The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Appropriations
BILL: SPB 2518
INTRODUCER: For consideration by the Appropriations Committee
SUBJECT: Health and Human Services
DATE: January 30, 2024
ANALYST STAFF DIRECTOR REFERENCE ACTION
Barr Sadberry Pre-meeting
I. Summary:
SPB 2518 conforms statutes to the funding decisions related to Health and Human Services in
the Senate proposed General Appropriations Act for Fiscal Year 2024-2025. The bill:
Expands independent living services programs in the Department of Children and Families
(DCF) for young adults aging out of foster care by decreasing the eligibility age for
“extended” adoption assistance and permanent guardianship benefits, and Post-Secondary
Education and Support (PESS) to support their transition to adulthood. Also allows young
adults aging out of foster care to receive Aftercare Services, if eligible for the “extended”
adoption assistance and permanent guardianship benefits, but are not participating in either
program.
Provides the Department of Health (DOH) with the authority to deposit certain healthcare
practitioner loan repayment program funds into the Grants and Donations Trust Fund.
Increases one-time adoption benefit payments provided by the DCF for eligible adoptive
employees, veterans, and servicemembers to those received by law enforcement officers, for
adopting a child from the Child Welfare System. The one-time payments will increase from
$10,000 to $25,000 for adopting a child meeting the criteria of “difficult to place” and from
$5,000 to $10,000 for a child who does not meet the criteria.
Authorizes an Area Agency on Aging to carry forward documented unexpended state funds
from one fiscal year to the next, however, the cumulative amount carried forward may not
exceed 10 percent of the area agency's planning and service area allocation for the
community care for the elderly program.
Provides specific rule-making authority to the Agency for Health Care Administration
(AHCA) for the administration of the Program of All-inclusive Care for the Elderly (PACE).
Clarifies and codifies the programs under the Children’s Medical Services program within
the DOH.
Transfers the Medicaid and Children’s Health Insurance Program (CHIP) provider and
operational contracting duties and responsibilities from the DOH to the AHCA.
Requires the DOH to competitively procure one or more specialty plan contracts for services
to children with special health care needs enrolled in Medicaid and CHIP with services
beginning no later than January 1, 2025. The DOH will retain responsibility for clinical
REVISED: BILL: SPB 2518 Page 2
eligibility determinations and must provide ongoing consultation to the AHCA for services to
children and youth with special healthcare needs.
Except as otherwise expressly provided in the bill, the bill takes effect July 1, 2024.
II. Present Situation:
Adoption from the Child Welfare System
Independent Living Services
The Department of Children and Families (DCF) strives to achieve permanency for all children
in care before their 18
th
birthday.
1
However, a child will age out of care upon reaching 18 years
of age if a permanent placement is not found.
2
From October 1, 2022, to September 30, 2023,
there were 801 young adults who aged out of Florida’s foster care system.
3
Florida provides independent living services to young adults to help them transition out of foster
care and to prepare them to become self-sufficient adults. Florida’s independent living services
include extended foster care (EFC), which applies to young adults who were in licensed foster
care upon turning 18 years of age.
4
Florida also offers two other independent living programs:
Postsecondary Education Services and Support (PESS) and Aftercare services (Aftercare). The
following tables provide information on the eligibility requirements to participate in Florida’s
independent living programs and the services provided by each.
Program Eligibility Services
Extended
Foster Care
(EFC)
5
Young adults who turned 18 in foster care and are:
Completing high school or its equivalent; or
Enrolled in college or vocational schooling; or
Working at least 80 hours per month.
To stay in EFC, the young adult must:
Meet with a case manager every month.
Continue to participate in a required activity.
Attend court reviews every six months.
Young adults may
choose to remain in
licensed foster care
and receive foster
care services until
the age of 21 (22
with a disability).
Postsecondary
Education
Services and
1. Young adults who turned 18 in foster care and
spent at least 6 months in licensed out-of-home
care before turning 18.
$1,720 per month
for:
Housing
Utilities
Living expenses
1
Section 39.01, F.S. Section 39.621, F.S., lists the permanency goals in order of preference as 1. Reunification; 2. Adoption,
if a petition for termination of parental rights has been or will be filed; 3. Permanent guardianship; 4. Permanent placement
with a fit and willing relative; or 5. Placement in another planned permanent living arrangement.
