A House panel Monday approved a proposal to overhaul the state’s public-health system, shifting responsibilities — and potentially thousands of jobs — from the Florida Department of Health to counties, reports Jim Saunders of the News Service of Florida.
The proposal (PCS for HB 1263) drew concerns and, in some cases outright opposition, from pediatricians, a statewide public health group and county officials. They raised questions about issues such as funding for county health departments and the future of the Children’s Medical Services program, which serves children with serious and chronic health conditions.
“We feel like it’s really not ready for prime time,” Leon County Commissioner Bryan Desloge told the House Health & Human Services Quality Subcommittee.
But sponsor Matt Hudson, R-Naples, said the bill is part of a three-year effort to revamp and more narrowly focus the Department of Health. He said county commissioners are in a better position than the state to know local health needs.
“We stand here today with the opportunity to do something bold, innovative and right for Florida,” said Hudson, who is a key player on health issues because he is chairman of the House Health Care Appropriations Subcommittee.
The subcommittee voted 7-4 to approve the bill, which emerged as lawmakers get ready to hit the halfway point of the legislative session Wednesday. It remains unclear whether the Senate would support such a bill, as its committees have not considered similar proposals.
The bill calls for the Department of Health to put together a plan by Oct. 1 to decentralize public-health services, including transferring responsibilities and employees to county health departments. The decentralization would take effect in January 2014, with the state sending block grants to counties to pay for services.
The 152-page proposal includes numerous other changes such as merging two divisions that are part of the Children’s Medical Services program. Also, it would allow the department to establish a provider-service network, a form of managed care, to serve children in the program.
Other changes in the bill include calling for the long-debated closure of the A.G. Holley state tuberculosis hospital in Palm Beach County and repealing a 2010 law that would require septic-tank inspections across the state.
Lucy Gee, acting deputy secretary at the Department of Health, said the changes could lead to eliminating 12,000 state jobs, though subcommittee Chairman John Wood, R-Winter Haven, said a lot of those jobs would simply be transferred to counties.
Gee said department officials were still studying the ramifications of the bill, which was released late last week. But she suggested that the department should do a feasibility study before the state moves forward with decentralizing public-health services.
Chris Nuland, a lobbyist for the Florida Public Health Association, which includes public health officials from various parts of the state, said his group has a fundamental disagreement with the direction of the bill and is concerned it could jeopardize public health.
“We believe that public health should be a state-directed function,” he said.
But people on both sides of the issue recounted frustrations Monday in dealing with the department. Wood said more local involvement would be an improvement.
“We all know that reform is very, very difficult, and the biggest difficulty with reform is fear,” he said.
A key question centered on the block grants and whether rural counties would receive enough money to meet their health needs. Chris Doolin, a lobbyist for a coalition of small counties, said public health departments are critical in regions that have few doctors and a lack of nearby hospitals.
“We want to close the gap,” Doolin said. “There is a health-care gap in this state, and it exists in dramatic fashion in our rural areas.”
The bill calls for distributing block grants on a per-capita basis, but that might provide relatively little money to rural counties with small populations. Hudson said he is working on a formula that would better distribute the money.
Also, Hudson said the bill would allow counties to enter into agreements to share services. For example, two small counties could join to hire a dentist who would serve public-health patients.
“I’m not going to do something that is going to hurt the rural counties and accelerate that gap,” he said after the meeting.
The subcommittee also faced questions about a series of changes in the Children’s Medical Services program. Hudson tried to defuse at least part of the concern by emphasizing that the bill would not require — only allow — the Department of Health to establish a provider-service network to manage children’s care.
Physician Lisa Cosgrove, president of the Florida Pediatric Society, said her group has been disappointed in the Department of Health’s support for Children’s Medical Services. But she said also said she doesn’t want to see the program damaged by the changes.
“CMS is working well, despite the lack of support from (the Department of Health),” she told the subcommittee.