E-Newsletter – State News Florida Council January 20, 2014

E-Newsletter – State News
Florida Council
January 20, 2014
estimated a 15 to 20 percent growth in the
homeless population coinciding with increases in
domestic violence and post-traumatic stress disorder
among military combat veterans. “Incrementalism
doesn't work,” he said. “I'm about disrupting the
entire way you do it and starting it from scratch.”
Throughout a roughly two-hour discussion, Marbut
cited statistics to argue drastic change does work.
He said similar programs in other places have
reduced homeless populations by at least 80
percent, and reduced jail populations by 25 percent.
Jail stays cost $100 a night, he said, while Pinellas
Safe Harbor costs $13 a night. In San Antonio, he
said, the program pulled 1,000 people off the
streets permanently in the first two years, cut jail
stays by 700 people per night and reduced
homeless emergency-room visits to four a day,
down from 24. The program is more effective than
jail, he said, because it is so intensive. It provides
mental health and substance abuse treatment, job
training and placement, family reunification and help
with basic but forgotten life skills. For the first 10
days, new residents just get lots of sleep and
hydration, two things that are taken for granted but
hard to come by living on the street. “If you feed
people in parks, or on a street, or drive your car up
and give 14 meals out the back of your car, all
you're doing is growing homelessness,” he said. “If
you want to dramatically change how the Daytona
Beach area deals with the homeless, align your
feeding with all the holistic services. And the only
place people should ever be fed is when you're in a
24/7 program that's holistic that deals with all the
issues.” (Daytona Beach News-Journal, 1/10/14)
Volusia Officials Get 'Tough Love'
On Dealing With Homeless
As Robert Marbut drove through Daytona Beach on
Friday, he saw and heard what he has grown
accustomed to seeing and hearing: Homeless
people gathered at the public library, in the park,
around a bus stop or in line for food. And then
community leaders explaining how this scenery has
persisted despite everyone's effort to fix it. “All the
things I've heard today, I've heard everywhere I go.
I literally have not heard anything new here,”
Marbut said to a room full of government officials,
homeless advocates and others concerned about
Volusia County's visible homeless problem. “If I
leave the room and I have not offended you ... I
have not done my job,” he added. “If you want to
keep getting the same result you have, keep doing
the same thing you're doing.” Marbut, a former San
Antonio city councilman, college professor and
homelessness consultant, once labeled “Dr. Tough
Love,” visited Daytona to lead a discussion on
Volusia Safe Harbor, a proposed 24/7 homeless
facility that mirrors several other “transition”
programs launched across the country. Momentum
for the program has been building in Volusia, which
recently sent a team of county officials to tour
another Marbut consulting project, Pinellas Safe
Harbor in Clearwater.
Daytona Beach city
commissioners sat in the front row to hear Marbut
on Friday. Two Volusia County Council members
attended, along with various elected officials from
other cities. The room was full. Marbut's model
depends on turning a fragmented homeless-service
system into a centralized one that pulls people off
the street for good. It's not designed for entire
homeless families, but individuals who routinely get
arrested for minor offenses and clog the local justice
system. Circuit Judge Belle Schumann, who started
the campaign for a Safe Harbor system here,
reported that 50 people in Volusia County account
for more than 6,100 arrests costing more than $12
million. Volusia Safe Harbor's costs, and who will
pay for them, are still unknown.
estimated the facility would cost $1.5 million to build
out near the Volusia County Branch Jail. Volusia
County Councilwoman Joyce Cusack, county
community assistance director Dona DeMarsh Butler
and Daytona Beach Housing Authority Executive
Director Anthony Woods all had budget questions.
The answers aren't all clear yet. But Marbut said
ideally the cost would be split in 25 percent shares
among the county, the cities, the business and
tourism community and faith-based or nonprofit
Hospital districts also could
contribute out of the money saved when homeless
people make fewer emergency-room visits. He said
without a new program, Volusia's homeless
population won't just stagnate but worsen. Marbut
New Behavioral Health Facility Accredited
By The Joint Commission
Alzheimer’s Community Care is now accredited in
behavioral health care by the Joint Commission after
going through a rigorous five-day evaluation process
that began Nov. 18.
With the first phase of
accreditation completed, Alzheimer’s Community
Care is moving on to disease-specific certification in
the care of families living with neurocognitive
disorders. Once accreditation has been achieved,
the organization is eligible to apply for diseasespecific certification. During this phase, Alzheimer’s
Community Care will work with its Community Care
Services Standing Committee to develop a
specialized work group of professionals with
expertise in defining outcomes and in the collection,
analysis and interpretation of the data necessary to
show the impacts of those outcomes on patients,
families and the community.
Community Care operates care centers in Palm
Beach, Martin and St. Lucie counties. (TC Palm,
E-Newsletter – State News
Florida Council
January 20, 2014
Editorial: Winning The War
Guest: How To Achieve Better Mental
Health Care For Lower Costs In Obamacare
Fifty years after President Lyndon B. Johnson
declared "war on poverty," it's nice to see
government to offering ideas to address the issue.
But so far, it's hard to believe that they're truly
interested in identifying the most effective ways to
reduce suffering and help the poor improve their
Instead, the chief concern of national
Republicans speaking out on the issue seems to be
countering a renewed Democratic focus on poverty
and income inequality. U.S. Sen. Marco Rubio of
Florida was particularly disingenuous in a speech
last week. He criticized Democrats for "stale
proposals" like raising the minimum wage, but
himself recycled the conservative notion that poor
Americans would thrive if only Washington gave
more authority to the states. That's a laughable
notion in his home state, where the Republicancontrolled Legislature has showed indifference to
the plight of our most vulnerable residents. Recent
examples include state lawmakers failing to expand
Medicaid or an alternative plan to cover more than
750,000 uninsured residents. The state has also left
the jobless mired in an unemployment insurance
system riddled with problems delivering benefits.
States from Florida through the South to Texas,
where the loudest cries are heard about taking
power from Washington, also have some of the
most dismal records on poverty.
The federal
government hasn't won the war on poverty, but
programs such as Social Security and food stamps
have improved the lives of countless Americans.
While the poverty rate has increased slightly since
the Johnson administration, a study last month by
Columbia University researchers found a 40 percent
reduction in poverty since that time when factoring
in social programs and more accurately accounting
for expenses. There's no doubt that fraud occurs in
government programs, but those instances and the
impact of welfare on the deficit are too often
exaggerated in a push to shrink government. Five
decades after Johnson's speech led to new social
programs, it's appropriate and necessary to reevaluate their effectiveness and make changes.
New ideas are worth exploring, such as Rubio's
proposal to replace the earned income tax credit
with a federal wage enhancement. It would be
easier to have a serious debate of those issues if
conservatives would acknowledge that government
has actually improved the lives of the poor, even if
doesn't offer all the solutions.
On the 50th
anniversary of Johnson's speech, there's more to
celebrate about efforts to end poverty than deride.
(Gainesville Sun, 1/12/14)
With the implementation of the Affordable Care Act
in 2014, states have an unprecedented opportunity
to improve the health of millions of Americans by
integrating physical care with mental health care.
The challenge is creating systems of care in which
doctors and specialists collaborate effectively to
realize this goal. How do we achieve, as the
Institute for Health Care Improvement recommends,
the triple aim of more satisfied patients, better
health outcomes and lower costs? The state of
Washington is a leader in this regard and has the
potential to serve as a model for the rest of the
country. From more than 20 years of research,
much of it done in Washington state, we have found
that integrating mental health and medical care
works. The federal passage of the Affordable Care
Act, which took effect on Jan. 1, triggered the final
implementation of the 2008 Mental Health Parity
Act, which requires insurers to cover treatment of,
say, depression just as they would cover a splint for
a broken leg. The expansion of Medicaid eligibility
in Washington state could further extend access to
328,000 new people. Many more may now have
access to mental-health care. If we act now, we
could help millions of people with mental illness get
the care they deserve. Twenty-five percent of
Americans will experience a mental health problem
over a lifetime. The problem often goes untreated,
and may lead to hardships with employment, family
and social relationships, and physical health. Most
people have had a friend or family member
experience these problems, and know of the
suffering and difficulty of obtaining effective
treatment. Currently only one in five adults living
with a mental-health or substance-use problem sees
a mental health specialist. Only half of all mentalhealth problems are accurately diagnosed in primary
care, and only half of those referred will actually see
a specialist. Many of the 39 counties in Washington
state don’t have a single licensed mental-health
professional. This shortage is particularly acute in
rural areas. But even in our cities, too many people
who desperately need help for mental health
problems are not receiving the treatment they need.
They wind up boarded in hospital emergency rooms
awaiting placement for treatment. Evidence shows
that collaborative-care programs work and would
help avert some of these crises. In this approach, a
mental health-care manager and a designated
psychiatric consultant work at a primary-care
doctor’s practice to care for patients with common
problems such as depression and anxiety. These
programs cannot solve all mental-health needs, but
E-Newsletter – State News
Florida Council
January 20, 2014
increasing access before patient problems escalate
is an important step in the right direction. More
than 80 studies have demonstrated the
effectiveness of collaborative care programs.
Millions of individuals have both mental and physical
health problems.
People afflicted with serious
depression, anxiety or other mental health problems
usually take better care of themselves under the
collaborative-care model. They are more likely to
follow medical and mental health treatment advice.
This often results in improved overall health. People
with one or more chronic illnesses, such as diabetes
and heart disease, have twofold higher rates of
common mental illness such as major depression.
Individuals with more severe mental illnesses, such
as bipolar disorder or schizophrenia, die 10 to 25
years earlier than those without mental disorders —
and not from their mental illness. These individuals
often succumb to poorly treated medical conditions.
Programs providing both physical and mental health
care in the same setting can help both of these
populations live longer, more rewarding lives.
Washington state has offered a collaborative care
program for behavioral health problems to lowincome and safety-net populations for the past five
years through the Mental Health Integration
Program. The program was originally supported in
2008 in King and Pierce counties to serve
unemployed patients receiving short-term disability
and expanded to more than 140 community health
clinics statewide in 2010, reaching vulnerable
populations in even the most remote parts of the
state. Tax-levy dollars in King County fund care for
other high-risk populations, including the uninsured,
military veterans and their family members, mothers
of infants and young children and older adults.
Since its inception, the Mental Health Integration
Program has served more than 35,000 patients and
has improved care while reducing costs.
service is also associated with lower rates of police
arrest and homelessness. A pay-for-performance
component was introduced in 2010 to reward clinics
that achieve high quality indicators, such as
reducing the time it takes for a patient with
depression to improve.
This innovation has
Integration has obvious benefits, and Washington
state’s Mental Health Integration Program is a great
example. The program has achieved the triple aim
of better access to care and better health outcomes
at a lower cost. Still, there is no denying that
reaching these goals will require a major change in
Health-care organizations as well as
medical and mental-health providers need to see
the value in integrated services and continue to
learn how to collaborate effectively. Regulators
need to remove barriers that make it difficult to
provide integrated services. Government agencies
and insurance companies have to create payment
mechanisms and financial incentives for providers.
Washington Gov. Jay Inslee recently released a
vision statement calling for integration that can help
move us in this direction. Our state sent an
ambitious State Innovation Plan to the federal
government. This plan further challenges us to
move toward this goal. Much work remains to be
done. It’s imperative that we grasp opportunities to
innovate and implement integrated care programs
that meet our patients where they are. Wayne
Katon and Jürgen Unützer are professors of
psychiatry at the University of Washington School of
Medicine. (The Seattle Times, 1/11/14)
Defendants With Disorders
Imagine you are a police officer who sees a
suspected drug seller, in an area where neither the
neighbors nor law enforcement feel safe. You
attempt to stop the man but he runs away. You
catch him but he defies orders and escapes. You
send out the police dog to seize the suspect -- who
then runs off again... and again, and again,
incurring one dog bite after another. After a lot
more effort the suspect (who has a long history of
drug arrests) is finally captured, treated for the bites
and taken to jail. Fortunately, the officer is OK.
Months later -- after an expensive trip through the
court system -- it is determined that the case cannot
go to trial. Why? Because the defendant suffers
from longstanding mental "retardation or autism."
