Diagnosis for 1.18.23: Checking the pulse of Florida health care news and policy

Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.

— Expire or extend —

For two years, Florida health care providers have enjoyed civil liability protections against COVID-19-related claims.

But those protections are set to expire June 1 unless lawmakers agree to extend them.

Gov. Ron DeSantis held a news conference earlier this week in which he announced his intent to pursue legislation to continue to ban vaccine mandates for both private and public employers and bar mask mandates in schools. The law, which authorized the Department of Legal Affairs to sanction businesses that violated the law up to $50,000, is also scheduled to sunset June 1.

DeSantis said Tuesday there continues to be a push for vaccine and mask mandates and therefore the life span of the laws need to be extended.

“It’s just nuts we are still doing this,” DeSantis said. “We believe there’s no turning back from our direction.”

To watch DeSantis discuss mask mandates, please click on the image below:

But DeSantis didn’t mention the civil liability protections or extending them beyond June 1.

As a refresher, the COVID-19 liability protections were initially passed in SB 72.

The bill required plaintiffs to satisfy heightened pleading requirements of alleging facts in sufficient detail to support each element of their claim; prove by the greater weight of the evidence that the health care provider was grossly negligent or engaged in intentional misconduct; and overcome any affirmative defense recognized in the statute that is properly raised by the health care provider defendant.

The COVID-19 liability protections for health care providers initially were set to expire on March 29, 2022, which was one year after DeSantis signed SB 72.

Last year, the Legislature agreed to extend the protections through June 1 when it passed SB 7014.

To date, no legislation has been filed to extend the protections beyond June 1.

— Sticker shock —

The amount of premium reported by managed care plans running in Florida’s Medicaid managed care program continues to increase.

Eleven managed care plans reported earning $17.19 billion in Medicaid premiums in the third quarter of 2022, according to the latest available data posted by the Florida Office of Insurance Regulation. That’s $5.71 billion more than what the plans reported being paid in Medicaid premiums in the second quarter of 2022, or in April, May and June.

A Florida Politics review of Medicaid enrollment data posted by AHCA shows the number of people in the Medicaid managed care program increased during the months of July, August and September, with Q3 enrollment in the managed medical assistance (MMA), long-term care (LTC) and the children’s medical services (CMS) programs reaching a high of 4,445,820 as of Sept. 30, 2022.

Enrollment increased by about 123,000 during the third quarter.

The $17.19 billion in Medicaid premium excludes Children’s Health Insurance Program (CHIP) premium.

In all, the 11 Medicaid managed care plans earned nearly $34.86 billion in the first nine months of the calendar year 2022, according to the OIR quarterly reports, which are compiled from information the managed care plans report to the National Association of Insurance Commissioners (NAIC) and the state insurance office.

The managed care plans earned substantially more premiums as the year progressed, reporting $6.18 billion in Q1, $11.49 billion in Q2, and $17.19 billion in Q3.

I welcome your feedback, questions and especially your tips. You can email me at SextonHealthNewsletter@gmail.com or call me at 850-251-2317.

— Start the clock —

Florida’s Medicaid program currently has more than 5.6 million enrollees, according to the December enrollment report compiled by AHCA and posted to the website this week.

But that’s about to change. The spending bill passed by Congress late last month contained a provision that ends a requirement that states keep people enrolled in Medicaid as long as there was a COVID-19 public health emergency.

The Biden administration — as expected — last week extended that public health emergency associated until April.

Congress, however, is ending the Medicaid continuous enrollment requirement at the end of March. The federal government is also going to phase out increased matching rates through the end of 2023.

That means states can begin to disenroll people from Medicaid in April, but state Medicaid officials must follow certain rules to remain eligible for the increased federal funding that is being phased out.

Health care advocates have pressed the DeSantis administration for details as to how it plans to tackle the massive job of deciding who is eligible for the program and who is not.

But as part of the transition — which has been called the “unwinding” of the continuous enrollment provision — federal authorities are requesting that states provide information as they begin this process.

AHCA and the Department of Children and Families, which handles eligibility determination on behalf of the state, are slated to appear before the Senate Health Policy Committee Monday to give Senators an update on the “unwinding.”