2
Fla. Admin. Code R. 65C-30.022.
3
Florida Department of Children and Families (DCF), Office of Child and Family Well-Being Dashboard, available at:
https://www.myflfamilies.com/ocfw-dashboard (last visited Jan. 12, 2024).
4
Chapter 2013-178, Laws of Fla.
5
Section 39.6251, F.S. BILL: SPB 2518 Page 3
Program Eligibility Services
Support
(PESS)
6
2. Young adults who are at least 18 and were adopted
from foster care after age 16 or were placed with
a court-approved guardian after spending at least 6
months in licensed foster care within the 12
months immediately preceding such adoption or
placement; and
Have earned a high school diploma or
equivalent; and
Are attending a college or vocational school
that is Florida Bright Futures eligible.
Available until the
age 23.
Aftercare
Services
7
Young adults who turned 18 while in licensed foster
care, but are not yet 23, and
Are not in EFC; or
Are not in PESS.
Mentoring;
Tutoring;
Substance abuse
treatment;
Counseling;
Job and career skills
training; and
Temporary financial
assistance for
necessities
Adoption Benefits Program
In 2015, the Legislature established the adoption benefit program in the DCF to provide a one-
time benefit to qualifying employees who adopt a child from the foster care system.
8
The following table includes information on the expansion of persons eligible for the adoption
benefit program over time:
6
Section 409.1451(2), F.S.
7
Section 409.1451(3), F.S.
8
Chapter 2015-130, Laws of Fla. BILL: SPB 2518 Page 4
Year Employees Eligible for the Adoption Benefit under s. 409.1664, F.S.
2015
Full-time or part-time employee of a state agency who is paid from regular salary
appropriations rather than a temporary employee. The term includes instructional
personnel who are employed by the Florida School for the Deaf and Blind.
9
2017
Full-time or part-time employees of charter schools or the Florida Virtual School to
the list of eligible employees.
10
2020
Full-time or part-time employee from a state agency, charter school, or Florida
Virtual School that is not an independent contractor.
Other personal services employees who have been continuously employed full-
time or part-time by a state agency for at least 1 year.
Veterans and servicemembers that are domiciled in the state.
11
2022 Law enforcement officers.
12
Qualifying adoptive employees, veterans, or servicemembers who adopt a child from the child
welfare system, who is “difficult to place,”
13
are eligible to receive a one-time monetary benefit
of $10,000 per child, while law enforcement offices are eligible for $25,000 per child.
14
If the
child being adopted is “difficult to place,” qualifying adoptive employees, veterans, and
servicemembers are eligible to receive $5,000 per child, while a law enforcement officer is
eligible to receive $10,000 per child.
15
The following table identifies the number of adoption subsidies requested from the DCF:
16
Fiscal Year DCF Adoptions
Adoption Subsidies
Requested
% with
Subsidies
2019-20 4,548 275 6%
2020-21 3,904 263 7%
2021-22 3,888 323 8%
2022-23 3,602 412 11%
9
Chapter 2015-130, Laws of Fla.
10
Chapter 2017-140, Laws of Fla.
11
Chapter 2020-22, Laws of Fla.
12
Chapter 2022-23, Laws of Fla.
13
Section 409.166(2), F.S., defines the term “difficult to place” as a child whose (1) permanent custody has been awarded to
the DCF or to a licensed child-placing agency; (2) has established significant emotional ties with his or her foster parents or
is not likely to be adopted because he or she meet a specific category (eight years of age; developmentally disabled;
physically or emotionally handicapped; a member of a racial group that is disproportionately represented among children
available for adoption or a member of sibling group of any age provided two or more members of a sibling group remain
together for purposes of adoption); and (3) for whom a reasonable but unsuccessful effort has been made to place the child
without providing a benefit.
14
Section 409.1664, F.S.
15
Id.
