1. FAC Legislative Review Webinar Series Thank you for joining us! Please mute your phones. If you have any questions during the presentation please feel free to use the chat function.

2. Agenda Health and Human Services –Heather Wildermuth Public Safety –Sarrah Carroll

3. Health and Human Services and Public Safety Legislative Review Wednesday, May 5, 2010 10:00 AM – 11:30 AM

4. Health and Human Services Agenda County Health Departments Homelessness Medicaid Reform Additional Priorities Additional Budget Issues

5. County Health Departments HB 979 by Rep. Dwayne Taylor and SB 1572 by Senator Nan Rich (Died) –Reinstating rate exemption for County Health Departments HB 5311 – Department of Health (Passed) –Budget conforming bill –Acted as a compromise to the House’s plan to completely reorganize the Department as covered in HB 7183 Prohibits DOH from creating new programs or applying for grants with expressed permission Directs OPPAGA to do a comprehensive study of the Department Establishes the Physician Workforce Advisory Council along with a Physician Workforce Graduate Medical Education Innovation Pilot Projects program

6. County Health Departments (Cont) County Health Department Budget Issues: –Cost based reimbursement reduction: $40.3 million reduction –General revenue reduction: $10.5 million reduction in GR, down from the original $46.8 million House position. –County health department positions: There is a $4.4 million in budget authority allotted to the Department of Health for additional “Critical Class” positions within County Health Departments. Critical class refers to physicians, nurses and dentists.

7. County Health Departments Impact Statement Health departments depend on clinic services reimbursement (also know as Cost Based) to support both the primary care services they provide in many counties and to help support public health services in all counties. The $40.3 reduction in clinic services represents a 34% cut in current CHD Medicaid earnings and will have a major negative impact on CHD infrastructure and client services. Depending on the county, the loss of revenue may force health departments to discontinue or scale back needed services such as prenatal care, obstetrical care, dental services, and primary care for children and adults. Many of these programs already operate on tight financial margins and a major loss of Medicaid revenue would make it difficult to continue at current levels. Because of the economies of scale achieved in seeing Medicaid patients, CHDs see large numbers of the uninsured. Their access to care would also be affected. Some CHDs can expect reductions in Medicaid in the range of $2-3 million. On top of this reduction, the $10 million reduction in General Revenue will further impact the public health infrastructure and can force cutbacks in some public health programs. Depending on the county, this may include reductions in children’s immunization capacity, school health, and disease control programs including TB, HIV/AIDS, STDs, and other reportable diseases.

8. Homelessness HB 923 by Rep. Betty Reed and SB 2654 by Senator Victor Crist (Died) –Authorize the collection of voluntary $1 contributions to be added to motor vehicle registrations and drivers licenses –Limit the amount a lead agency can spend on administrative costs under a Challenge Grant HB 11 by Rep. Ari Porth and SB 506 by Sen Jeremy Ring (Passed) –Relating to Crimes Against Homeless Persons –Adds extra penalties for those who target and attack the homeless, now a protected class under hate-crime laws.

9. Homelessness (Cont) Homelessness budget issues: –$2 million for Challenge Grant –$3.25 Homeless Housing Assistance –Bump issue: Restored $4.1 million for the homeless program

10. Medicaid Reform SB 1484 by Senate Health & Human Service Appropriations –Originally called for the expansion of the Medicaid reform pilot to an additional 19 counties –Directs the AHCA to extend the existing Medicaid 1115 waiver –Preserves the Low Income Pool program. –Directs AHCA to develop methodologies to maintain the use of intergovernmental transfers (IGTs) in a Medicaid managed care environment. The Secretary is to convene a workgroup of stakeholders (hospitals, counties, medical schools, managed care plans, and Medicaid provider-service-networks) and provide a report by January 1, 2011, on the developed methodologies. –Creates the Medicaid and Public Assistance Fraud Strike Force to develop a statewide strategy to prevent, investigate and prosecute Medicaid and public assistance fraud. –Requires the Auditor General and OPPAGA to review and evaluate AHCA’s Medicaid fraud and abuse systems

11. Additional Issues Physician Workforce (HB 935 and SB 1256) –Amended on to the Department of Health budget conforming bill (HB 5311), previously below. Children's Services Councils (SB 1216 / HB 1227) –The substance was amended on to SB 2014 relating to Early Learning Coalitions which passed both the House and the Senate. Senior Services Special Taxing Districts (HB 153 and SB 146 ) –Died

12. Additional Budget Issues Eliminate Substance Abuse and Mental Health Corporation: The House and Senate agreed to eliminate the SAMH Corp. Reinvestment grant still in play. Reduce Healthy Families: Healthy Families an overall reduction of $10 million. The program was up for elimination. Restore Direct Services Funding for Mental Health and Substance Abuse (County Programs): The full funding was restored for programs: $14.4 million provided to 30 counties across the state. **Broader budget overview during Thursday’s State Budget Webinar

13. Questions? Contact: Heather Wildermuth (850) 922-4300 hwildermuth@fl-counties.com