He doesn't fit criteria for involuntary commitment,
but he's deemed incompetent to stand trial. Experts
aren't sure treatment will ever get him to a level at
which a trial could proceed. The above scenario
mirrors a Sarasota incident involving a man who has
continued to have risky run-ins with the police. But
many communities face similar struggles as they try
to navigate the shoals between law enforcement
and offenders with disabilities. These are cases -whether involving mental illness or developmental
problems -- that don't fit a standard approach to
policing. They are vulnerable to misunderstanding,
which can elevate risk for everyone on the scene. If
an arrest does occur, the courts and social-service
system may lack resources to deal with the
individual. If he lands back on the street with little
after-care, a downward spiral can accelerate. It is
important to sensitize communities to this issue,
ensuring that they have the necessary tools, training
and social services to deal with it safely and
E-Newsletter – State News
Florida Council
January 20, 2014
Complex Challenges
the court system. (A mental-health court diversion
program exists, but it is currently limited to minor
misdemeanor cases). Local officials and boards -such as Sarasota County's Human Services Advisory
Council, Criminal Justice Commission and the city's
Independent Police Advisory Panel -- could bring
more focus and attention to this issue. What's
needed is an initiative by the overall community -federal, state and local -- to weave a safety net of
housing, education and support services that will
enable affected individuals to reach for a better life.
(Sarasota Herald Tribune, 1/12/14)
More police departments, including Sarasota's, are
getting specialized training for interactions with the
mentally impaired. Sarasota also is in the process
of hiring a licensed clinical social worker. Both steps
should help police meet this complex challenge.
Disabilities cover a whole spectrum and are not
always readily apparent. Officers on the scene must
quickly and accurately size up each situation,
evaluate the risk, and carry out a response that
balances public safety needs and civil rights. That's
a tough call, especially if a suspect is resisting or
panicking. It is all too easy to see how tension
could escalate. Cognitive problems and severe
mental illness can impair a person's judgment and
communication skills. This can thwart compliance
with law enforcement and sometimes inflame
emergency situations. Some national organizations
consider this such a source of concern that they
have issued recommendations -- including proposals
that agencies get training and have a written policy
on dealing with mentally impaired individuals. (Over
half of Sarasota police have received this training,
recommendations include the use of calming tactics.
Enlisting an individual's family or a crisisintervention specialist can help, too.
New Law Means More
Foster Parents Needed
On the morning of his 18th birthday last year, Deon
Richards had to pack up all his worldly belongings in
plastic garbage bags and move out of his South
Florida foster home. Though the state gave him a
monthly stipend as long as he stayed in high school,
Richards had no idea how to go about paying rent
on his new apartment. He didn't know how to get
the utilities turned on. He didn't have a car, bank
account or identification card. "It kind of sucked,"
said Richards, who now lives in Orlando. "On the
one hand, when you're 18, you're anxious to leave.
But you don't really know what it's like out there."
But under a new state law that took effect Jan. 1,
Richards and hundreds of others like him are now
able to stay in — or return to — the foster-care
system through age 21. The only requirement:
They must be working toward a high-school
diploma, college degree or job-training certificate.
It's good news for those in the foster-care system,
but it also means there is a need for more families
to open their homes. "Turning 18 should be a
milestone to celebrate," said Bill D'Aiuto, who leads
the central region of the Florida Department of
Children and Families. "But for some young adults
in foster care, this birthday can bring strong mixed
emotions. We want [them] to know that they are
still part of a family at 18, rather than feel the entire
weight of making it on their own."
The bill,
sponsored by state Sen. Nancy Detert, R-Venice,
passed after testimony from dozens of foster teens
with stories similar to Richards'. When it took
effect, he immediately opted back into the system
— while state child-welfare workers launched a
campaign to recruit more foster parents. "Right
now there's a need for foster homes for all ages,
said Glen Casel, president and CEO of Community
Based Care of Central Florida, the nonprofit agency
that contracts with the state to manage foster care
and adoptions for Orange, Osceola and Seminole
counties. "A lot of our kids are now going to stay
Potential for Tragedy
Several reports on this subject emphasize how
difficult it can be for police to recognize and adapt
to special-needs individuals. It sometimes leads to
tragedy, such as a Maryland case last year in which
a young man being restrained by theater security
guards died of asphyxiation. Last September, the
U.S. Department of Justice announced that The Arc
will receive funding to develop "a national center on
justice and intellectual and developmental
disabilities." (The Arc advocates for people with
diagnoses that include Down syndrome, autism,
cerebral palsy, fetal alcohol spectrum disorders and
others.) According to The Arc, "The goal of this
project is to create a national clearinghouse for
research, information, evaluation, training and
technical assistance for justice and disability
professionals and other advocates ... " The Arc
noted that people with intellectual disabilities "are
overrepresented in the nation's criminal justice
system -- both as victims and offenders."
Smoothing interactions between police and the
mentally impaired is important. But the larger
concern is how to improve the long-term outcome
after the confrontation is over. That's an issue for
the whole community, not police. If the disabled
individual does not have family or supportive
services, it's a recipe for a vicious circle of recidivism
and decline. Alternatives are needed that don't
send a person bouncing helplessly through jail and
E-Newsletter – State News
Florida Council
January 20, 2014
with us past age 18, so this is going to be a real
challenge." About 200 foster kids throughout the
12-county Central Florida region — from Hardee to
Marion to Brevard — will turn 18 this year. Childwelfare officials don't know how many will choose to
stay in foster care, but the agencies won't get any
additional money to pay for their care. Casel
estimates the expense will run about $2 million a
year for his organization alone. In Orlando, both
Covenant House and the BETA Center, charities that
help teens in crisis, are working to increase their
capacity. But Casel said about 100 new individual
foster homes are needed this year, too. "We've
made a commitment to do everything we can for
the kids — and then we'll figure out how to pay for
it," Casel said. For Richards, that meant bringing
him into the nonprofit Faine House near Orlando
after he came close to sleeping on the streets, a
common danger for former foster kids. According to
the Children's Home Society, a third end up
homeless within the first three years, and a quarter
of the males end up in jail or prison. "I'd never had
money before, and in foster care you don't really
have any nice things, so I just splurged," Richards
"I bought a nice phone and some
furniture — because I didn't have any — and I got
some nice clothes. I was still in high school, but I
started missing classes." The truancy led the state
to cut his stipend, which meant he could no longer
pay his rent. Ultimately, he pawned his newly
acquired possessions, buckled down at school and
got another apartment, though he often went
without food or such basics as toothpaste or laundry
soap. "When I heard about the new law, I jumped,"
said Richards, who is now studying to take his GED
and hopes to attend college to become a physical
therapist. "This is a great opportunity for kids that
are aging out of the system, and this place is great.
They teach you basically like they're your parents."
(Orlando Sentinel, 1/11/14)
Dade and Monroe counties. In December, the
Health Foundation announced awards of as much as
$7.5 million over the next six years for the city of
Miami Gardens and for the Little Havana
neighborhood to identify and support programs that
engage residents in their own healthcare, such as
nutrition and exercise, and that build partnerships
with physicians and clinics that emphasize
preventive care. The program, called the Healthy
Community Partnerships Initiative, will be unlike any
other in the Health Foundation’s 20-year history,
said Loreen Chant, vice chair of the board and
president of Johnson & Wales University’s North
Miami campus. Chant said the program calls for the
Health Foundation to work with Miami Gardens city
officials and representatives of ConnectFamilias, a
nonprofit agency leading the Little Havana effort, to
identify and prioritize each community’s healthcare
“What Little Havana decides will be
important in terms of a priority area may look very
different from what the city of Miami Gardens is
going to identify,’’ she said. Health Foundation will
help residents of those communities identify existing
programs or create new ones that address their
most pressing healthcare needs, Chant said. The
foundation also will provide administrative and
technical support, such as vetting proposals and
groups that apply for grants, and developing metrics
to evaluate success. “So Health Foundation doesn’t
simply give funding out, and leave an organization
to itself to figure out how to be successful with the
grants they receive,’’ she said. Collaboration among
residents and other stakeholders in a community is
a central tenet of the Health Foundation’s work,
whether it’s partnering with area primary-care
physicians to increase access to preventive
medicine, or working with local schools to teach
children and their parents about nutrition, said
Richard Laviña, board chairman and regional
president of HSBC Bank. “The basic role of the
foundation is healthcare-related sustainable social
investment. That’s the way I view it,’’ he said. “It
doesn’t work if everybody isn’t involved.’’ Since its
inception in 1993, the Health Foundation has
awarded more than $104 million in grants to 330
organizations to support community health
programs in South Florida. The foundation was
created 20 years ago as a successor to the Cedars
Foundation, which raised donations for community
health programs through the former Cedars Medical
Center, now University of Miami Hospital. In 1993,
the Cedars Foundation formed a partnership with
private hospital companies Columbia/HCA to
manage and co-own the medical center.
foundation changed its name to the current
iteration, and focused on funding community
nonprofit health programs. In 2001, the Health
Foundation sold its minority interest in Cedars
Healthcare Group, which owned the medical center,
Health Foundation Of South Florida Invests
In Partnerships For Healthy Communities
Traditional healthcare policy long has emphasized
the role of physicians, hospitals and other clinical
providers in ensuring good public health. Now a
South Florida nonprofit is making a multimilliondollar investment in Little Havana and Miami
Gardens that may improve the health of residents
through non-clinical factors, such as personal
behavior and social and economic opportunities.
“Health occurs literally every place you walk and sit
in your day,’’ said Steven Marcus, president of the
Health Foundation of South Florida, a nonprofit that
funds public health initiatives in Broward, Miami-
E-Newsletter – State News
Florida Council
January 20, 2014
and divested itself of ownership in healthcare
facilities. Since then, the group’s leadership has
focused the Health Foundation’s efforts on specific
areas, including primary care, behavioral health,
preventive health and programs that promote good
nutrition and regular physical activity — funding
priorities that receive about 80 percent of grants.
The Health Foundation also funds strategic
initiatives that can take two to seven years,
including programs to promote healthy aging, school
fitness and nursing through scholarships. “You just
can’t address health problems in one population or
one ethnic group,’’ Marcus said. “You have to apply
different methods and different approaches to
different populations.’’ (Miami Herald, 1/11/14)
committee to gauge health care workforce needs
and recommend changes in Florida law.
committee has focused most on Florida regulations
for advanced practice nurses, the most restrictive in
the nation. "Florida is really behind the curve on
addressing the workforce issues; many other states
throughout the nation have made some of the
changes that were suggested here today with
tremendous success for many years," Rep. Jose
Oliva, R-Miami Lakes, said Friday after a committee
meeting. Nurses with post-graduate training want
to prescribe controlled substances, sign death
certificates and practice independently from medical
doctors. The Florida Medical Association, a powerful
advocacy organization for doctors, has fought
against proposals to give these professionals more
duties outside of a physician's supervision.
Telemedicine — the emerging practice of using
technology and the Internet to facilitate virtual
doctor-patient visits — is also a field where other
states have outpaced Florida.
Some Florida
hospitals and doctors, especially in rural areas and
certain specialties, are using telemedicine for
evaluations and checkups. Right now, a state Board
of Medicine rule requires face-to-face meetings in
order for a doctor visit to be reimbursed except in
some instances where drugs are being prescribed.
Proposals in the House and the Senate would
require insurers to pay for services regardless of
whether they are provided in-person or via services
like Skype. Lawmakers will also discuss whether
telemedicine should be reimbursed at the same rate
as face-to-face visits. And, of course, there are the
perennial requests for more health care spending.
