Florida legislators are considering a bill that would streamline services for medically complex kids provided by a state program. But critics are concerned the effort would harm families seeking care for their children with chronic conditions.
House Bill 1085 and its companion Senate Bill 1490 seek to streamline the administrative operations of the Children's Medical Services program, which is a state and federally subsidized health insurance for low-income families who have children with physical, mental, or emotional disabilities.
According to the Florida Department of Health, which oversees CMS, there were about 123,000 children enrolled in the insurance in 2024.
Among several changes, the bills would transfer operations of CMS from the Florida Department of Health to the Agency for Health Care Administration, or AHCA.
The way it works now is that AHCA receives funding for CMS through Title XXI of the Social Security Act. FDOH is in charge of CMS administrative services, such as determining the income and medical eligibility of children. When services for a family are approved by FDOH, the department sends an invoice to AHCA.
What the proposed bills are set to do is cut out the middleman, said the sponsor of the House bill, Rep. Vanessa Oliver.
“That back and forth is kind of pointless and just administrative for no reason. Just cut that out and make the government operate more efficiently so the program can be administered in a more efficient way,” said Oliver, a Republican representing Florida House District 76. “If there are issues that come up, there is one department that is solely responsible for the administration of those plans. You don't have to wonder ‘who do I complain to?’”
Secondly, the bill would also expand home health services, also known as the Medicaid model waiver, so that it can serve all Medicaid-eligible children who receive skilled nursing services.
Should the bill pass, it would reduce the workforce of administrative duties from about 50 people at FDOH to four people at AHCA, Oliver said.
In 2014, the Florida legislature passed the Statewide Medicaid Managed Care Act. The act required AHCA to manage contracts with Medicaid health plans, and rather than the state paying individual doctors for Medicaid services, it would pay the plans to act as health insurers. At the time, FDOH was already doing this for children with CMS.
Oliver believes the move to AHCA would not only give one location for families to speak with regarding issues in care, but also give AHCA more bargaining power against managed care companies (private insurers) in contract with the state.
“AHCA can say, ‘Okay, well if you're not meeting the requirements under this particular contract, we have other sticks at our disposal that we can use to help encourage compliance,’” Oliver said.
There was talk of transferring the administrative duties from FDOH to AHCA in 2014, but it was ultimately rejected and instead left in the hands of FDOH to avoid any kind of disruption families might feel in the transfer, Oliver said.
“These children are so fragile, and any disruption to their care would be more detrimental than it would be to the rest of the population,” Oliver said.
But now Oliver believes that a transfer could occur more easily.
Not everyone is so sure.
“It's a false equivalency to say, well, (CMS) is just another managed care contract, because these are highly specialized services,” said Steve Freedman is the Founding Director of the Institute for Child Health Policy. “Medicaid admittedly has a terrific benefit structure, but managing networks for a presumably healthy population, a relatively healthy population of children, and managing a specialized population is really two different animals.”
Freedman has a long career in child health insurance, including serving as the director of CMS twice. His concern comes from whether or not AHCA has the institutional knowledge and availability to handle the financial duties that come with a specialized population, such as Florida’s most vulnerable.
“Adults could face five or six major diseases, right? And those are the things that are really the concerns of health insurance, but kids can be born with hundreds of different issues, and they're not acquired later in life. Some kids are born with a genetic anomaly, like some kids are born without fully formed diaphragms,” Freedman said. “A design for kids has to accommodate a lot more variability than a design for adults.”
Freedman said it would be like if a fast-food restaurant received the recipes for a fine dining experience.
“The needs of these kids are, the more complex menu, the ingredients for them are more complex, and we have to make them look like chicken nuggets,” he said.
Additionally, he’s concerned with splitting up the duties of determining eligibility. The bill would make it so AHCA would determine financial responsibility, but FDOH would still determine medical eligibility.
“If you think about what happens as a parent, so you get a determination like, my kid is eligible medically, but not financially. That's nuts,” he said.
Oliver isn’t convinced of the issue. She believes the specialties of both government entities will improve the insurance experience.
“Let the Agency for Healthcare Administration focus on its core goals now of administering the contracts while the Department of Health is able to focus more on that clinical aspect,” she said.
Central Florida Public Media reached out to Sen. Gayle Harrell, the sponsor of SB 1490, but her office did not respond. That bill had its first reading on Tuesday.
HB 1085 is in a Health Care budget subcommittee, and Oliver is working to get the bill back on the schedule for its second reading in the House.
