“Healthy Florida” alternative unveiled; first hearing set for Thursday

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To continue Friday’s news on federal interest in Florida’s alternative plan for expanding health care coverage sans Medicaid, Senator Joe Negron’s plan, now called “Healthy Florida” will have a hearing Thursday in the Senate Appropriations Committee at 2:00 pm.

Health care committees in both chambers recently voted along party lines to reject the expansion of Medicaid that would make Florida eligible for approximately $51 million in federal funds over ten years. 

According to Negron, as reported by Health News Florida, Healthy Florida is intended to expand access through “a better system than the one Washington created.”

SPB 7038 would provide health insurance coverage to households at or below 138 percent of the federal poverty level, or about 1 million of Florida’s low income adults, by expanding the role of the state’s Florida Healthy Kids Corporation (FHK).  FHK is a non-profit that contracts with and oversees private health plans to provide coverage to children on a sliding scale based on family income. 

Benefits under Healthy Florida would be “actuarially equivalent to the benchmark benefit plan offered under [KidCare], excluding dental, and meets the alternative benefits package requirements under section 1937 of the Social Security Act.” The Healthy Florida proposal makes various changes to current law, such as removing limits on inpatient days or outpatient visits for mental health  services, detoxification services, and hospice.

In addition to benchmark benefits, other plan components include:

  • Giving enrollees a choice of plans, including a 90-day trial period.
  • Rewarding enrollees for healthy behaviors, wellness program adherence, and other activities in compliance with preventive care or disease management guidelines.
  • The establishment of health reimbursement accounts (HRAs) or a comparable health savings account for each enrollee. Funds deposited into these accounts may be used to pay cost-sharing obligations or to purchase over the counter health related items, to the extent allowed under federal law or regulation.
  • Requiring that administrative costs and profits are restricted to no more than 15% of premiums.

Enrollment for Healthy Florida is proposed to begin on October 1, 2013, with coverage beginning by January 1,2014. Enrollment may occur directly, through third party administrators, referrals from DCF, or through a health exchange under the federal PPACA.

To be implemented, this plan must be deemed eligible by federal regulators for the funding provided to states under PPACA.  At any point that the federal match falls below 90 percent, Healthy Florida would expire at the end of that state fiscal year.

More on how this proposal is received following tomorrow’s hearing.