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DOH chief John Armstrong gives update on Early Step programs, staff cuts

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To abate a $6.9 million shortfall the Florida Department of Health has trimmed back from 22 to seven the number of  Tallahassee staff administering the Early Steps program that serves infants and toddlers with special healthcare needs.

Department of Health Secretary John Armstrong, M.D., told members of the Appropriations Subcommittee on Health and Human Services on Wednesday that the money saved on salary and benefits has been plugged into Early Step program on the service end and that the department has used money from two trust funds to help plug the gaping hole.

“We care about the people who work in the Department of Health and we are assisting our former Early Step employees to find other opportunities through active transition coordination,” he said.

Additionally, going forward, the department will discontinue the use of a third-party administrator to pay the local Early Step provider, saving nearly $2 million. Additionally, the department will put in the local contracts a 15 percent cap on administrative charges local providers can charge the state.  Armstrong said it was a “reasonable accommodation,” noting that other programs have lower administrative overhead.

Early Steps is a program that serves newborns through age 3. It’s funded with $32 million in general revenue and has another $22 million in matching federal grants. The majority of the funds are spent on local Early Step providers, who received nearly $36 million in 2014-15 and their direct service payments, which amounted to nearly $15 million.

Although initially the program was targeted as the payor-of-last-resort, federal guidelines changed in 2012, Armstrong said, which resulted in the program picking up costs that once were covered by insurance companies. “Obviously that has had an impact on costs for the program.”

Armstrong said that 27,000 infants and toddlers have been referred by their clinicians to receive services and care through the Early Steps program. He also told staff not all referrals are accepted into the program. Nevertheless, the referrals have caused the costs in the program to increase.

Both state Sens. Rene Garcia and Lizbeth Benacquisto expressed concerns that the deep cuts in staff adversely impact referrals to the program or communication between the state and families as to whether children have been accepted into the program. Garcia said he heard that some families wait as long as three months to hear whether they have been accepted into Early Steps.

“How do we make sure, or tell the locals, they will be fine, that this program will not go away, and we will not put the federal funds in jeopardy,” Garcia asked.

Armstrong said the Department of Health is committed to the success of Early Steps.

“I cant overstate we are all in this together. But I think it does bare  emphasis it is the local Early Step providers who are actually providing the services to the children,” Armstrong said.

Early Steps is part of Children Medical Services, a division within the Florida Department of Health established for children with special healthcare needs. There are three healthcare programs that children tap into: Early Steps, CMS Medicaid managed care and CMS Children’s Health Insurance Program.

There are 64,000 children with special health needs in CMS Medicaid and another 14,000 children in the CMS Children’s Health Insurance Program. All three programs are being reviewed as part of CMS, Armstrong said.

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