The state increased funding for medical residency
slots to $80 million last year, but hospitals say more
is needed. The Florida Medical Association is also
lobbying for a loan forgiveness program to
encourage new doctors to go into primary care
instead of more lucrative specialties. "We come out
of school with an incredible amount of debt, and it
would be easy to be a radiologist and get that debt
paid off faster but we really want to be family
doctors," said Dr. Bob Raspa, the Jacksonville-based
board chairman of the Florida Academy of Family
Physicians. Even with all of these new topics, many
old ones will still need attention, such as Medicaid
funding for hospitals and ongoing implementation of
the Affordable Care Act. For example, the federal
government provided 100 percent of the funding for
states to boost reimbursement rates for Medicaid
doctors through the end of 2014. If states want to
keep those higher rates in 2015 and beyond, they
will have to shoulder at least some of the cost. The
Florida Medical Association estimates Florida's share
to be $150 million a year, money that would have to
be reflected in the 2014-15 budget crafted during
the 2014 session. The president of the South
Florida Hospital and Healthcare Association believes
As Focus Shifts To New Health Care
Issues, Florida Democrats Say Medicaid
Expansion Still A Priority
Florida's 2013 legislative session practically started
and ended with Medicaid expansion at the center of
debate, with House Republicans blocking a plan to
use federal dollars to reduce the number of
uninsured Floridians. This year, House Republicans
pledge to tackle issues that have long lingered on
the back burner, such as providing more
independence for highly trained nurses, increasing
the number of medical students who go into primary
care and regulating virtual doctor visits. But even
as the focus shifts from Medicaid expansion,
Democrats say it remains a top priority. "I don't
think they'll have it in their agenda, but it's on our
agenda," said House Minority Leader Perry
Thurston, D-Fort Lauderdale. "So we will be talking
about it. And if they want to pretend it's a big
elephant in the room that's not really there, then it's
up to them." Sen. Joe Negron, a Stuart Republican,
He crafted the plan that House
Republicans rejected to use $51 billion in federal
funding to purchase private insurance for poor
Floridians. The House and the Senate had the same
goals but after "spirited, full and fair debate" were
unable to reach an agreement, Negron said. "I
don't know how productive it would be to simply
film the same movie over again," he said. " … I
think the fact there are so many other health care
issues is an indication that the Legislature has
moved on to other issues where we can make
progress." Proponents of Medicaid expansion are
working behind the scenes to come up with an
alternative that House Republicans will allow, but it's
a steep, uphill battle. Meanwhile, all sides agree
these other topics deserve attention.
Speaker Will Weatherford created a special
E-Newsletter – State News
Florida Council
January 20, 2014
that all of those topics are worthy of discussion, but
not at the expense of Medicaid expansion. "We
haven't given up on it," said Linda Quick. Health
care groups have started engaging the business
community to make the economic case for reducing
the number of uninsured Floridians. Florida is not
only rejecting billions of federal dollars, they argue,
but is also allowing businesses with low-wage, fulltime workers to shoulder the health insurance costs
while stifling the creation of tens of thousands of
jobs the federal funding would have created.
Nothing is more important than providing health
care for the 764,000 Floridians who make too much
to qualify for Medicaid under current standards but
not enough to qualify for subsidies to buy insurance
on the federal health exchange, Quick said. The
nurse practitioner and telemedicine conversations
are worth having, she said, but amount to small
peanuts in the grand scheme of things. "I don't see
them as controversial or hotly contested," she said,
"so I would like to think that (legislators) could
come to some consensus on those issues relatively
early in session and then do the work that will be
required to craft an expansion option that everyone
could agree to." (Tampa Bay Times, 1/12/14)
Southeastern University and Hands on Broward are
joining forces to assist in the Homeless PIT Count
Survey, which will take place on Tuesday, Jan.21,
through Thursday, Jan. 23. All volunteers will
require a short training session, and you can decide
which day you'd like to attend (from January 13 –
17). The more people experiencing homeless that
are surveyed during the PIT count, the more
funding Broward County receives to help these
individuals get back on their feet and provide for
themselves. The data collected from each survey
information they need to determine who needs
services and what type of services. The results and
turnaround from the survey are immediate: housing
placement — the first step in creating selfsufficiency and independence — will begin before
Jan. 30. The PIT survey coincides with BSO's
commitment to the Homeless Management
Information System (HMIS). We have dedicated
$350,000 of Law Enforcement Trust Funds to HMIS,
as well as time, resources and training to educate
our deputies. HMIS is an integral part of how law
enforcement and non-profits now communicate and
share information to better assist those who are
experiencing homelessness.
When a deputy
homelessness, HMIS is a crucial tool in directing that
person to the proper care.
We've found that
arresting the homeless doesn't address the issues of
homelessness; if anything, it adds to the problems
that the individuals are facing. The PIT survey and
HMIS are critical steps in reaching the goal of
ending all homelessness by 2020, but we cannot
reach this goal without the involvement and
dedication of volunteers. By volunteering for the
PIT survey, you are helping our community get one
step closer to ending the cycle of homelessness.
BSO deputies and civilian employees will be
volunteering during the PIT count not only to
survey, but also to offer food, water, clothing and
other necessities. The deputies assisting are CIT
(Crisis Intervention Team) trained, which means
they learn how to gain a trusting relationship with
the homeless, especially those with mental illnesses.
When we all work together, we can truly make a
difference and help these individuals to rebuild and
reclaim their lives.
As Sheriff, I believe that
homeless people aren't problem people; they are
people with problems, problems that can be
corrected with help, understanding and guidance
from our community. By volunteering, you can be
part of the solution. A person in need today can
become the person you turn to tomorrow. Scott
Israel is sheriff of Broward County. (South Florida
Sun-Sentinel, 1/13/14)
Scott Israel: Homeless Count Survey Will
Help Quality Of Life For Many
Homelessness is a nationwide crisis that affects
Broward County. Through my experiences in law
enforcement, I have found that many people are
just one paycheck away from being homeless.
Anybody can become homeless, but it is not a
permanent condition. When we see someone on
the street asking for money, our initial reaction is to
offer help, but giving a person spare change doesn't
result in aiding that person off of the streets. Every
year, the county participates in the Homeless PointIn-Time (PIT) Count Survey, which is the first step
in improving the quality of life for these individuals.
Through the efforts of the PIT survey, people
experiencing homelessness have a better chance of
receiving meals, housing, job opportunities and
treatment for substance abuse and/or mental
illness. This year, the PIT survey is conducted over
three days to maximize the potential of reaching
everyone. However, volunteers are still needed to
administer the survey in all communities. If you've
often thought about volunteering but didn't know
where to start, I encourage you to get involved in
this important event.
This year, the Broward
County Homeless Initiative Partnership, the Broward
Regional Health Planning Council, Inc., the Broward
Sheriff’s Office, the TaskForce Fore Ending
E-Newsletter – State News
Florida Council
January 20, 2014
race with plenty of promise, winning endorsements
from a group of House GOP women eager to expand
their ranks. But some Republicans believe her
campaign has fizzled, with the candidate scoring low
in recent polls. Mark Bircher, a little-known Iraq War
veteran, has struggled to raise money. And then
there’s Sink, one of Florida’s most prominent
Democratic figures, gliding to her party’s
While the Republicans spent the
holiday season flailing at each other, Sink — who
had the primary field to herself — has so far been
unscathed. “You have a superior candidate with
Alex Sink, and she is raising a lot of money, she is
getting a lot of support. And you have two subpar
candidates in Peters and Jolly,” said Mike Fasano, a
popular former Republican state senator from
nearby Pasco County. “The candidates that should
have run did not run, so we’re stuck with Peters and
Jolly.” Tom Slade, a lobbyist and former Florida
Republican Party chairman, said: “Alex Sink is going
to be hard to beat. She is so well-known. … It’s not
going to be an easy race for Republicans to win. I
hope I’m wrong.” One of the biggest concerns for
the eventual GOP nominee is money.
Republicans have been emptying their bank
accounts in the primary, Sink has been stocking her
reserves with more than $1 million in donations.
And Sink will be able to count on a flood of outside
cash, with groups like the Democratic Congressional
Campaign Committee, EMILY’s List and House
Majority PAC primed to spend big bucks to prop her
up. She’s also received an endorsement from the
National Realtors Association, a group that often
doles out large sums in congressional races. GOP
groups sound a lot less enthused about getting
involved. One strategist for a prominent Republican
group said he was “disinclined” to plow cash into
the race.
Another operative with a GOP
organization said, “Jolly is the clear underdog in this
race for obvious reasons.” But at a time when the
national environment favors Republicans, many
Democrats aren’t convinced Sink is a sure thing. In
mid-December, a national Democratic group
commissioned a poll that projected the pool of
special election voters would be mostly white,
Republican and older — a potentially ominous sign
for the party. And many Democrats simply don’t
buy the idea that Republican groups won’t spend on
their nominee’s behalf in a race as high profile as
this one. When that happens, they say, the race is
bound to tighten.
“National Republicans and
outside groups aren’t hesitating to take a page from
Rick Scott’s false playbook against Alex Sink and are
poised to spend millions of dollars spreading lies
against her,” said Emily Bittner, a DCCC
spokeswoman. Sink did not respond to a request
for comment. Republicans are swimming against
the district’s demographic trends, which have
shifted from solid red to purple in recent years as
Alex Sink Rises To Top In
Florida Special Election
Republicans have slugged it out while Sink runs
unopposed in her primary.
It’s been framed as the clearest barometer of the
public’s mood heading into this year’s midterms: a
special election battle for a 50-50 congressional
district in the famously 50-50 state of Florida. But
upon closer inspection, the race for Florida’s 13th
Congressional District, occupied by Republican Bill
Young for more than four decades until his death in
October, is not quite the bellwether it’s being
portrayed as. More than a dozen operatives and
officials from both parties interviewed by POLITICO
were almost unanimous that Democrat Alex Sink,
her party’s 2010 nominee for Florida governor, has
emerged as the unambiguous favorite in the race.
The primary, in which Sink has run unopposed as a
group of Republicans have slugged it out, is on
Tuesday. The general election is on March 11.
Democrats need to gain 17 seats to win the House
majority in November. An early win in Florida would
give the party ammunition to argue they‘re in for a
better year than political handicappers expect. A
loss, on the other hand, would be widely seen as a
serious blow: On Thursday, political analyst Stu
Rothenberg penned a piece in Roll Call titled, “The
Race Democrats Can’t Afford to Lose.” Republicans
admit they are increasingly alarmed about the
prospect of losing the St. Petersburg-area district.
Democrats, after enduring a heartbreaking loss in a
2013 South Carolina special election they thought
was theirs, are carefully managing expectations but
can smell victory. Among Republicans there is
unhappiness with the candidates in Tuesday’s GOP
primary and disappointment that many of the
party’s best and brightest who long had been
thought of as successors to Young didn’t run. David
Jolly, who’s seen as the favorite to get the GOP nod,
is a Washington lobbyist — a profession that leaves
him vulnerable to being portrayed as a hired gun
and insider. State Rep. Kathleen Peters began the
E-Newsletter – State News
Florida Council
January 20, 2014
more young voters arrived. Barack Obama narrowly
won the district in the past two presidential
elections. Jolly, in a telephone interview last week,
acknowledged he would enter the general election
as the underdog. But he expressed confidence that
he would erode Sink’s standing, particularly by
casting her as an avowed supporter of Obamacare.
Polls show that the newly implemented health care
law is unpopular throughout Florida. “Listen, we
knew we were going to be outspent. No question,”
he said. “But we’re going to win this race on the
issues.” “I promise you,” he added, “in the coming
weeks, I will close the gap with Alex Sink.” Not all
Republicans, however, think painting Sink — who
served as Florida’s chief financial officer before
narrowly losing to now-Gov. Rick Scott — as a leftwing lackey of President Barack Obama is going to
work. “She is popular. She is not perceived as a
liberal,” said Fred Piccolo, a Republican consultant in
the state and a former congressional chief of staff.
Republicans are “going to hang Obamacare around
her neck — and rightfully so — but she’s not a
Other concerns are cropping up for
Republicans. This month, the Tampa Bay Times
published an article revealing that Young had kept a
secret second family for more than two decades. In
the 1980s, the paper reported, Young deserted his
wife and three children to wed his 26-year-old
secretary, Beverly. Young had been a revered
figure in Florida politics, known for securing federal
funds for the state’s defense industry, but some
Republicans worry that the piece could take some
luster off his name as the special election
approaches. Republicans will also have to find a
way to deal with Lucas Overby, a Libertarian
candidate whose presence on the general election
ballot could siphon GOP votes. If there’s one major
question surrounding Sink’s candidacy, it’s her skills
as a candidate and whether she’s prone to
campaign trail mistakes. In a 2010 debate with
Scott, she came under fire after she was caught
checking notes on a cellphone — a violation of
debate rules. “I’m not sure she wins at the end of
the day,” said Mac Stipanovich, a Republican
lobbyist in the state and former top adviser to
onetime Gov. Jeb Bush. “She’s anti-charisma. She’s
not a very good campaigner.” (Politico, 1/12/14)
average 41 minutes before receiving care in an
emergency room, according to the Centers for
Medicaid and Medicare Services.
UF Health
Jacksonville, formerly Shands Jacksonville, has the
fifth-longest wait time in the state at 78 minutes.
The federal government calculates wait times from
when patients enter the hospital until they are seen
by a qualified medical practitioner. Russ Armistead
is the chief executive officer at UF Health,
Jacksonville’s level-one trauma center. Armistead
attributes the over-an-hour wait time to a
disproportionate number of charity and Medicaid
patients. Also, parts of the emergency department
are out of date with today’s standards, he said. A
floor is undergoing renovations at a cost of about $5
million, and another floor needs similar renovations.
