal battle over whether the new law violates Florida’s Constitution is finally resolved, meaning it may not be decided before this year’s elections.
—Docs endorse pharmacist: The Florida Medical Association (FMA) PAC is endorsing House District 5 candidate Shane Abbott. “The FMA PAC is proud to endorse Shane Abbott for the Florida House,” said FMA PAC President Jason Goldman. “As a valuable member of the health care team, Shane has a unique understanding of the health care system and the complexities of the issues we face as physicians. We look forward to working with him to address these issues and help take care of the patients of our state.”
—Happy trails: resident and CEO of the Florida Association of Community Health Centers, Andrew Behrman, is stepping down from his position at the end of the year. On Tuesday, Behrman, who joined the Association in September 2002, announced his retirement at the Association’s annual conference in Fort Lauderdale.
—Congratulations: Seminole County Commissioner Lee Constantine has been named president of the Florida Association of Counties (FAC). Constantine has served on the executive committee since 2019 and sat on several of the Association’s policy, legislative, finance and audit committees.
—A place called Hope: As part of her Hope Florida initiative connecting nonprofit charities doing social work with public and private funding, First Lady Casey DeSantis handed out $5,000 each to five groups in Northwest Florida on Thursday. The groups help those with autism and other special needs, shelter domestic violence victims, and feed and clothe low-income children and families in need.
— FOR YOUR RADAR —
Aside from coverage by Florida Politics, these stories are worthy of your time.
—“As monkeypox cases surge in South Florida, demand for vaccines intensifies” via Michelle Marchante and Grethel Aguila — Broward, with 124 confirmed and suspected cases as of Thursday, is the state’s epicenter, followed by Miami-Dade with 65 confirmed and suspected cases. The rare disease is in the same family as smallpox. While both viruses share similar symptoms, monkeypox is usually milder. According to the Centers for Disease Control and Prevention, it is rarely fatal. It also is not as contagious as COVID-19. The surge in monkeypox cases is coming at the same time Florida has been battling an outbreak of meningococcal disease caused by bacteria. The two most common meningococcal infections are meningitis — infections of the brain and spinal cord lining — and bloodstream infection.
—“COVID hospitalizations, deaths on the rise in latest Florida BA.5 surge” via Chris Persaud of The Palm Beach Post — While Florida’s official COVID-19 caseload has remained flat for more than a month, every other significant indicator shows the latest wave of the disease is getting worse. As the number of new statewide weekly infections logged each week stays around the same level as late May, hospitalizations and deaths continue to rise, as do the share of coronavirus tests with positive results and the concentration of the pathogen found in sewage.
—“UF Health unveils imaging machine, one of 42 in world, to tackle difficult cancers” via Leah Buletti of UF Health News — UF Health is now the first site in the southeastern United States to house a groundbreaking device that will provide personalized cancer treatment by combining extremely detailed magnetic resonance imaging, or MRI, with precision radiotherapy. The technology paves the way for new therapeutic options for patients with the most challenging cancers, such as pancreatic and liver cancers, and tumors that have metastasized or spread into soft tissues.
—“Jared Moskowitz, who helped oversee the pandemic response, says he wasn’t involved in Florida’s most controversial vaccine sites” via Anthony Man of the South Florida Sun-Sentinel — Jared Moskowitz, who was Gov. Ron DeSantis’ director of emergency management during the first 14 months of the coronavirus pandemic, said Tuesday he refused to have his agency operate several of the state’s most controversial COVID vaccination sites in early 2021. Democrats loudly criticized the vaccination sites in question as favoring well-off Republican communities with political connections — and being impossible or difficult to access by people not connected or without good transportation. DeSantis emphatically rejected the criticism.
—”I am terrified’: Doctors warn lawmakers of grim health impacts from Roe reversal” via Rebecca Pifer of HealthCare Dive — Anti-abortion laws have had a chilling effect on patient care, resulting in providers — concerned about the potential for legal action — delaying or denying lifesaving services in some cases, doctors told a House committee.
— PENCIL IT IN —
Happy birthday to Rep. Anika Omphroy.
Happy birthday to Larry Polivka, former Claude Pepper Center executive director.
2 p.m. The First Responder Suicide Deterrence Task Force meets. Meeting link here.
9 a.m. The Board of Governors of the Florida Medical Malpractice Joint Underwriting Association meets. Sawgrass Marriott, 1000 PGA Tour Blvd., Ponte Vedra Beach.
10 a.m. The state Medical Examiners Commission meets. Omni Orlando Resort at ChampionsGate, 1500 Masters Blvd., ChampionsGate.
Happy birthday to Bill Cotterell, formerly a reporter with the Tallahassee Democrat.
8 a.m. The Board of Medicine Probation Committee meets. Meeting link here.
9 a.m. The Florida Board of Massage Therapy meets. Marriott Orlando Airport Lakeside, 7499 Augusta National Dr., Orlando.
9 a.m. The Florida Board of Massage Therapy meets. Marriott Orlando Airport Lakeside, 7499 Augusta National Dr., Orlando.
9 a.m. The state Correctional Medical Authority meets. Call (888) 585-9008; participant code: 344085830.