Policy, System, and Environmental Change Priorities
2017
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PRIORITY AREA: PRIMARY CARE
ISSUE: KIDCARE/CHILDREN HEALTH INSURANCE PROGRAM (CHIP)
(State/Local)
Background: Florida KidCare is the state’s children’s health insurance program for
uninsured children who meet income and eligibility requirements. The program provides
health insurance to children in families with incomes up to 200 percent of the federal
poverty level. MediKids, Florida Healthy Kids and Title XXI Children’s Medical Services
Managed Care Plan compose the Title XXI Children’s Health Insurance Program (CHIP).
CHIP is not an entitlement program and the families pay a monthly family premium of $15
or $20 depending on the family’s income. Florida KidCare also includes Medicaid for
children.
At the end of 2014, the Florida KidCare program included 2,263,615 enrolled children.
This is an increase of 8.7% from the previous evaluation year. A 2016 report1 by
Georgetown University Center for Children and Families shows Florida had approximately
284,000 uninsured children in 2015. Florida’s uninsured rate for children is 6.9 percent,
significantly higher than the national average of 4.8 percent. It is estimated that the large
majority of uninsured children are eligible, but not enrolled in KidCare. In addition, many
of those enrolled lose coverage because of system-level barriers.
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Issue
SUPPORT efforts to maintain or increase funding for the KidCare program.
SUPPORT efforts to streamline processes and eliminate system-level barriers that
will lead to an increase in enrollment and retention in KidCare.
SUPPORT outreach projects that aim to increase awareness and enrollment of
children in KidCare.
Georgetown University Health Policy Institute. Center for Children and Families. Children’s Health
Coverage Rate Now at Historic High of 95 Percent. Oct 2016. Retrieved from:
http://ccf.georgetown.edu/wp-content/uploads/2016/11/Kids-ACS-update-11-02-1.pdf
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ISSUE: MEDICAID
(Federal/State)
Background: By July 2016, Medicaid enrollment had surpassed 3.6 million.2 Florida’s
decision not to expand Medicaid means about 948,000 Floridians don’t qualify for
Medicaid, despite having incomes under 138 percent of the poverty level. 567,000 of
them are in the coverage gap — ineligible for Medicaid and also ineligible for tax
subsidies to help them afford private health insurance. Florida is projected to lose out on
$66.1 billion in Medicaid funding — more than any other state — over the decade
beginning in 2014 as a result of their decision to not expand Medicaid.
Historically, Medicaid has relied on open-ended federal funding, as well as significant
cost-sharing contributions from states. However, the President-elect is proposing to
replace Medicaid with block grants. This approach would disconnect the level of funding
from the number of Medicaid beneficiaries and the cost of providing care. In other words,
the federal contribution would remain the same, or grow only according to a preset
formula, no matter how large the population in need becomes or how much a state
actually must spend on health care for Medicaid recipients.3 To permit states to manage
their Medicaid programs with a fixed amount of federal funding, the entitlement to
coverage would need to be eliminated, and federal rules regarding eligibility, coverage,
and payment would need to be substantially restructured or repealed.
Another way to control spending on Medicaid is to establish limits on per capita
spending—per capita caps. These caps have the advantage of allowing funding to
increase along with enrollment and underlying need, while setting an annual upper limit
on federal spending per enrollee, and are supported by many advocates of Medicaid
finance reform. The effects of per capita caps could have significant consequences for
people’s health care and for insurers. For example, states might reduce already-low
provider payment rates, forcing out many current providers and thus limiting access to
care, a shift that research suggests would be especially detrimental for people who need
specialized treatment and long-term care.
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Issue
MONITOR federal efforts that would make Medicaid a block-grant or a percapita program and identify appropriate measures to ensure minimum impact on
enrollment and services covered.