He said he’s unsure of where the next $5 million will
come from as the hospital stands on a shaky
financial foundation as many patients at UF Health
Jacksonville don’t pay anything and Medicaid pays
little. “We are just at razor’s edge with very little
financial backup,” he said. The city offsets some of
the cost of indigent care with about $26 million in
funding. However, the hospital spent about $60
million in free services last year alone, Armistead
said. “We [Jacksonville’s emergency hospitals] are
one of the places where people come when they
don’t have money,” he said. After a Medicaid or
indigent care patient has been treated for
emergency care, Armistead said it’s almost
impossible for the hospital to send them to a nonemergency care facility. As beds are filled with
patients who no longer need emergency care,
people waiting to see a doctor wait for a bed to
empty. “We have a really difficult time getting them
out of the hospital because nobody else wants to
take them because they don’t have any money, and
if they take them, they are responsible for their
care,” he said.
ProPublica.org, a nonprofit investigative news
organization, pulled data from the Centers for
Medicaid and Medicare Services for hospitals across
the country and compiled it in a searchable, online
database. The information was gathered by the
federal government starting in April 2012 and
ending March 31, 2013.
Lena Groeger, designer and developer of the online
database, said the news organization took on the
project to generate public discussion about
emergency room care.
The organization’s
headquarters is in Manhattan, N.Y. Because of long
wait times at emergency departments there, it was
faster for some New Yorkers to travel to New Jersey
when a medical emergency struck, she said. Type
Jacksonville into the database and it provides a list
of nearby hospitals, current drive times, average
wait times and the percentage of patients that
would “definitely recommend” the hospital. Groeger
Jacksonville ER Patients Wait 41
Minutes On Average; UF Health
Fifth Highest In State
Emergency rooms fill with anxious people waiting to
see a doctor for broken bones, bleeding gashes,
fevers and chills. In Jacksonville, patients wait on
E-Newsletter – State News
Florida Council
January 20, 2014
warned the database shouldn’t necessarily be used
in all cases.
Emergency room wait times are
averages, and when patients show severe
symptoms, they are bumped to the front of the line.
“If you are having a heart attack or other lifethreatening emergencies, you shouldn’t use the
app,” she said. The database can be found at
assistants. He said this contributes to longer wait
times. Baptist Health uses historical data to create
a model that it uses to guide staffing levels at its
hospitals, he said. But like other hospitals in the
area, Roark said Baptist focuses on process
efficiencies. “We try to look at all those process
efficiencies whereby we can shorten that length of
stay thereby we can increase our supply of rooms
available so that we can then meet demand as
demand changes,” he said. Still, Roark pointed out
that wait times are an average and when 30
patients present needing emergency care, all
averages can go out the window. “When patients
arrive in an unpredictable pattern, it certainly can
challenge our resources,” he said. “And it’s what
any emergency department struggles with.”
Fred Jenkins, Memorial Hospital’s medical director of
the emergency room, said administrators have
focused on improving wait times. The severity of a
patient’s condition can be subtle, he said. “By
getting a provider in front of the patient as quickly
as possible, there’s a potential for picking up on
very serious conditions sooner than later,” Jenkins
Memorial has the fastest wait time in
Jacksonville at 20 minutes. “We constantly work to
improve and make that happen,” he said. Eleanor
Lynch, Memorial’s senior vice president of
operations, said a patient’s symptoms, availability of
beds, staffing levels and efficiency of hospital
processes typically drive wait times. Amy Riley,
Memorial’s director of emergency services, said the
hospital drove down its wait times by eliminating
waste and changing the culture. She said the
culture change wasn’t just in the emergency
department but the entire hospital.
improvement is something that can yield meaningful
results,” Jenkins said. “Our times look dramatically
different than they did five years ago.” Michael
Aubin, president at Wolfson Children’s Hospital, said
children’s fast metabolic systems mean mild
symptoms can quickly progress to severe. For
instance, flulike symptoms that start with a runny
nose can progress to respiratory distress to
respiratory failure in a matter of hours. Wolfson’s
wait-time information wasn’t on the ProPublica.org
database, but Aubin said the emergency room
averages 34 minutes. That wait time is achieved by
fast tracking the sickest patients and focusing on
processes that can be sped up by improving in all
other areas of service. By improving other areas in
the hospital, patients can be seen faster and others
can then use the rooms, Aubin said. Still, the focus
is on the quality of care, not the expedience of care,
he said. “We don’t want to sacrifice quality for
speed,” Aubin said. Darin Roark, administrator for
Baptist Clay and the emergency service line for all of
Baptist Health’s hospitals, said Baptist Medical
Center in Jacksonville has already improved its
average wait time from the 54 minutes in March to
about 35 now. “We have been working all year to
put in some performance improvement initiatives,”
he said. “We have been able to substantially reduce
that wait time [54 minutes].” Roark said every
patient seen in an emergency room at a Baptist
hospital is guaranteed to see an actual medical
doctor, unlike some of the hospital’s competitors
that use nurse practitioners and physician
Kyle Sanders, president at St. Vincent’s Medical
Center Southside, said both the Riverside and
Southside hospitals have focused on improving their
wait times by not only performance improvement
initiatives, but with a website that lets patients wait
at home. WaitathomeER.com allows a patient to
see when St. Vincent’s hospitals have an available
appointment and gives a time when they should
arrive. Sanders said people who use the website
wait on average about 15 minutes before seeing a
The program has a 90 percent
recommend rate, and 51 percent of users sign in
with a mobile device. “We want to make sure we
eliminate the time that a patient waits to as close to
zero as we can,” Sanders said.
If something
changes the next available appointment time, the
patient is sent a notification and a new time they
should plan on arriving. “The beauty of it is they
can wait at home,” he said. (Florida Times Union,
Florida ACA Enrollment Surges
In December With 140,000
Roughly 140,000 Floridians signed up for the new
federal health insurance program last month. That's
nearly eight times the 18,000 others who signed up
in October and November combined, according to
figures released Monday.
Of the 158,030
enrollments thus far, about 55 percent were women
and 45 percent were men. Roughly 20 percent fell
into the crucial 18- to 34-years-old demographic and
about 60 percent were between 45 and 64 years
old. And 83 percent of those who purchased plans
qualified for a tax credit, according to enrollment
statistics from the Health and Human Services
Department. Florida continues to lead enrollment
efforts among the three dozen states relying on the
E-Newsletter – State News
Florida Council
January 20, 2014
federally run marketplace, one of the main tenants
of the Affordable Care Act.
Florida's 158,030
enrollees compares to 118,532 in Texas.
Nationwide, nearly 2.2 million have selected a plan.
December figures are much higher than the
previous months' enrollment, which was plagued by
technical glitches from healthcare.gov. But it was
still far less than what officials had originally
projected for Florida and nationwide. Federal health
officials said during a conference call with the media
that they expect the numbers to climb in coming
months, with a likely surge closer to the March
enrollment deadline. The Obama administration
projected 7 million consumers would sign up for
coverage during the first year, including about
477,000 in Florida. Young healthy adults are among
the most important group targeted by federal health
officials' outreach efforts, prized by insurers in the
marketplace to offset the costs of paying for older,
sicker consumers.
Stacy Sylvain a 19-year-old
college student in Miami, was one of last month's
late sign-ups online. In roughly one hour, the parttime waitress signed up for a plan with a $158
monthly premium with the feds kicking in $48. She
has a $2,500 deductible. "Many people have a
preconceived notion that young people are healthy
and don't need to go to the doctor," said Sylvain
who suffered a minor injury when she fell and hit
her head during an indoor soccer class in 2012.
"Not having to worry about being uninsured and the
what-ifs has made an incredible impact on my life."
It's unclear what percentage of so-called "young
invincibles" the government needs to balance out
the risk pool. Federal health officials said Monday
the figures suggested an appropriate mix, but noted
they're only halfway through the open enrollment
period. "We expect that a number of young healthy
individuals may wait until the very end to sign up,"
said Julie Bataille, communications director for the
Centers for Medicare and Medicaid Services. The
mid-tier silver plans were the most popular choice
among consumers with 60 percent choosing such
plans nationally and 57 percent in Florida. Platinum
plans were the next most popular choice,
accounting for 17 percent in Florida, according to
figures from HHS. Monday's enrollment data did not
break out demographics by race. Applicants are not
required to give that information. But federal health
officials said they're planning to ramp up outreach
to Hispanics, a disproportionately uninsured group,
after they've worked out kinks in the Spanish
language website. Some groups have complained
of sloppy translations and say CuidadoDeSalud.gov
moves more slowly than its English counterpart.
Anecdotal evidence suggests Latinos could be
lagging their peers because of confusion about
naturalization documents and fears they could
unwittingly identify relatives in the country illegally.
An estimated 1.3 million Hispanic Floridians lack
health insurance, according to the Kaiser Family
Foundation, a nonprofit that studies health care
issues. That's about one-third of the roughly 3.5
million uninsured people in Florida. The Epilepsy
Foundation of Florida, which received a federal
grant, has been flooded with Hispanics seeking inperson assistance at its Miami headquarters. But
enrollment counselors there said the federal
government's website frequently asks for residency
and naturalization papers from Hispanic applicants,
which can stall the process for weeks if they are
mailed in.
Yolanda Madrid, a 52-year-old
housekeeper living in Miami, hasn't been able to
afford health insurance until now. With the help of a
counselor, Madrid learned last week that she
qualifies for a tax credit. She hasn't signed up for a
plan yet and is still narrowing down her choice,
which includes one offering no monthly premium
and a very low deductible. She initially tried to sign
up for a plan through the federal government's
Spanish-language hotline, but the operator couldn't
find the application they'd helped her fill out before,
so she decided to get help in person last week.
"Now I have more options to choose from that are
affordable so I'm happy," she said. (Gainesville Sun,
Fla. Gov: Boost Spending
To Prevent Child Abuse
Reeling from a string of child abuse-related deaths
in the last year, Gov. Rick Scott wants to spend
millions in order to hire more than 400 additional
investigators in the coming year. Scott on Tuesday
will outline a proposal to boost the budget of the
Department of Children and Families by nearly $32
million. He also wants an $8 million increase for
sheriff's departments handling abuse cases. "While
DCF has made significant changes to protect
children, we still have much to do to protect the
most vulnerable among us," Scott said in a
statement. "Even one child's death is a death too
many." If approved by state legislators during the
annual session that starts in March, the funding
would reduce the caseloads of child abuse
investigators to 10 cases each. Scott's proposal also
calls for extra funding to allow for two-person teams
to handle cases involving children the most at risk of
abuse. DCF has already launched a pilot program
with two-person teams in Miami-Dade and Polk
counties. The governor's budget proposal also calls
for hiring additional state workers to do reviews of
ongoing child abuse investigations, as well as
reclassifying 50 current positions to higher-paid
E-Newsletter – State News
Florida Council
January 20, 2014
positions. The move comes after the state's child
welfare system has come under increased criticism
and scrutiny due to a series of deaths in the past
year. A report released in November said Florida
was failing in its efforts to prevent child abuse
deaths because welfare authorities aren't picking up
warning signs in families at risk.
The report
reviewed the deaths of 40 children and concluded
that welfare authorities who were involved with the
families had overlooked danger signs like drug
abuse or domestic violence. Most of the children
who died were less than 5 years old. The causes of
death include suffocation, drowning and physical
abuse. The most common cause was suffocation or
asphyxia where most of the parents or caregivers
had histories of drug abuse or tested positive for
drugs following the child's death.
The budget
recommendations endorsed by Scott mirror ones
already suggested by Interim DCF Secretary Esther
Jacobo. "Armed with input from national experts
and data to back up our proposals, we are prepared
to ensure that these funds will be laser-focused on
protecting children who are most at-risk," Jacobo
said in a statement.
"With Governor Scott's
steadfast support of DCF initiatives to improve child
safety, I am confident that these strategic
investments will be made to keep Florida's children
safe." In the wake of recent deaths, Democrats last
month called on Scott to shield DCF from any more
budget cuts. Scott said last fall he planned to cut
spending by $100 million in state agencies in 2014.