16
DCF, SB 1486 Agency Bill Analysis (January 2024), p. 15, (on file with the Senate Committee on Children, Families, and
Elder Affairs). BILL: SPB 2518 Page 5
The Florida Reimbursement Assistance for Medical Education Program (FRAME) and the
Dental Student Loan Repayment Program (DSLR)
Sections 1009.65 and 381.4019, F.S., establish student loan repayment programs for various
healthcare practitioners and dentists, respectively.
FRAME
The FRAME program
17
offers student loan reimbursement to various healthcare practitioners to
offset their educational expenses
18
to entice them to practice in underserved locations
19
where
there are shortages of such practitioners. The Department of Health (DOH) is authorized to
reimburse as follows:
Up to $20,000 per year for medical and osteopathic doctors with primary care specialties;
20
Up to $15,000 per year for autonomous advanced practice registered nurses (APRN) with
primary care specialties;
Up to $10,000 per year for APRNs and physician assistants (PA); and
Up to $4,000 per year for licensed practical nurses (LPN) and registered nurses (RN).
DSLR
Section 381.4019, F.S., establishes the Dental Student Loan Repayment Program (DSLR
Program). The program requires the DOH to award up to $50,000 to a dentist who, as required
by DOH rule, demonstrates active employment in a public health program
21
that serves Medicaid
recipients and other low-income patients and is located in a dental health professional shortage
area or medically underserved area. Current law caps the number of dentists allowed to receive
awards at 10 per state fiscal year.
Loan Reimbursement Payments
Loan reimbursement payments are disbursed directly by the DOH to lenders for qualified
loans.
22
Under the program, a lender may be any entity involved in making, holding,
consolidating, originating, servicing, or guaranteeing any loan to students to finance higher
education expenses. This includes lenders who provide private educational loans as well as
lenders who provide loans that are made, insured, or guaranteed by the U.S. Department of
17
Section 1009.65, F.S., titles the program the “Medical Education Reimbursement and Loan Repayment Program” however,
the Department of Health (DOH) and other stake holders refer to the program as the FRAME program. To reduce confusion,
this analysis will refer to the program as the FRAME program.
18
Current law specifies that educational expenses that qualify for reimbursement include costs for tuition, matriculation,
registration, books, laboratory and other fees, other educational costs, and reasonable living expenses as determined by the
DOH. See section 1009.65, F.S.
19
Fla. Admin. Code R. 64W-4.001 defines an “underserved location” as a public health program; a correctional facility; a
Health Professional Shortage Area (HPSA) as designated by Federal Health Resources and Services Administration (HRSA)
in a primary care discipline; a rural area as identified by the Federal Office of Rural Health Policy; a rural hospital as defined
in s. 395.602(2)(b), F.S.; a state hospital; or other state institutions that employ medical personnel.
20
Primary care specialties are defined as obstetrics, gynecology, general and family practice, internal medicine, pediatrics,
and other specialties which may be identified by the DOH.
21
The section defines “public health program” as a county health department, the Children's Medical Services program, a
federally funded community health center, a federally funded migrant health center, or other publicly funded or nonprofit
health care program designated by the department.
22
Fla. Admin. Code R. 64W-4.005. BILL: SPB 2518 Page 6
Education. Additionally, a qualified loan is any federal and/or private student loan with a US-
based lender that has a verified balance remaining which loan proceeds were used to pay
educational expenses.
23
Whether a loan is a federal or private student loan, a company that owns a student loan may sell
or transfer that loan, or a pool of loans, to another lender or servicer. Typically, lenders will sell a
pool of loans packaged together, known as a security, to free up capital to make additional loans.
The FRAME program completed the first year of operation and successfully distributed loan
reimbursement payments to 1,097 healthcare professionals during the 2022–2023 fiscal year.
Loan reimbursement payments were mailed to 37 different lending institutions. Sixteen loan
reimbursement payments, totaling $160,581, were returned to the DOH due to the loan having
been sold.
Returned loan payments received during the same fiscal year as the original payment may be
reissued by the DOH to the appropriate lender. However, returned loan payments received in a
subsequent fiscal year may not be reissued by the DOH and instead must be deposited into the
General Revenue Fund.
24
Community Care for the Elderly
The Community Care for the Elderly (CCE) program provides community-based services in a
continuum of care to help elders with functional impairments to live in the least restrictive and
most cost-effective environment suitable to their needs.