ISSUE: INDIGENT CARE IN MIAMI DADE COUNTY
(State/Local)
Proposed reductions and elimination of major sources of funding, such as the Low
Income Pool and the Medicaid Disproportionate Share Hospital Program, is placing a
strain on the safety net system. Given the greatly reduced federal funding for the safety
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Retrieved from: https://www.healthinsurance.org/florida-medicaid/
Retrieved from: http://www.commonwealthfund.org/publications/issue-briefs/2016/nov/medicaid-blockgrants
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net and Legislature’s rejection of funding for coverage expansion, the Miami Dade
County Commission passed a resolution that called for a comprehensive report regarding
funding for indigent health care that included issues such as: (1) the amount of funding
the County presently spends on indigent care; (2) the various sources of funds presently
used for indigent health care services; (3) the likelihood that indigent health care funding
sources will continue; (4) whether the County’s indigent health care services can remain
the same or will need to be reduced; (5) whether the County can retain and reallocate
Intergovernmental Transfer funds previously used for Low Income Pool or
Disproportionate Share Hospital Payments; (6) and recommendations to maximize the
County’s funding for indigent care. Related to this is how to best ensure that individuals
who are uninsured but eligible for the Jackson Prime card can enroll and gain access to
primary care. Over the years, a number of system-level barriers have been identified that
would assist with enrollment of eligible patients.
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Issue
SUPPORT an assessment of local funding and charity care program policies and
practices to inform how to best use County funding for indigent care.
SUPPORT system-level improvements at Jackson Health Systems to ensure
increased access to primary care among those that are eligible for the Jackson
Prime card.
PRIORITY AREA: HEALTHY EATING ACTIVE COMMUNITIES
ISSUE: HEALTHY FOOD FINANCING INITIATIVE
(State)
Background: In 2016, legislation passed establishing a Healthy Food Financing Program
in Florida. Legislation directs the Florida Department of Agriculture and Consumer
Services to establish a Healthy Food Financing Initiative Program to provide financial
assistance for the rehabilitation or expansion of grocery retail outlets located in
underserved or low-income communities. It will draw upon and coordinate the use of
federal, state, and private loans or grants, federal tax credits, and other types of financial
assistance. The goal of the program is to improve public health and well-being of lowincome children, families, and older adults by increasing access to fresh produce and other
nutritious foods at participating independent grocery outlets that will be required to allocate
at least 30 percent of their retail space to the sale of perishable foods, which may include
fresh or frozen dairy products, fresh produce, and fresh meats, poultry, and fish.
Annual reporting of the Program’s accomplishments is required to be made to the President
of the Senate and Speaker of the House, and, after seven years, the Office of Program and
Policy Analysis and Government Accountability is directed to review the impact and
successfulness of the program. The bill provides for an appropriation of $500,000 in
nonrecurring general revenue in the 2016- 2017 fiscal year to the Department of
Agriculture and Consumer Services to implement this bill. It specifies that no more than
three recipients may receive funding.
Amendments introduced at the end of session make the program nearly unworkable.
Concerns with approved legislation include:
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Limits to the number of projects that can be funded with state resources at any one
time to three;
Restricts use of dollars for new grocery stores, rather only allow for renovation or
expand;
Limits the areas where dollars can be applied to low income, not moderate income.
Expands the definition of which entities can apply to include convenience stores
and gas stations.
Requires third party administrator to approach any existing retail stores (including
gas stations / convenience stores) first, giving those retailers the right of first
refusal.
Issue
SUPPORT legislative efforts to improve the Healthy Food Financing Program.
ISSUE: HEALTHY COMPREHENSIVE PLANS AND ZONING
(Local)
Background: Comprehensive plans are long-term plans that provide policy direction for
the implementation of regulations (land development regulations, zoning) and programs.
As such, comprehensive plans can go a long way toward creating healthier neighborhoods
– increasing opportunities to buy fresh foods, making it easier to walk and bike throughout
the day, reducing crime and pollution, and more.
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Issue
SUPPORT counties and municipalities in the adoption of health-promoting
policies in their comprehensive plans that support access to healthy foods and
walkable, bikeable communities.