The Scott administration said Monday that the
governor also plans to recommend that funding for
state subsidized substance abuse and mental health
programs remain at current levels because they also
help prevent child abuse. (Palm Beach Post,
also announce that he will steer an additional $8
million to sheriff's offices to investigate child abuse
complaints, a turnabout for the governor who
recommended a $17 million reduction in the grants
to sheriffs for child protective efforts in his 2013-14
budget proposal. The governor’s proposal, which is
only a recommendation to the Legislature, includes
restoring money for Substance Abuse and Mental
Health programs, services that play a vital role in
reducing child abuse, the agency said in a statement
released to the Herald/Times on Monday. The
governor said his “historic increase to DCF funding”
will pay for the hiring of 400 additional child
protective investigators. The proposal also aims to
reduce caseloads for child protective investigators
from the current 13.3 cases per investigator to 10,
and institute two-person teams in cases involving
children under age 4 when the family has a history
of domestic violence, substance abuse or mental
illness, the statement said. The program would be
modeled after a pilot program DCF is currently
running using paired investigators for high-risk
cases in Miami-Dade and Polk counties. DCF interim
Secretary Esther Jacobo said she is confident the
proposals “will keep Florida children safe.” “Armed
with input from national experts and data to back
up our proposals, we are prepared to ensure that
these funds will be laser focused on protecting
children who are most at-risk,” Jacobo said in the
statement. The governor’s recommendation also
includes restoring 26 of the 72 quality assurance
positions that were cut under former DCF Secretary
David Wilkins. Child advocates blame those cuts for
contributing to some of the child deaths. Another
50 current investigator positions would be eligible
for career advancement under a new “Child
Protective Master Practitioner” plan that would
reward case workers with the most knowledge and
experience. The Casey Family Programs reviewed
40 child deaths last year and concluded that both
DCF and community-based care organizations
should focus more resources on providing services
aimed at stabilizing families to prevent abuse. The
governor’s track record in his previous budget
requests to the Legislature has been to reduce
funding to the child welfare agency. In his first
budget proposal in the 2011-12 budget year, for
example, the governor recommended reducing
funding for DCF by $238 million below its current
levels at the time. In 2011-12, Scott recommended
increasing the agency budget by $1.7 million over
the level approved by lawmakers a year before but,
in 2013-14, he recommended reducing the budget
again — by $75.7 million — below what lawmakers
had approved the year before. (Miami Herald,
Gov. Scott To Propose Increased
Funds For Child Protection
In an effort to repair his child welfare track record,
Gov. Rick Scott will announce Tuesday in Miami that
he is steering $31 million in additional money to
child protection efforts, a move aimed at reducing
caseloads and increasing oversight of vulnerable
children in Florida. The announcement comes in the
wake of dozens of child deaths from abuse and
neglect in the past year, and amid calls for reform of
the Department of Children & Families from the
non-profit Casey Family Foundation and Democrats
in the Legislature. “While DCF has made significant
changes to protect children, we still have much to
do to protect the most vulnerable among us,’’ the
governor said in a statement on Monday. "Even one
child death is a death too many." The governor will
E-Newsletter – State News
Florida Council
January 20, 2014
and presence is just right.” While touted by MiamiDade Republican activists as a potential Scott
running mate, Lopez-Cantera remained for months
out of favor with Scott’s chief of staff, Adam
Hollingsworth, who also was angling for the
lieutenant governor’s job. But Hollingsworth’s star
has dimmed since he acknowledged last month that
he had falsely claimed a college degree while
working for a former employer. Besides, having an
Hispanic as his running mate could help Scott with a
powerful voting bloc that so far seems cool to the
Republican governor. A Quinnipiac University poll in
November showed Scott trailing Democrat Charlie
Crist, the former Republican governor, by 15
percentage points among Hispanic voters compared
to trailing Crist by 7 percentage points among all
voters. Scott’s first lieutenant governor, Jennifer
Carroll, was the first black to serve in that role. But
she was forced out of the administration last March
after the revelation of a criminal case against a
charity operating internet cafes that she previously
consulted for. The Legislature soon after outlawed
internet cafes, and many of the leading figures in
the investigation have been convicted or pleaded
guilty to running a wide-ranging criminal enterprise.
Carroll was never charged in the case. Since then, a
host of possible replacements have been mentioned
— some by the governor’s office, which
acknowledged having prepared a short-list. Still,
many of those cited by the governor’s office quickly
took themselves out of the running. Among them
were Orange County schools Superintendent
Barbara Jenkins, St. Johns County schools
Superintendent Joseph Joyner and Seminole County
Sheriff Donald Eslinger. Sen. Tom Lee, R-Brandon,
and Hillsborough County Commissioner Sandra
Murman have been interviewed by the governor’s
representatives, and Sen. John Thrasher, R-St.
Augustine, also loomed last fall as a possible choice.
Scott, though, showed few signs of being hurried
with his choice. Last week, Tallahassee Democratic
activist Barbara DeVane filed a lawsuit in the Florida
Supreme Court maintaining that Scott is breaking
state law by not having a lieutenant governor. (Palm
Beach Post, 1/13/14)
Scott Expected To Name
Miami-Dade Property Appraiser As
Lieutenant Governor Tuesday
Florida Gov. Rick Scott plans a “major
announcement” Tuesday, with all signs pointing to
his naming a new lieutenant governor. Scott’s office
posted the comment, “Be the first to know who the
lieutenant governor will be,” on his official Facebook
page Monday evening. The Florida Republican Party
quickly tweeted a link to the page.
Meanwhile, Scott also has scheduled a Department
of Children & Families budget event in Miami —
home to Miami-Dade Property Appraiser Carlos
Lopez-Cantera, a former state House member seen
as a likely choice. Lopez-Cantera, 40, became
property appraiser last year after serving eight years
in the state House, the last two years as majority
leader. Born in Spain, Lopez-Cantera initially rose in
influence in the House under former Speaker Marco
Rubio, R-West Miami, now a U.S. senator. He’s also
been a Scott loyalist, even in a Florida House that at
times has tussled with the governor and his
priorities. After a rough start with lawmakers, Scott
by his second year in office won praise from LopezCantera in 2012 for his tax-cut plans and his
“It’s not too much, not too little. I
think it’s just right. Like ‘The Three Bears,’ ” LopezCantera told The Palm Beach Post. “His influence
Florida's Fiscal Strength Lags Most
Other States Report Finds
More than four years after the Great Recession
officially ended in June 2009, the financial condition
of Florida and most other states is improving but it
remains far from where it was on several key
measures of fiscal health, according to a new report
by The Pew Charitable Trusts' Fiscal 50: State
E-Newsletter – State News
Florida Council
January 20, 2014
Trends and Analysis. The report examined tax
revenues, employment rates, debt ratios and
reserve funds and compared the fiscal health of
each of the states. Florida fared worse when it
comes to tax collections and employment but better
in terms of reserves and debt. According to the
report, Florida collects 21 percent less in tax
revenues as of June 20, 2013 than it did during its
pre-recession peak, giving the state significantly less
spending power than it had seven years ago. Only
Alaska and Wyoming are further behind in restoring
their tax collections to pre-recession levels, the
report found, while Arkansas saw the least dip in its
tax collections of any other state, followed by Illinois
and Minnesota. Florida's employment rate is also
among the worst in the nation, the report found.
The report measured the number of people ages 2554 in the work force before the recession and again
in 2013. It found that the 2007 employment rate in
Florida was 81.1 percent and, in 2013, it was 74.8
percent, the third largest drop of any other state,
behind only Nevada and New Mexico. Nationally,
the average drop was 4.1 percentage points.
Meanwhile, Florida's reliance on federal dollars as a
share of state personal income continues -- like
other states -- to be the highest in history. Federal
funds have largely driven growth in total state
spending over the past two decades and, despite
efforts by Gov. Rick Scott to routinely reject federal
funds for numerous spending needs, that pattern is
not changed. Federal dollars make up 36.3 percent
of all state revenue, up from only 1.6 percent since
1992. But during that time, federal funds have
offset a drop in state funds which have decreased
by 1.4 percent as a share of the total state budget.
The state with the highest share of federal dollars is
Mississippi with 48.8 percent -- mostly because of its
high federal Medicaid payment rate -- and the
lowest is Alaska with 24 percent, which relies on oil
revenues for most of its income. The average share
of federal dollars as a percent of the state budget is
34.7 percent and only 10 states had less than 40
percent. One area where Florida is stronger than
most other states is its pension and retiree health
care costs, which are funded at higher rates than
most other states. The biggest burden is the state's
public debt from bond issuances and other state
borrowing, which is $37.1 billion, according to the
report. The unfunded pension cost is $26.9 billion
and the unfunded retiree health care costs is $4.5
billion. Florida also compares well when it comes to
its reserve account. According to the report, the
number of days most states could run tapping just
its general funds is 29.9 days but Florida, with its $3
billion in reserve, could operate for 43.8 days.
(Tampa Bay Times, 1/13/14)
Feds Target HMA's Ex-CEO
The U.S. Department of Justice has signed on to
eight false claims lawsuits against Health
Management Associates, claiming the Naples-based
hospital chain billed for unnecessary patient
admissions and paid kickbacks to doctors who
referred patients.
Former HMA CEO Gary Newsome
The government specifically alleges that former
HMA executive Gary Newsome personally led the
push to pressure emergency department physicians
and hospital administrators to increase the number
of inpatient admissions, “regardless of medical
necessity,” the Department said in a statement.
Newsome retired from HMA last year and is now
president of a South American mission program for
the Church of Jesus Christ of Latter-Day Saints.
While some of the complaints about kickbacks and
unnecessary admissions had been public since
December 2012, when they were aired by CBS' 60
Minutes, some of the lawsuits remained sealed until
last week. HMA has denied wrongdoing all along.
On Tuesday, spokeswoman MaryAnn Hodges said in
an e-mail that the current management is
cooperating with the investigation. She said she
could not comment on pending litigation. "HMA
associates and physicians who practice at our
facilities are focused on providing the highest quality
patient care in all of our hospitals," she wrote. The
chain owns or leases 23 hospitals in Florida,
including some that it bought or leased after the
accusations began. They include Bayfront Medical
Center in St. Petersburg and Munroe Regional
Medical Center in Ocala.
Those who may be
touched by the wide-ranging investigation include
UF Health, which is in a joint venture with HMA in
three hospitals. Now, writes Tampa Bay business
columnist Robert Trigaux, "What did Bayfront Health
step in?"
He says the once-independent St.
E-Newsletter – State News
Florida Council
January 20, 2014
Petersburg hospital is now caught up in a mess with
a "nose-pinching aroma."
The whistle-blower
lawsuits allege that HMA broke anti-kickback laws
that apply to those who bill Medicare and Medicaid.
The Department said Monday that bonuses or
contracts were given to physician groups staffing
HMA emergency rooms, by providing free office
space, staffing or offering direct payments. The
Department singles out Primary Care Associates, a
practice in Port Charlotte, for its referrals to two
Florida HMA hospitals.
“Unlawful financial
relationships between hospitals and physicians
solely to increase referrals are, unfortunately, a
common practice that corrupts the health care
system,” U.S. Attorney for the Southern District of
Florida Wifredo A. Ferrer said in a statement. “The
system also suffers a direct financial hit when
hospitals fraudulently increase admissions where
they are not indicated, solely to benefit hospitals’
bottom line. We will not relent in our efforts to
combat these kinds of fraudulent schemes and
recover funds for the Medicare program.” The
announcement is just the latest in troubles for the
community-hospital network, which operates 71
hospitals in 15 states.
Just last week, HMA
stockholders approved its nearly $4 billion sale to a
Systems. Janet Goldstein, an attorney for two
Florida whistleblowers, told Bloomberg News that
the government’s involvement “speaks to the quality
of the evidence.” (Health News Florida, 1/14/13)
Management Associates), 1,083%
4. Heart of Florida Regional Medical Center (Health
Management Associates), 1,058%
5. Oak Hill Hospital (HCA), 1,052%
6. St. Petersburg General (HCA), 1,046%
7. Ft. Walton Beach Medical Center (HCA), 1,043%
8. Lawnwood Regional Medical Center (HCA)
9. North Florida Regional Medical Center (HCA)
10. Gulf Coast Medical Center (HCA), 927%
As the Northwest Florida Daily News reports,
hospitals are criticizing the methodology used by
National Nurses United, saying the analysis didn’t
take consider all the factors that influence what they
charge, including charity care. North Okaloosa
Medical Center CEO David Fuller points out that
Medicare and other insurance companies pay a
negotiated rate. “‘Charge’ in today’s healthcare
arena doesn’t really mean anything,” Fuller told the
Daily News. National Nurses United says even with
negotiations between insurers and hospitals, “ the
higher the charges, the greater the ultimate
reimbursement that insurers pay.” (Health News
Florida, 1/14/14)
Uninsured Patients Lead To $1 Million Loss
In December For Jackson Health System
A surge of uninsured patients in December has led
to a nearly $1 million loss for Jackson Health
System, according to the latest financial report on
Miami-Dade’s public hospital network.
