Diagnosis for 12.19.22: 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.

With less than a month to go in the open enrollment period, more than 1.44 million Floridians have signed up for health insurance under the federal health care exchange, according to data released this month by the Centers for Medicare & Medicaid Services.

Florida continues to lead the nation in the number of residents who rely on the exchange implemented as part of the Affordable Care Act, also known as Obamacare. Texas is second in the nation, with slightly more than 1 million residents enrolled in an exchange.

CMS reported that so far in December, nearly 5.5 million Americans have signed up for 2023 coverage. This includes 4.9 million selections made through the federally run HealthCare.gov platform and about 600,000 through state-based marketplaces.

This year’s open enrollment period began Nov. 1 and runs until Jan. 15 for states that rely on the federally run Healthcare.gov platform.

In 2022, more than 2.7 million Floridians signed up for health care coverage through the health care exchange, according to data compiled for KFF. The enrollment totals have been rising over the past decade.

U.S. Census data released in September estimated that 12.1% of Floridians do not have health insurance coverage in the state. Florida has the fourth-highest uninsured rate behind Texas, Oklahoma and Georgia.

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

— Buh bye —

After more than a decade at the helm of the Agency for Persons with Disabilities (APD), Director Barbara Palmer is resigning effective Dec. 30.

In a Dec. 2 letter, Palmer said that Gov. Ron DeSantis, who has been her boss for the last four years, asked for her resignation.

“Helping protect the health and safety of individuals with developmental disabilities has been my privilege and the pinnacle of my career,” Palmer wrote. “Since my start at APD in 2011, with the help of our dedicated and professional staff, we have worked to improve the lives of some of the most vulnerable citizens of Florida.”

Attached to the one-page resignation letter were another nine pages that include what Palmer described as her “accomplishments and highlights,” including shuttering Carlton Palms Educational Center, setting up the Medicaid iBudget waiver program, and taking 7,000 people off the waiting list for the iBudget Medicaid waiver program.

The iBudget waiver allows people with intellectual or developmental disabilities to obtain home and community-based services that, while not traditionally covered by the Medicaid program, will keep them from being institutionalized.

While Palmer, who earns $168,000 annually, lists it as a success, passed before she headed the agency, and the 7,000 individuals Palmer says she removed from the Medicaid iBudget waiting list include projections.

Meanwhile, the iConnect program Palmer calls an accomplishment was supposed to be fully implemented by 2018 but hasn’t been and it’s been decried by Medicaid IB support coordinators, providers and clients.

“There’s been a whole host of problems with iConnect, and there’s a lot of people experiencing difficulties with iConnect from waiver support coordinators to providers to the consumers it supports. It’s been very difficult to implement, very difficult for providers to use and there’s been ongoing issues for several years,” Mark A. Swain, the CEO and President of ARC of Alachua County and Arc of Florida Board Chair, told Florida Politics. “I think the value of iConnect will be seen upon its completion. I don’t think the state has seen the value of iConnect yet.”

Swain does credit Palmer for “seeing the closure of Carlton Palms through,” but it occurred after a series of deaths published by media reports that took place under her watch.

“Carlton Palms was a real black eye for Florida,” he said. “It went on far too long, and it should have been shut down before it was. The state had no other choice but to finally close it.”

Palmer’s departure leaves the top position at the APD open. DeSantis’ office did not immediately comment on who would replace Palmer or when the new director will be announced.

Palmer is not the only agency head to resign in recent weeks.

Agency for Health Care Administration Secretary Simone Marstiller submitted her resignation letter to DeSantis on Nov. 9, after the Governor was re-elected. Dane Eagle, secretary of the Department of Economic Development, has also resigned. And Florida Insurance Commissioner David Altmaier tendered his resignation Thursday. Altmaier has not publicly disclosed where he will be working.

The agency head resignations come before a new six-year lobbying ban takes effect and prevents Florida’s top regulators and agency secretaries from lobbying the Florida Legislature, or the offices they once worked at, for six years. Florida law precludes former executives from lobbying the agencies they served and the executive office for two years. The ban doesn’t apply to lobbying the Florida Legislature.

Not all agency heads are resigning. Department of Children and Families Secretary Shevaun Harris is staying with DeSantis for his second term, and so is Department of Health Secretary and state Surgeon General Joseph Ladapo.

— Who’s running the OIR? —

Florida’s top health insurance regulator, John Reilly, is stepping down from his position as the OIR Deputy Commissioner of Life and Health and has taken a job at Oscar Health, sources close to the Commissioner said.

Reilly has headed the state insurance unit regulating licensed life and health care plans. The unit reviews all life and health policy rates and forms and also conducts examinations and investigations into business practices and alleged statutory violations. According to a state website, Reilly was hired in 2008 and earned about $137,000 annually.

Reilly is the third insurance regulator to leave the state department before a new six-year lobbying ban takes effect.

Susanne Murphy stepped down as the Deputy Commissioner of Property & Casualty earlier this month and took a job at Meenan PA; she oversaw the regulation of property and casualty insurance policies, which includes Florida’s beleaguered homeowners’ insurance market, and was Reilly’s counterpart.

Meanwhile, Reilly’s arrival at Oscar Health comes as the plan announced it was cutting off open enrollment in Florida on the federal health insurance exchange two days before the end of the open enrollment period.

In third-quarter filings with the SEC, the company said it had “proactively engaged CMS regarding options to manage (its) membership growth to a level at the end of the 2023 Open Enrollment Period that enables us to prudently manage (its) capital.”

— Another meeting —

Members of one of the state’s medical boards will hold another public meeting on proposed rules to ban physicians from offering gender-affirming care to minors.

The Department of Health is scheduling a Board of Medicine meeting after receiving two requests to do so, said department spokesperson Brad Dalton. Dalton told Florida Politics the DOH was working with board members on completing a meeting date.

The Board of Medicine agreed in November to alter the standard-of-care rules to ban doctors from performing gender-confirming surgeries on anyone under 18 and from supplying puberty blockers and hormones to anyone under 18, a position that Ladapo advocated.

It’s not clear whether the Board of Osteopathic Medicine will also hold a meeting on its proposed rule on gender-affirming care, also approved on Nov. 4.

Its proposed rule would allow osteopathic physicians to treat patients with puberty blockers and hormones if they agreed to take part in Institutional Review Board-approved, investigator-initiated clinical trials at one of Florida’s medical schools.

It is one of the first times, according to the medical board’s legal staff, that there could be different standard of care rules based on whether someone is a medical doctor or an osteopathic physician.

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