ISSUE: INCREASING PHYSICAL ACTIVITY OPPORTUNITIES
(Local)
Background: Community and street design is important in the ability to encourage and
support engagement in physical activity in communities. The Centers for Disease Control
and Prevention refers to places where everyone can enjoy daily, moderate levels of
walking, bicycling and other exercise as Active Community Environments. A walking- and
bicycle-friendly community is also a more livable community where people of all ages and
abilities can travel safely and freely. Complete Streets is a transportation policy and design
approach that requires streets to be planned, designed, operated, and maintained to enable
safe, convenient and comfortable travel and access for users of all ages and abilities
regardless of their mode of transportation. Pedestrian friendly zones is a similar street
design concept where streets are designed with pedestrians as the main focus.
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Issue
SUPPORT counties and municipalities in the adoption of complete streets
policies.
SUPPORT efforts to establish pedestrian friendly zones.
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PRIORITY AREA: COMMUNITY BUILDING AND ECONOMIC PROSPERITY
INITIATIVE
ISSUE: ENGAGEMENT OF ANCHOR INSTITUTIONS TO ADDRESS SOCIAL
DETERMINANTS OF HEALTH
(Local)
Background: Social determinants of health are conditions (social, economic, and
physical) in the environments in which people are born, live, learn, work, play, worship,
and age that affect a wide range of health, functioning, and quality-of-life outcomes and
risks. Anchor institutions, such as universities and hospitals that are rooted in their local
communities by mission invested capital, or relationships to customers, employees, and
vendors have the potential to improve the overall economic well-being and health of
residents in their communities. U.S. hospitals and universities combined spend over $1
trillion a year, have endowments in excess of $500 billion, and employ 8 percent of our
labor force. Such funds, if more clearly focused on local community wealth building,
could have a considerable economic and health impact.
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Issue
SUPPORT hospitals and universities in adopting and enhancing their anchor
institution mission and related strategies (e.g. procurement, hiring, community
investments, community benefit).
ISSUE: AFFORDABLE HOUSING
(Local)
Background: Housing is an important social determinant of physical and mental health
and well-being. According to national data, the Miami metro area is the third least
affordable area to live in the entire country. For example, in Miami Dade County, 60% of
households are “cost-burdened,” meaning they spend more than 30 percent of income on
rent; 62 cents on every dollar in the average household is being spent on housing and
transport alone; and 82% of Miami-Dade households can’t afford to own a home.
Assisted multifamily properties have finite periods of affordability under the terms of
their subsidies and use restrictions. Miami-Dade alone stands to lose around 6,000
affordable housing units in the next decade. Both prior to and upon expiration of these
subsidies and use restrictions, properties can be at risk of loss to the affordable housing
stock. A property is either lost as a result of conversion to market-rate housing or as a
result of deterioration and default. As a result, in Miami Dade County, there has been a
number of policy solutions proposed to preserve affordability, increase resources for
affordable housing, and community benefit agreements among others.
Community benefit agreements: These are agreements between developers and
community representatives from the area that will be impacted, where a developer offers
to provide certain incentives (affordable housing, green space, etc.) in exchange for the
community’s support.
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Mandatory inclusionary zoning: A policy tool used that incentivizes developers who set
aside who set aside a certain percent of the units for affordable housing in certain
developments.
Community land trusts: Land trusts are nonprofit, community-based organizations
designed to ensure community stewardship of land. Community land trusts can be used
for many types of development (including commercial and retail), but are primarily used
to ensure long-term housing affordability. To do so, the trust acquires land and maintains
ownership of it permanently.
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Issue
SUPPORT legislation to make community benefit agreements mandatory
whenever County-funding is involved in certain real estate development deals.
SUPPORT the adoption of mandatory inclusionary zoning.
SUPPORT a pilot program for a community land trust in Miami-Dade County.
SUPPORT efforts to ensure preservation of affordable housing.
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