Jackson officials reported more than 6,090 patient
admissions at the system’s three hospitals for the
last month of 2013 — exceeding the budgeted
number of 5,922, and the prior year’s December
total of 5,926 — the number included many
uninsured or self-paying patients.
At Jackson
Memorial, the main campus in Miami, about 17
percent of admitted patients in December were
uninsured, compared to 13.3 percent in December
2012. At Jackson South, about 19.6 percent of
patients were self-pay, exceeding the December
2012 rate of nearly 14 percent. Only Jackson North,
where nearly 11 percent of patients admitted in
December were uninsured, did the rate of self-pay
patients fall below the prior year’s rate, which was
14.6 percent. In a memo to the Public Health Trust
that runs Jackson, Chief Executive Carlos Migoya
said that despite the December loss of $963,000,
the hospital system remains ahead of budget for the
financial year ending Sept. 30 by about $600,000.
He said the increase in uninsured patients has been
Nurses Blast Hospital Charges
A nurses' union says some hospitals are charging
exorbitant rates, in certain cases more than 10
times more than what they need to cover costs,
according to its analysis of Medicare Cost Reports.
Florida Orange Park Medical Center tops the list for
Florida, the Florida Times-Union reports. The group
says Florida has the second highest hospital charges
in the nation, with an average charge-to-cost ratio
of 555%. The Tampa Bay Business Journal reports
six of the 10 most expensive hospitals in the nation
are owned by either Health Management Associates
and Community Health Systems Inc. Those two
chains are expected to merge in the coming
National Nurses United published this
list of what it says are the most expensive charges
in Florida (by total charges as a percent of total
1. Orange Park Medical Center (HCA) 1,139%
2. North Okaloosa Medical Center (Community
Health Systems, Inc.) 1,137%
E-Newsletter – State News
Florida Council
January 20, 2014
taking place for “a few months.” “A review of our
financial assessment processes found no substantial
errors,” Migoya wrote in the memo. “This appears
to be an actual increase in the number of patients
who are uninsured and do not qualify for assistance
programs, rather than a flaw in our screening and
assistance process.’’ It is unclear how many of
Jackson’s patients who were uninsured in December
may qualify for subsidized private health plans sold
on the Affordable Care Act’s insurance exchanges,
or how many of those patients will qualify for
Medicaid, the state-federal health program for the
poor and disabled. Migoya reported that federallyfunded
counseling to consumers applying for coverage
through the exchanges, have helped more than 80
people enroll.
Jackson also has developed
partnerships with managed-care companies and
private-practice physicians, and launched a
marketing campaign to attract more insured
patients, Migoya said.
Miami-Dade voters in
November approved an $830 million bond to be
repaid with property taxes to finance upgrades for
Jackson over the next 10 years, including new
buildings and medical equipment, renovated patient
rooms, and other improvements — all in an effort to
attract more insured patients and position Jackson
to better compete against private and nonprofit
hospitals for those consumers. The Public Health
Trust meets at 9 a.m. Wednesday in the West Wing
board room of Jackson Memorial. (Miami Herald,
whose office has supported the program since its
inception in 1997. “Without any doubt in my mind,
it’s one of the best ones,” Brodsky said. County
commissioners are considering how to finance the
drug court program in the future. This year’s
county budget calls for spending $737,839 on drug
court. The total includes $141,460 from a grant,
and the balance from the general revenue fund,
according to county documents. “At $3,700 per
person to be in this program, you can’t hardly beat
(Bradenton Herald, 1/14/14)
Plan By Gov. Scott To Restore DCF Money
Hailed, But Some Say It’s Only A Start
The millions of dollars in new money for DCF
announced by Gov. Scott could help offset cuts from
past years — and shore up a political liability.
Manatee Drug Court Costs 10 Percent
Compared With Jail
Florida Gov. Rick Scott on Jan. 14, 2014 in Miami.
Those who commit crimes as a result of substance
abuse and go through drug court cost Manatee
County between $2,500 and $3,700 a year, officials
estimate. If they go to jail, it costs $25,915 a year,
officials say. At its cheapest, drug court is about 10
percent of the cost of jail, drug court administrator
Walt Smith told county commissioners Tuesday.
“Drug court is cost-effective, and generally cheaper,
compared with other alternatives,” Smith said
during a workshop session at County Administrative
Due to the specialized drug court’s
extensive supervision of those arrested for
nonviolent offenses related to substance abuse,
criminal behavior can be halted quickly following an
arrest, officials said. “There’s a reduction in crime.
They’re not out there committing crimes,” Smith
About 175 people are now under the
jurisdiction of drug court, officials said. “Drug court
is very effective,” said State Attorney Ed Brodsky,
A year’s worth of horror stories about children
beaten, shot and starved and drugged to death by
their caregivers has taken a toll on the men and
women on the front lines of child protection in
Florida, who must cope with high case-loads and
low pay. And so when Gov. Rick Scott called a news
conference Tuesday in Miami to announce an
infusion of new money for the Department of
Children & Families, Erica Lee, a senior child
protective investigator, was eager to attend — and
happy with what she heard.
“It means more
support for us,” Lee said Tuesday morning after
Scott made the announcement of an additional $31
million to, among other things, hire additional
investigators. “Case-load is important, and they are
very high, so of course we want to reduce that
case-load, and in order to reduce that we need
E-Newsletter – State News
Florida Council
January 20, 2014
more [investigators.]” Scott’s proposal — which
must pass muster with the Legislature — would
mean DCF could hire more than 400 additional
investigators. The announcement comes at a time
when DCF has been under fire over dozens of child
deaths due to abuse and neglect in families that
were already on the agency’s radar. “This is the
right thing to do for our children,” said Scott.
“There are vulnerable children all across this state.
Adding this funding to DCF, making sure we have
more investigators . . .is just historical.” Scott
recognized Lee and other child protective
investigators who, he said, save children on a daily
basis. “Erica goes above and beyond and her
energy is contagious,” he said. “She is always
available to the families she serves, and ensures
they receive the best services for their needs.” The
governor’s proposal also includes an additional $8
million to sheriff's offices to investigate child abuse
complaints. In some counties, including Broward,
responsibility for child abuse investigations has been
shifted to the local sheriff’s office. DCF interim
Secretary Esther Jacobo, who was present for the
news conference, called the move “a historic
response to the urgent need in child welfare.”
“Your budget proposal is a concrete demonstration
of your support and commitment to those doing the
job of protecting children,” Jacobo said to Scott.
“Thank you for having the faith that we can do this
right and for fighting to get the resources so we can
do this right.”
The state’s dismal record of
protecting vulnerable children could become a
liability for the governor heading into an election
cycle. In the past, Scott has made a practice of
cutting child welfare funding. In his first budget in
2011-12, for example, the governor recommended
reducing funding for DCF by $238 million. In 201112, Scott recommended increasing the agency
budget by $1.7 million over the level approved by
lawmakers a year before but, in 2013-14, he
recommended reducing the budget again — by
$75.7 million — below what lawmakers had
approved the year before. After the Herald reported
last summer on a cluster of child deaths in South
Florida, some involving bungling by the agency,
DCF’s secretary stepped down, and Jacobo stepped
in as a stopgap replacement. The governor also
used the news conference to announce his selection
of Miami-Dade Property Appraiser Carlos LopezCantera as his new lieutenant governor, and that
announcement quickly overshadowed the one about
DCF dollars. Afterward, Jacobo said the more than
400 new positions will include 296 child protective
investigators, 61 senior child protectors and0 59
supervisors. The governor’s recommendation also
includes restoring 26 of the 72 quality assurance
positions that were cut under the governor's
previous budget proposals — reductions that child
advocates blamed for contributing to some of the
child deaths. Currently, there are about 1,084 DCF
child protective investigators, not including
supervisors. “The thing about our job is we are not
in just one place, we are everywhere,” said Lee, the
“We are visiting homes; We are
visiting schools; We are going to police stations for
police reports; We are interviewing family members;
We are talking to doctors; We are getting collateral
contacts; We are driving; We are picking up children
and going to court. We are doing a lot and it’s hard
to do that if you are getting one or two cases a
day.” A goal of Tuesday’s proposal, according to
Jacobo, is to reduce the case-load from the current
13.3 cases per investigator to 10. She said there
also would be some new safeguards, including
having two-person teams handle cases involving
children under age 4 when the family has a history
of domestic violence, substance abuse or mental
illness; and the ability to assign employees to do
random quality checks on open cases. “If you don’t
have the resources you can’t do the job,” she said.
“What we have found is it’s not that investigators
are not doing their job, it’s when you have a caseload of 20-30 cases, how can you do your job?”
Scott’s proposal was called a “welcome first step” by
the Florida Coalition for Children, which advocates
on behalf of abused and neglected children and the
agencies that serve them. “However, what Florida’s
community child welfare agencies understand better
than anyone in Tallahassee is that with improved
identification of children and families in crisis also
comes a need for a greater commitment to
providing adequate resources for the front-line
workers.” “To that end, we look forward to working
with the administration and the Legislature to
guarantee that we are fully funding all of the
services and programs necessary to protect our
state’s most vulnerable children,” it said in a
statement. Miami-Dade Commission Chairwoman
Rebeca Sosa, who was present at the news
conference, lauded the proposal. “We have a great
responsibility in this country to make sure that
children are respected, that children are loved and
that children are safe,” she said. (Miami Herald,
Scott Carves Out More
Cash For Embattled DCF
Gov. Rick Scott continued to release aspects of his
budget on Tuesday, touring the state and
showcasing his proposals for the 2014-2015 fiscal
year. The governor highlighted more funding for
protecting children and public safety on Tuesday.
At the media event in Miami at which he announced
Carlos Lopez-Cantera would become lieutenant
E-Newsletter – State News
Florida Council
January 20, 2014
governor, Scott announced that his proposed
budget would increase funding to the Department of
Children and Families (DCF) by almost $31.9 million
while another $8 million would go to sheriffs’ offices
that handle child-protection issues.
“Today, I’m
announcing that in my ‘It’s Your Money Tax Cut
Budget’ we will propose an historic increase to DCF
funding,” Scott said on Tuesday.
“We are
committed to increasing funding this year by more
than $31 million. This funding will directly support
critical services for children by hiring more than 400
new child-protective investigators. We are also
investing $8 million to support sheriffs who work in
child-protection services. While DCF has made
significant changes to protect children, we still have
much to do to protect the most vulnerable among
us. Even one child's death is a death too many.”
Scott is calling for the money to fund more
investigators, ensure DCF investigators handle no
more than 10 cases each, and create positions to
review cases involving the most vulnerable children.
The governor is also calling for restoring funding for
mental health and substance abuse programs.
“Armed with input from national experts and data to
back up our proposals, we are prepared to ensure
that these funds will be laser focused on protecting
children who are most at risk,” said Interim DCF
Secretary Esther Jacobo. “With Governor Scott’s
steadfast support of DCF initiatives to improve child
safety, I am confident that these strategic
investments will be made to keep Florida’s children
safe.” Scott’s proposal won the applause of some
legislative leaders on Tuesday. “I want to thank
Governor Scott for making the protection of Florida's
children a top priority in his upcoming budget,” said
House Speaker Will Weatherford, R-Wesley Chapel.
“I appreciate his leadership and look forward to
working with him on the issue this session.”
Senators sitting on the Appropriations Committee,
including Sen. Denise Grimsley, R-Sebring, also
praised the proposal. “DCF has opened their doors
for full evaluation and scrutiny by working with
outside agencies to assess how they can improve
their system and prevent even one more child from
dying at the hands of abuse or neglect,” Grimsley
said. “We know what needs to change, and we
know how to make it better.
I applaud the
governor for backing these improvements with the
budget needed to make those changes happen.”
Later on Tuesday, Scott hit Orlando to attend the
Florida Police Chiefs Association’s conference.
There, the governor announced his proposed
budget would include $3.2 million to train law
enforcement. “Florida’s law enforcement officers
deserve to have the tools they need to keep Florida
families and communities safe,” Scott said.