25
The CCE program provides a wide range of services to clients, depending on their needs. These
services include, but are not limited to, adult day care, chore assistance, counseling, home-
delivered meals, home nursing, legal assistance, material aid, medical therapeutic services,
personal care, respite, transportation, and other community-based services.
26
The Department of Elder Affairs (DOEA) administers the program through contracts with Area
Agencies on Aging (AAAs), which subcontract with CCE Lead Agencies. Service delivery is
provided by 49 Lead Agencies around the state. The CCE program is not a component of
Medicaid but rather is funded by a combination of state general revenue and client contributions.
Clients are assessed a co-payment based on a sliding scale developed by the DOEA. Co-
payments are not assessed on clients whose income is at, or below, the federal poverty level as
established by the U.S. Department of Health and Human Services.
27
23
Fla. Admin. Code R. 64W-4.001.
24
Current year refunds may only be processed for refunds received and deposited during the same fiscal year that the warrant
was issued for the disbursement. See, Department of Financial Services, Reference Guide to State Expenditures, page 58
(2022).
25
Section 430.202, F.S.
26
Department of Elderly Affairs, 2023 Summary of Programs and Services- Page 39, available at
https://elderaffairs.org/publications-reports/summary-of-programs-and-services/ (last visited Jan. 25, 2024).
27
Id. BILL: SPB 2518 Page 7
To be eligible for the CCE program, an individual must be 60 years of age or older and
functionally impaired, as determined by an initial comprehensive assessment and annual
reassessments. Primary consideration for services is given to elders referred to the Department of
Children Family’s Adult Protective Services (APS) and determined by APS to be victims of
abuse, neglect, or exploitation and in need of immediate services to prevent further harm.
Individuals not referred by APS may still receive services, but according to a prioritization which
is based upon the potential recipient’s frailty level and likelihood of institutional placement. The
DOEA is also required to consider an applicant’s income when prioritizing services. Those less
able to pay for services must receive higher priority than those with a greater ability to pay for
services.
28
Program of All-Inclusive Care for the Elderly (PACE)
The Program of All-Inclusive Care for the Elderly (PACE) is a capitated benefit model
authorized by the federal Balanced Budget Act of 1997 (BBA)
29
that features a comprehensive
service delivery system and integrated federal Medicare and state Medicaid financing
mechanism. The model was developed to address the needs of long-term care clients, providers,
and payers.
The PACE operates as a three-way agreement between the federal government, the state
administering agency, and a PACE organization. In Florida, the PACE is a Florida Medicaid
Long-Term Care managed care plan option providing comprehensive long-term and acute care
services which support Medicaid and Medicare enrollees who would otherwise qualify for
Medicaid nursing facility services.
30
The PACE provides a range of integrated preventative, acute care, and long-term care services to
manage the often complex medical, functional, and social needs of the frail elderly. PACE was
created as a way to provide clients, family, caregivers and professional health care providers the
flexibility to meet a person’s health care needs while continuing to live safely in the
community.
31
The purpose of a PACE program is to provide comprehensive health care services
that are designed to:
Enhance the quality of life and autonomy for frail, older adults;
Maximize dignity of and respect for older adults;
Enable frail, older adults to live in their homes and in the community as long as medically
and socially feasible; and
Preserve and support the older adult’s family unit.
32
28
Section 430.205(5)(b), F.S.
29
Specifically, services under the PACE are authorized under Section 1905(a)(26) of the Social Security Act.
30
Department of Elder Affairs and Agency for Health Care Administration, Program of All-Inclusive Care for the Elderly
and Statewide Medicaid Managed Care Long-term Care Program Comparison Report (January 14, 2014), available at
https://ahca.myflorida.com/Medicaid/recent_presentations/PACE_Evaluation_2014.pdf (last visited January 24, 2024).
31
Department of Health and Human Services, Centers for Medicare and Medicaid Services, CMS Manual System: Pub. 100-
11 Programs of All-Inclusive Care for the Elderly (PACE) Manual (Rev.2, issued 6-9-2011),
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/pace111c01.pdf (last accessed January 42,
2024).
