Florida health care officials announced last week a plan to submit a sweeping Medicaid waiver request that would allow the state to spend $3 billion to bolster its medical workforce over five years.
The Agency for Health Care Administration (AHCA) posted details of its proposed Medicaid 1115 Demonstration Project waiver on Wednesday and gave the public until Jan. 24 to weigh in on the details. The Centers for Medicaid and Medicare Services’ approval of the waiver would authorize Florida to implement four workforce development programs the Legislature passed earlier this year through the Live Healthy Act.
Republican Sen. Kathleen Passidomo of Naples spearheaded the act during her last year as Senate president with the idea that it would help increase the number of doctors, dentists, and nurses as the state’s population grows and gets older.
What are the four programs?
While hospitals have traditionally received funding to train doctors, Passidomo’s Live Healthy expands the compensation to places other than hospitals to train people studying other areas of medicine, such as nursing.
Under the Training, Education, and Clinicals in Health (TEACH) Funding Program, clinics in underserved areas would receive up to $100,000 a year for residency programs and up to another $75,000 to offset the costs of training medical, nursing, and dentistry students and others studying to become licensed practitioners.
Between 633 and 844 qualified health facilities could get funding for training health care providers, according to the proposed waiver application.
The state Nursing Indirect Medical Education (IME) Program pays public teaching hospitals with higher percentages of Medicaid patients to recruit, train, and retain nursing staff. AHCA estimates that around 13 hospitals would benefit. How much money each hospital gets would depend on the ratio of full-time nurses to beds and the facility’s Medicaid caseload.
Live Healthy also expanded the state’s student loan program for physicians, nurses, and physician assistants, known as Florida Reimbursement Assistance for Medical Education (FRAME). Mental health providers, including social workers, would qualify for the loan program under Live Healthy.
AHCA wants to spend $519 million over five years to encourage providers eligible for FRAME to work in parts of Florida and with populations that the federal government deems underserved.
Lawmakers funded a separate loan program for dentists and dental hygienists serving Medicaid recipients in areas with provider shortages. The Dental Student Loan Repayment Program would add nearly $113 million over the demonstration period.
The amounts of reimbursements would vary depending on the profession, but the programs would pay off up to $150,000 of physicians’ student loans over four years and up to 20% of dentists’ and dental hygienists’ loans.
Largest health care package in recent years
Mary Mayhew, president of the Florida Hospital Association, said the Live Healthy programs are important to address workforce shortages before they become a crisis. The federal Health Resources and Services Administration has projected that Florida would be among 37 states in which the supply of primary care doctors wouldn’t meet the demand.
“We want to recognize how critically important Medicaid is in helping to fund these initiatives because of the dependency,” Mayhew said in a phone interview with Florida Phoenix. “Of course, we have 4.2 million Floridians that depend on Medicaid and depend on having a robust health care workforce to provide timely access to health care services.”
The Florida Policy Institute was among groups that criticized the Republican-led Florida Legislature last year over its refusal to expand Medicaid. “Live Healthy is the largest health care package passed in Florida’s recent history,” Erica Li, an institute analyst, told the Florida Phoenix.
“It is workforce-focused and, unfortunately, it does miss the opportunity to provide more direct access to care for those who need it. Because of this, it will be important to ensure that all of these programs and their implementation are tracked and monitored for areas of potential improvement, so it’s good to see that the 1115 waiver has been submitted for public comment,” Li wrote via email.
AHCA also announced plans to hold an inaugural meeting of a blue-ribbon graduate medical education council on Thursday, also under Live Healthy. The council has to produce an annual report about the cost of training residents and whether they’re staying to practice in the state after finishing their education.
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