“Florida’s 43-year low in crime is due in large part to
the quality and training of our officers. To continue
this trend our officers need the proper training and
funding for that training. My proposed budget will
help ensure that Floridians remain among the safest
they have ever been.” The proposal won the
backing of Panama City Chief Philip Thorne, the
president of the Florida Police Chiefs Association.
“Governor Scott recognizes that trained officers are
key to reducing crime in Florida’s communities,”
Thorne said. “The funding of the trust fund for
additional training classes is important to maintain a
high level of training.” (Sunshine State News,
Republican National Committee's
Statement On Lt. Gov.
Carlos Lopez-Cantera
Republican National Committee (RNC) Chairman
Reince Priebus and Co-Chairman Sharon Day
released the following statement Tuesday on Florida
Gov. Rick Scott’s choice of Carlos Lopez-Cantera to
fill the vacant position of lieutenant governor:
“Carlos Lopez-Cantera will make an outstanding
lieutenant governor, and I applaud Governor Rick
Scott on his decision,” said Chairman Priebus.
“Carlos Lopez-Cantera has exactly the kind of
experience Florida needs; he is a proven leader and
will be an important voice in our party. “He’s also
made history today by becoming Florida’s first
Hispanic lieutenant governor. He is one of over 160
Hispanic Republicans in public office who are
working diligently to keep government accountable
and making sure our country continues to move in
the right direction at the local, state and federal
levels.” “As a Floridian, I’m proud to call Carlos
Lopez-Cantera my new lieutenant governor,” said
Co-Chairman Day. “He has an admirable record of
public service, a commitment to conservative
principles, and the ability to bring people together.
I’m confident he will make a great leader in
Tallahassee and will be an effective advocate for the
Republican Party.” (Sunshine State News, 1/15/14)
Smart Choice For No. 2
Give Gov. Rick Scott credit for making a smart and
politically savvy decision in selecting Miami-Dade
Property Appraiser Carlos Lopez-Cantera to become
Florida’s next lieutenant governor. The 40-year-old
onetime House majority leader is a seasoned
legislator with proven administrative skill. He brings
youth, energy and diversity to Mr. Scott’s team and
Florida’s Cabinet. Now that Mr. Scott has made the
E-Newsletter – State News
Florida Council
January 20, 2014
choice, we hope Mr. Lopez-Cantera manages to
avoid the usual fate of pols that fill the state’s No. 2
position in Tallahassee. Assigned few constitutional
duties of any import, they’re stashed away in a back
office and generally ignored by other state leaders
and the news media, to be seen only at occasional
ceremonial events and ribbon-cuttings. Unless, of
course, they manage to stumble into a scandal like
Mr. Lopez-Cantera’s unwise predecessor, Jennifer
Carroll, whose poor judgment made her an
embarrassment to Mr. Scott and the state in
general. She finally resigned her post in March after
the disclosure of her affiliation with a company
connected to Internet cafés considered a front for
gambling. Unlike Ms. Carroll, a state legislator
whom Mr. Scott essentially plucked from political
obscurity prior to the 2010 election, Mr. LopezCantera brings significant credentials and years of
experience in state government to the job. He can
provide good political counsel and effective
legislative advice to Mr. Scott — if the governor is
willing to listen. Much has been made of the fact
that Mr. Lopez-Cantera is the first Hispanic to hold
the position since voters reestablished it in 1968.
That’s a definite political plus in terms of sending a
message about inclusion. But it won’t matter much
unless Mr. Lopez-Cantera has some policy input on
issues relevant to the state’s fastest growing
demographic group. Gov. Scott’s veto last year of a
bill that would have allowed access to driver’s
licenses for some undocumented immigrants
brought to this country as children did not exactly
endear him to Hispanics. Putting Mr. Lopez-Cantera
on his team won’t count for much on election day if
Mr. Scott’s record on Hispanic issues doesn’t
improve. More important than ethnicity is that Mr.
Lopez-Cantera brings to Tallahassee a South Florida
perspective often lacking in the state capital. He
understands the particular needs and problems of
South Florida, with its huge population, urban
dynamics and unique natural environment — not to
mention a distinctly different culture. That is where
Mr. Lopez-Cantera may have his biggest impact.
There is a downside to the governor’s pick of Mr.
Lopez-Cantera, of course. Tallahassee’s gain is
Miami-Dade County’s loss. During his relatively brief
tenure as property appraiser — little more than one
year — he made good on a promise to make the
office more open to the public and customerfriendly. He made it easier to contest property
valuations, allowed homestead exemptions to be
filed online and revamped the front office so that
the visitors with questions and concerns could speak
to staff more readily — among other innovations.
Just as important, combating property tax fraud
became a major priority in 2013. By deploying police
officers from nine local municipalities to bolster
investigations into homestead fraud — a scandal of
long standing — the county reaped millions of
dollars in fines and violations. His successor should
continue these smart policies and build on them.
(Miami Herald, 1/14/14)
Palm Beach County Health District Could
Bring In Millions By Selling HMO
As the state readies to move all Medicaid recipients
into private managed care plans, the Palm Beach
County Health Care District’s HMO plan — one that
covers 14,000 Medicaid recipients — faces imminent
closure. But rather than allowing the plan to simply
fade away and have its members shifted into private
plans this summer, the district’s newest board
member suggested another route – one that could
return millions of dollars to taxpayers. Palm Beach
investment banker Les Daniels, an appointee of
Gov. Rick Scott, told district staff and board
members that the 14,000 members in Healthy Palm
Beach’s Personal Health Plan Medicaid HMO
represented an asset — one that could be sold.
Finding it hard to believe, several district staffers
just before Christmas met informally with
investment bankers from Raymond James to see if
this was a viable proposal. “They told us it was
maybe a $9 million deal,” said district legal officer
Nicholas Romanello. So on Wednesday, the board
will take the first steps needed to sell its Medicaid
HMO. “We view it as being a real responsible step
for two reasons,” Romanello said. “The first is
because there is a public asset that can be sold and
returned to taxpayers. The other issue is that it
benefits the members. It provides members with
some certainty and helps provide them with
continuity of care.” The district’s chief program
officer, Tom Cleare, said keeping the HMO plan
open isn’t an option. When discussing this issue
two years ago, the district’s board concluded its
services could be directed only to residents of Palm
Beach County, who pay for those services through
their property taxes. But when reforming and
privatizing the state Medicaid program, state
officials created 11 regional service areas. Palm
Beach County is in the state’s region 9, which also
includes Martin, St. Lucie, Okeechobee and Indian
River counties.
Because HMOs taking state
Medicaid clients must serve all counties in a region,
the Palm Beach County Health Care District was
knocked out of that business. Cleare said the
district’s HMO is rather specialized, specifically
serving families who receive TANF – temporary
assistance to needy families – otherwise known as
welfare. “That’s basically women and children,”
Cleare said. “Eighty percent of our members are
children.” Four companies have won state contracts
to serve Medicaid beneficiaries in this region. They
E-Newsletter – State News
Florida Council
January 20, 2014
are Molina Healthcare; Sunshine Health – a
subsidiary of Centene; the Prestige provider service
network; and Humana. It remains to be seen if any
of those companies would be interested in bidding.
If they aren’t, Cleare said, the program will just
sunset, and the clients will be asked to select one of
the four plans or the state will assign one to them.
If it all goes according to plan, the extra millions
could come in handy. The district is saving to
replace its Trauma Hawk helicopters. Its annual
subsidy to Lakeside Medical Center in Belle Glade is
close to that amount every year. And it has had to
help the county health department plug multimillion-dollar holes in its budget. But if the district
wants the extra money, it’s going to have to work
The state’s timetable for rolling out
Medicaid managed care calls for the first letters to
beneficiaries to go out to this region on April 1, and
the shift to managed care to go live on Aug. 1. Any
sale would have to get the blessing of the Florida
Agency for Health Care Administration, the Florida
Office of Insurance Regulation and the federal
Centers for Medicare and Medicaid Services. Gov.
Rick Scott offered a staff member’s time to help
speed the process along, Romanello said, so he
expects support from the agencies. “It will go away
in August. So if there is an opportunity to bring
value back to the district, I think it makes sense,”
Cleare said. “It certainly makes sense to investigate
it.” (Palm Beach Post, 1/14/14)
the nation,” he said during a meeting of the Senate
Criminal Justice Committee.
The bill, SB 526,
among other things, also adds sentencing enhancers
to particularly severe sex crimes. The reform push
is being fueled by bipartisan support after the death
of Cherish Perrywinkle, a Jacksonville 8-year-old and
a scathing series of South Florida Sun-Sentinel
stories detailed sexual offenders recommitting
crimes after being released from custody. Donald
Smith, who had was a registered sex offender, is
facing charges in Perrywinkle’s abduction and death.
Senate Majority Leader Chris Smith, D-Fort
Lauderdale, did express concern over a provision in
Bradley’s bill that would remove the ability for
certain offenders convicted of sex crimes to receive
shorter sentences for good behavior. “That makes
it tougher within the prison system,” said Smith,
who voted for the bill. Separate legislation looks to
strengthen the process to determine if someone
convicted of a sex crime should be committed as a
“sexually violent predator,” which is someone
deemed a high risk to commit another sex crime.
Under the current process, a state agency like the
Department of Children and Families or Department
of Corrections gives notice to a state attorney’s
office that someone convicted of a sex crime is set
to be released. Details of the case are then turned
over to a team of experts, which recommends to the
state attorney whether or not the offender meets
the criteria to commit them as a violent sexual
predator. If the state attorney pursues the case, a
judge or jury determines if the person can be
committed as a violently sexual predator. Those
that are deemed sexually violent predators are
“civilly committed” at the Florida Civil Commitment
Center in Arcadia. A provision in a bill sponsored by
state Sen. Denise Grimsley, R-Sebring, would
require offenders held in local detention facilities like
county jails to also be referred for review, which is
not currently laid out in law. Normally, those
offenders are referred back to the state, but not
always. There have been cases of offenders that
should have been evaluated being held in a county
jail for re-sentencing hearings and released by a
judge. If released from a county jail, the state does
not have the ability to require the evaluation. Other
proposals in the handful of reform bills include:
increased training requirements for the teams that
do sexual predator evaluations, allowing state
attorneys to commit someone for confinement even
if the team of experts finds no evidence that the
person is a sexually violent predator, and expanding
the statute of limitations related to some sex crimes
on minors. (Florida Times Union, 1/14/14)
Lawmakers Move Quickly On Rewrite Of
Florida Sexual Predator Laws
With a flurry of unanimous votes, the Legislature is
quickly pushing forward a multi-pronged overhaul of
state sexual predator laws, with the ultimate goal of
making those laws “the toughest in the nation.”
Both the House and Senate are looking to rewrite a
handful of state statutes that deal with issues
ranging from how potential sexual predators are
evaluated to sentencing guidelines, which would be
strengthened under the proposals. A trio of Senate
bills passed the Senate Criminal Justice Committee
Monday, and another two passed a separate Senate
committee Tuesday morning. One piece, sponsored
by state Sen. Rob Bradley, R-Fleming Island, looks
to significantly increase penalties for committing a
host of sexually-related crimes.
Among other
things, his bill makes a host of “adult-on-minor” sex
crimes first-degree felonies punishable by up to life
in prison. Currently, the crimes covered are firstdegree felonies punishable by up to 30 years in
prison. This bill “ensures that Florida’s criminal
penalties for sexual predators are the toughest in
E-Newsletter – State News
Florida Council
January 20, 2014
governor and lawmakers fashion a budget this year,
they also should address some of the state’s longneglected needs. Of particular concern are mental
health and substance abuse care. Florida ranks
49th in mental health per capita spending and has
cut client services more than $41 million in the past
two years. This means gravely troubled individuals
are on the street, posing a danger to themselves
and society. This means many families can’t get
treatment for loved ones. It means more expenses
for law enforcement and health care operations.
When it comes to mental health and substance
abuse, Florida’s safety net is thoroughly shredded.
The state spends about what it did in the 1950s on
per-person treatment.
Consider: The Florida
Department of Children and Families estimates only
34 percent of adult mental health need is met in
Florida, and just 27 percent of children’s mental
health need is met. State law enforcement officials
say each year 125,000 people who need mental
health care are arrested and booked into jails.
About $600 million is spent a year housing mentally
ill people in Florida prisons or other facilities.