32
Supra note 30. BILL: SPB 2518 Page 8
The federal government established the PACE organization requirements and application
process; however, the state is responsible for oversight of the application process, which includes
reviewing the initial application and providing an on-site readiness review before a PACE
organization can be authorized to serve participants. An approved PACE organization must sign
a contract with the federal Centers for Medicare and Medicaid Services (CMS) and the state
Medicaid agency.
In 2021, the Legislature codified the PACE program in statute and designated the Agency for
Health Care Administration (AHCA) as the state agency responsible for overseeing both the
application process and the monitoring of Florida’s PACE program and organizations.
33
The current PACE approval process requires any entity interested in becoming a PACE
organization to submit a comprehensive PACE application to the AHCA, which sets forth details
about the adult day care center, staffing, provider network, financial solvency and pro forma
financial projections, and policies and procedures, among other elements. Providers operating in
the same geographic region must establish that there is adequate demand for services so that each
provider will be viable. The application requires that documentation be submitted demonstrating
that neither provider is competing for the same potential enrollees.
The AHCA reviews an organization’s application and, when the entity has satisfied all
requirements, conducts an on-site survey of the entity’s readiness to serve PACE enrollees. Once
all requirements are met, including full licensure of the center, staffing for key positions, and
signed provider network contracts, the AHCA certifies to federal CMS that the PACE site is
ready. At that time, CMS reviews the application and readiness certification and, if all
requirements are satisfied, executes a three-way agreement with the PACE provider and the
AHCA. The PACE provider may then begin enrolling members, subject to an appropriation to
fund the slots.
34
Ten PACE organizations are currently operating under the program, and an additional 13
organizations have submitted applications that are pending state and federal CMS approval.
35
Current PACE Programs
PACE Organization
Service Area
(County)
Nov. 1, 2023
Enrollment
Hope PACE Charlotte 68
Empath Hillsborough 0
Florida PACE Miami-Dade 856
Florida PACE Broward 166
Hope PACE Lee 331
33
Chapter 2021-149, Laws of Fla.
34
The Florida Senate, SB 1242 Bill Analysis (Apr. 20, 2021)(on file with the Senate Appropriations Committee on Health and
Human Services).
35
The Agency for Health Care Administration, PACE Monthly Report November 2023, available at
https://ahca.myflorida.com/content/download/23798/file/PACE Monthly Report November 2023.pdf (last visited January 24,
2024).
BILL: SPB 2518 Page 9
Hope PACE Charlotte 68
Hope PACE Collier 67
MorseLife PACE Palm Beach 807
Mt. Sinai Miami-Dade 11
PACE Partners of Northeast Florida Duval and Clay 109
Suncoast Pinellas 318
Total Enrollment 2,801
The AHCA does not currently have specific rule-making authority related to the administration
of the PACE program.
Florida Medicaid
The Agency for Health Care Administration (AHCA) is the chief health policy and planning
entity for the state and is primarily responsible for the state’s Medicaid program; the licensure
and regulation of the state’s 48,500 health care facilities; and the sharing of health care data
through the Florida Center for Health Information and Policy Analysis.
36
Medicaid is the medical assistance program that provides access to health care for low-income
families and individuals. Medicaid also assists the elderly and people with disabilities with the
costs of nursing facility care and other medical and long-term care expenses.
37
With federal
approval, Florida has used a comprehensive managed care delivery program model for primary
and acute care services since 2014, with the Statewide Medicaid Managed Care (SMMC),
Managed Medical Assistance (MMA) program, and SMMC Long-Term Care (LTC) programs.
38
Children’s Medical Services Program
The DOH is tasked with protecting and promoting the health of residents and visitors in the state
and has been responsible for the administration of the Children’s Medical Services (CMS)
programs and the CMS Network since the program’s inception in 1978.
The Children’s Medical Services (CMS) program is a compilation of programs that serve
children and youth with special health care needs. Administered by the CMS Program within the
DOH, each program is responsible to either provide a managed system of care; preventive,
evaluative, or early intervention services; or statewide children’s services.
39
The following components are currently named in statute as part of the CMS program:
Children’s Medical Services Managed Care Plan;
Early Steps;
Newborn Screening; and
36
Agency for Health Care Administration, About, available at https://ahca.myflorida.com/about (last visited Jan. 16, 2024).