Florida devotes about half of its mental health
dollars to institutional care, which may be
necessary, but this forsakes the needs of those with
manageable conditions who might avoid the need
for costly services with proper treatment. The
problem is not going to go away. According to the
Florida Council for Community Mental Health, about
one in five adults experience a mental health
disorder in a given year, and one in 10 children live
with serious mental or emotional disorders. Adults
living with serious mental illness die 25 years earlier
than other Americans, often due to treatable
medical conditions that are neglected. Many Florida
families simply cannot afford the cost of treatment.
Yet simply leaving the mentally ill to their own
devices is certain to create heavy costs for
taxpayers — and heartbreak for families. Scott and
lawmakers should see that investing in mental
health care treatment will ultimately save money —
and lives — and provide more support. (Tampa
Tribune, 1/16/15)
Editorial: Child Protection: Fully Fund
Social Services
Gov. Rick Scott says Florida should increase funding
for child-protection services. That's an about-face
for him but he's right. Let's hope state legislators
agree. Last year, deaths from child abuse and
neglect surged terribly in Florida. Various factors
contributed to the increase, but one — lowered
funding for child social services, because of budget
cuts fostered by Scott — was especially noticeable.
The cuts, combined with other effects of the long
recession, had pushed child-welfare caseloads too
high, making it harder for the system to carry out its
protective mission. In Florida, that system is a
decentralized partnership of local, community-based
care organizations and law enforcement, overseen
by the state Department of Children and Families.
The 2013 child deaths brought management shakeups at DCF. The agency's new interim leader,
Esther Jacobo, initiated a diagnostic review by the
respected Casey Family Programs, which made
numerous recommendations — including the
addition of caseworkers and staff to treat and
investigate cases more comprehensively.
Legislators should cooperate with this effort when
they pass a budget this year. In announcing his
proposed funding increase Tuesday, the Governor's
Office said an additional $31 million would "support
critical services for children by hiring more than 400
new child-protective investigators. We are also
investing $8 million to support sheriffs" conducting
child-protection investigations. In another welcome
development, the governor's office said Scott "is
recommending restoring all nonrecurring funding for
substance-abuse and mental health programs.
These programs play an integral role in preventing
child abuse and supporting healthy families." These
are important, overdue steps. For too long, Florida
government has been told to stop "throwing money"
at the child-welfare system and "do more with less."
The limitations — and dangerous results — of that
mantra are all too clear. It's time to see childprotection expenditures for what they are:
necessary investments in our future. (Lakeland
Ledger, 1/16/14)
Black Lawmakers Cancel Meeting With
Scott; Say It Would Be ‘Fruitless’
In the latest sour note of an increasingly testy
relationship, Florida’s Legislative Black Caucus
abruptly cancelled a meeting Wednesday with Gov.
Rick Scott.
The caucus chairman, Rep. Alan
Williams, D-Tallahassee, said the meeting with Scott
would prove a waste of time. “Based on your lack
of action on matters of importance to this caucus
that we have brought to your attention at prior
Invest In Mental Health Care
Florida is expected to have a budget surplus of $1
billion or more this year, and Gov. Rick Scott wants
to return half of that to the public through tax and
fee cuts. Giving citizens such relief will help the
economy and household finances.
But as the
E-Newsletter – State News
Florida Council
January 20, 2014
meetings, we believe another meeting at this time
would be fruitless,” Williams wrote Scott in
scrubbing the scheduled lunchtime huddle. Williams
went through a list of differences with Scott,
including the support by the caucus for expanding
Medicaid, making it easier to restore civil rights and
the governor’s past vetoes of state spending aimed
at black communities. “We believe you can and
should do more to ensure that your administration –
as well as the various staffing and judicial
appointments you make — reflects the racial and
ethnic diversity of Florida,” Williams wrote. Scott
spokeswoman Jackie Schutz said the governor was
“disappointed” by the cancellation. “Gov. Scott
believes the best way to serve Floridians is for the
Legislature and the governor’s office to work
together to find solutions,” she said. The two sides
share a troubled history. In his initial meeting with
the caucus during his second month in office, Scott
told black lawmakers that he could empathize with
them since he once lived in public housing. But
many of the lawmakers said they were offended by
the multimillionaire governor’s apparent perception
that his humble beginnings, alone, would be a
bridge with Florida’s black community. The last
couple of years, Scott has been on the receiving end
of stern messages from the caucus. Many members
have complained about his policies on voting rights,
judicial appointments and funding for historically
black universities. Scott’s renewed attempt to rid
state voter rolls of potentially ineligible voters has
become another flash point with black leaders.
Earlier this week, a Florida NAACP leader said
Scott’s action was “malicious” and aimed at
removing minority voters from the rolls. (Palm
Beach Post, 1/15/14)
would not have any interaction with the surrounding
neighborhood or nearby students was met with
skepticism by the city's Planning and Zoning Board,
which voted 5-0 on Monday to recommend denial of
the project. The City Commission has the final say
on the plans, but no date has been set yet for
commissioners to consider the proposal.
Partners officials tried to assuage concerns, saying
the center would not be taking Medicaid patients,
court-ordered cases, jail inmates or indigents.
Walk-in clients would not be allowed, and no
patients would be released into the surrounding
area. "These aren't homeless people," said Palm
Partners CEO Peter Harrigan, who indicated clients
would be coming from around the country. "We get
people from the airlines, from the unions." The
Broward County School District notified the city that
"the proposed project is incompatible with due to
potential spillover effects from the proposed
establishment." It requested the city ensure the
nearby high school wouldn't be negatively impacted.
Northeast wasn't the only school on the minds of
North Andrews Gardens neighbors, who complained
students at Rickards Middle and North Andrews
Garden Elementary schools would also be put at
risk. "You're having a facility that's deliberately
bringing into our neighborhood a potential danger,"
said Planning Board member Diane Wendt. "They're
introducing something into a community surrounded
by schools that's inappropriate." The property is
owned by Holy Cross Hospital, which purchased it in
2008 and promptly closed the former medical
center. Palm Partners has a contract to purchase
the 11-acre site if the project is approved. "We
would rather have a dilapidated building," resident
Tina Chase said. Others were concerned about who
might use the center's planned out-patient services,
but Harrigan said those services were for patients
already admitted who wanted to supplement their
30-to-90-day treatment plans. Resident Mitchell
Stollberg was leery of the proposal. "I'm hoping
that it's basically like Lindsay Lohans coming down
to stay for a while, possibly get some treatment,"
Stollberg said. (Orlando Sentinel, 1/15/14)
Psychiatric Facility Opposed At Former
North Ridge Medical Center
A vacant hospital could become a psychiatric and
behavioral health treatment center, but the plans
are raising fears that its patients would pose a
danger to students attending nearby schools. Palm
Partners LLC wants to give new life to North Ridge
Medical Center, which has been shut down for more
than five years, by turning the Dixie Highway
property into a 300-bed treatment facility that would
create up to 300 jobs. The company, which caters
to an upscale clientele and those covered by
insurance, currently runs a center in Delray Beach.
The planned center would deal heavily with people
who have drug and alcohol addictions and include
detox programs, officials said. But the company's
claim that people seeking treatment at the facility
Florida Legislators Hear Push For
Alternatives To Incarcerating Youths
Advocates for juvenile justice reform told state
senators Wednesday that more time and money
need to be spent on alternatives to incarcerating
underage offenders. The Senate Appropriations
Subcommittee on Criminal and Civil Justice, which
oversees policy and funding for the Florida
Department of Juvenile Justice, listened to concerns
E-Newsletter – State News
Florida Council
January 20, 2014
about the number of juveniles in state custody and
the facilities that keep them. Committee member
Sen. Darren Soto, D-Orlando, said the meeting was
spurred by reaction to a recent story in the
Huffington Post about allegations of abuse and poor
oversight against Youth Services Inc., a for-profit
prison company that operates roughly 10 percent of
the state’s private juvenile detention centers. Wells
Todd, a retired social worker from Atlantic Beach,
said he has seen budget cuts wipe out programs
designed to keep low-level juvenile offenders out of
Todd, who is part of the newly formed
Jacksonville Juvenile Justice Coalition, said there’s
also a lack of qualified people involved in the
programs that exist. “We need to revisit these
programs that were wiped out because of budget
cuts,” Todd said. “The money is there, we need to
understand where it should go.”
Promises, Promises … Our Opinion: Gov.
Scott Can’t Let The State’s Most Vulnerable
Residents Down — Again
The state Department of Children & Families needed
a huge dose of good news and, this week, the
agency got some. Gov. Scott threw his support
behind DCF on Tuesday, announcing that he wants
to add $31 million to the agency’s budget. That
money will let DCF add more than 400 new
investigators. After a year of horror stories in which
children in the agency’s files were killed by
negligent, violent, drunken and abusive caregivers
— a word used very loosely, of course — could the
governor really propose anything less? n the past,
he has, cutting DCF’s budget, which, along with
flawed policies, hamstrung its ability to keep kids
safe and rehabilitate troubled families. Plus, the
tragedy of children dying while under DCF oversight
is nothing new, unfortunately. What made 2013
extraordinary was the seemingly unrelenting
frequency of the deaths. So the governor has seen
the light — and, perhaps, the ballot box it
illuminates in November. But the governor can
make his good news even better by showing that he
actually means it. His $31-million proposal is just
the start of what likely will be a long and tortured
road to actual funding. The Legislature has to
approve it. And for any reluctant lawmakers to vote
Yes, the governor has to make it unequivocally clear
that he considers it a priority. Let’s face it — we’ve
been here before, with little to show for the
governor’s stated commitment to making life better
for the state’s most vulnerable residents other than
the headlines. Two years ago, after the Miami
Herald laid out in stomach-churning detail the
horrific treatment many elderly and mentally
challenged Floridians endured — or succumbed to —
at loosely regulated assisted-living facilities, Mr.
Scott promised to take action. But in 2012, there
was barely a peep out of him when the Legislature
met, and reform went nowhere. The governor did,
however, appoint a task force to address ALF
regulation, one that was top-heavy with industry
insiders. Needless to say, the industry remained
well cocooned from more-stringent rules. Mr. Scott
took a similar tack last year, when he did a 180 and
declared that he supported expanding Medicaid
coverage for up to 1 million poor and low-income
Floridians. This after steadfastly refusing to do so
— even though the federal government was picking
up the hefty tab. But his support was late, and
Lawmakers failed to come up with
legislation, and the governor didn’t call a special
session. Mr. Scott’s declaration of intent to give
DCF $31 million could be the real deal, but he will
David Utter, Florida policy director for the Southern
Poverty Law Center, said that 45 percent of the
juveniles in state custody in 2012 and 2013 were
locked up for committing misdemeanors or violating
probation. Instead of paying to jail them, Utter said
the state should fund community programs
designed to keep them out of trouble. “The worst
thing you can do is put a bunch of kids in residential
[facilities] surrounded by tougher kids,” Utter said.
“We don’t have enough money for communitybased programs that are much more effective and
much less expensive and do not destroy our kids.”
Juvenile Justice Secretary Wansley Walters spoke to
the committee about the department’s detention
programs and how it chooses the contractors who
run private facilities. She said the department is
phasing out large facilities with smaller ones, and
that the 2,471 youths who were in state custody at
the beginning of this year is about half the number
in 2009. In the Jacksonville area, court officials are
working to better use its civil citation program,
which allows juvenile offenders who committed their
first misdemeanor to pay a fine and complete
community service instead of being arrested.
Advocates of the program say it’s a more effective
way to keep low-level offenders out of trouble and it
has less of a burden on taxpayers and long-term
impact to the offender. More than two-thirds of
juveniles in the Jacksonville area who were eligible
for the program were not given the chance to
participate and were instead arrested, according to
DJJ. The number of arrests was higher compared to
some other larger judicial circuits in the state.
(Florida Times Union, 1/16/14)
E-Newsletter – State News
Florida Council
January 20, 2014
have to show a higher level of leadership than he
has so far on these issues. Additionally, all the
money in the world won’t mean a thing for children
and their dysfunctional caregivers if new
investigators — and those already on the job — are
not properly and thoroughly trained and given the
tools to do their jobs efficiently. For instance, the
proposed funding would allow DCF to send two
investigators to a family’s home, instead of one. But
what’s the point if two ill-trained workers end up
saying, “Gee, when the drunken mom and her
abusive boyfriend promised to be stellar caregivers,
how were we to know that they would kill the
toddler?” It happened too many times last year.
Right now, DCF needs a permanent leader. If Mr.
Scott can both secure the funding he says he wants
and appoint a progressive agency head with a
proven track record on child welfare, then his good
news will be great news for Florida’s vulnerable
children. (Miami Herald, 1/15/14)