37
Agency for Health Care Administration, Medicaid, available at https://ahca.myflorida.com/medicaid (last visited Jan. 16,
2024).
38
Agency for Health Care Administration, Statewide Medicaid Managed Care, available at
https://ahca.myflorida.com/medicaid/statewide-medicaid-managed-care (last visited Jan. 16, 2024).
39
Department of Health, 2023 Agency Legislative Bill Analysis, House Bill 1503 (Feb. 24, 2023) (on file with the Senate
Committee on Health Policy). BILL: SPB 2518 Page 10
Regional Perinatal Intensive Care Centers.
Additional functions and programs of the DOH CMS Program which are not currently named or
outlined in statute include:
Child Abuse Death Review;
Child Protection Team and Special Technologies;
Children’s Multidisciplinary Assessment Team;
Medical Foster Care;
Newborn and Infant Hearing Screening Program;
Poison Information Center Network;
Safety Net;
Sexual Abuse Treatment Program;
Specialty Contracts, including Statewide and Regional Networks for Access and Quality;
State Systems Development Initiative;
Title V for children and youth with special health care needs;
Research and evaluation projects to improve the delivery of services to children and youth
with special health care needs; and
Conducting clinical screening to determine the medical eligibility of children and youth with
special health care needs for programs such as Medicaid, the Children’s Health Insurance
Program (CHIP), and Safety Net.40
Children’s Medical Services Network
The Children’s Medical Services (CMS) Network provides children with special health care
needs a family-centered, comprehensive, and coordinated statewide managed system of care and
provides essential preventative, evaluative, and early intervention services for children at risk for
or having special health care needs. Originally, the CMS Network was a fee-for-service program
serving children with special health care needs who were enrolled in either Medicaid or CHIP. In
August 2014, the CMS Network was transitioned to a managed care model under the purview of
the AHCA and became known as the Children’s Medical Services Managed Care Plan (CMS
MCP). Current law has not been updated to reflect the name change.
41
The AHCA contracts with the DOH, who is responsible for administering the CMS MCP. The
DOH conducts the clinical eligibility determination for CMS clients, subcontracts with private
vendors for the plan’s operation, including case management, and provides vendor oversight in
the areas of clinical operations, compliance, performance management, family level grievance
remedies, and provider technical assistance. The DOH sends all contractors’ and vendors’
invoices to the AHCA for payment, often causing delays.
42
The CMS MCP must meet requirements of health plans for participation in the managed medical
assistance program established in s. 409.974, F.S., except for the requirement to be competitively
procured by the AHCA.
40
Department of Health, 2023 Agency Legislative Bill Analysis, House Bill 1503 (Feb. 24, 2023) (on file with the Senate
Committee on Health Policy).
41
Id.
42
Id. BILL: SPB 2518 Page 11
In January 2024, the CMS MCP provided services to 91,277 members enrolled in Medicaid
43
and 9,210 members enrolled in CHIP.
44
CMS Network Advisory Council and Technical Panels
Sections 391.221 and 391.223, F.S., establish the Statewide CMS Network Advisory Council
and technical advisory panels, respectively. These bodies serve to advise the State Surgeon
General on the operations of the CMS Network as a fee-for-service program. The CMS MCP
conformity with the requirements in ch. 409, F.S., renders the role and responsibilities of these
councils and panels obsolete. In accordance with s. 20.43(6), F.S., the State Surgeon General
retains the authority to implement ad hoc advisory committees, as needed, without the need for
this provision specifically for the CMS MCP.
III. Effect of Proposed Changes:
Section 1 amends s. 39.6225 F.S., to increase the number of young adults eligible to receive
Guardianship Assistance Program payments by allowing a youth who was at least 14 years of
age when he or she was adopted or placed in permanent guardianship (formerly age 16) to be
eligible for Postsecondary Education Services and Support (PESS) between the ages of 18-22,
provided other eligibility requirements are met.
Section 2 amends s. 381.4019, F.S., to authorize the Department of Health (DOH) to deposit any
payments made under the Dental Student Loan Repayment Program, and subsequently returned
by a lender, into the Grants and Donations Trust Fund and used for the same purpose. The DOH
may submit a budget amendment, pursuant to the requirements of chapter 216, F.S., to make
payments under this section.
Section 3 amends s. 381.402, F.S.,
45
to authorize the DOH to deposit any payments made under
the Florida Reimbursement Assistance for Medical Education Program, and subsequently
returned by a lender, into the Grants and Donations Trust Fund and used for the same purpose.
The DOH may submit a budget amendment, pursuant to the requirements of chapter 216, F.S., to
make payments under this section.
Section 4 amends 409.166, F.S., to increase the number of young adults eligible to receive
adoption assistance by allowing a youth who was at least 14 years of age (formerly age 16) when
adopted or placed in permanent guardianship to be eligible for adoption assistance between the
ages of 18-22, provided other eligibility requirements are met.
Section 5 amends s. 409.1664, F.S. to increase the amount of the adoption benefit lump sum
monetary payment for qualifying adoptive employees, veterans, and servicemembers for
43
Department of Health. 2024, Title XIX Enrollment by CMS Region (1/16/24), available at
https://www.floridahealth.gov/programs-and-services/childrens-health/cms-plan/about/_documents/cms_enroll_XIX_map_1-
24.pdf (last visited Jan. 24, 2024)
44
Department of Health, Title XXI Enrollment by CMS Region (1/16/24), available at
https://www.floridahealth.gov/programs-and-services/childrens-health/cms-plan/about/_documents/cms_enroll_XXI_map_1-
24.pdf (last visited Jan. 24, 2024)
45
The bill amends s. 3814019, F.S., as it is transferred, renumbered, and amended by SB 7016, 2024 Regular Session. BILL: SPB 2518 Page 12
adopting a child within the child welfare system from $10,000 to $25,000 for a child meeting the
criteria of “difficult to place” and from $5,000 to $10,000 for a child who does not meet the
criteria.
Section 6 amends s. 409.1451, F.S. to increase the number of young adults eligible to receive
PESS by allowing a youth who was at least 14 years of age (formerly age 16) when adopted or
placed in permanent guardianship to be eligible for PESS between the ages of 18 and 22,
provided other eligibility requirements are met.
The section also amends s. 409.1451, F.S. to allow for young adults between the ages of 18 and
20, who were adopted or placed in permanent guardianship between the ages of 14 and 17, who
are eligible but not currently participating in the Guardianship Assistance Program extension or
extended adoption assistance, to receive Aftercare Services.
Section 7 amends s. 430.204, F.S., to authorize the Area Agencies on Aging to carryforward
documented unexpended state funds from one fiscal year to the next. However, the cumulative
amount carried forward may not exceed 10 percent of the area agency’s planning and service
area allocation for the community care for the elderly program. Any unexpended state funds
above the percentage must be returned to the department. The bill provides the following
requirements:
The funds carried forward may not be used in any way that would create increased recurring
future obligations and such funds may not be used for any type of program or service that is
not currently authorized by existing contracts;
Expenditures of funds carried forward must be separately reported to the department;
Any unexpended funds that remain at the end of the contract period shall be returned to the
department; and
Funds carried forward may be retained through any contract renewals and any new
procurements as long as the same area agency on aging is retained by the Department of
Elder Affairs.
Section 8 amends s. 430.84, F.S., to provide specific rule-making authority to the Agency for
Health Care Administration (AHCA) for the purpose of administering the Program of All-
Inclusive Care of the Elderly (PACE).
Section 9 amends s. 391.016, F.S., to update the DOH Children’s Medical Services (CMS)
programs terminology to include “children and youth” and to delete the obsolete requirement
that the DOH CMS Program coordinate and maintain a consistent medical home for participating
children.
Section 10 amends s. 391.021, F.S., to rename “Children’s Medical Services Network,” to
“Children’s Medical Services Managed Care Plan” and to update terminology to include
“children and youth” in place of “children.”
Section 11 amends s. 391.025, F.S., to clarify the scope of the DOH CMS Program to include
the following additional programs:
The Children’s Medical Services Managed Care Plan through June 30, 2024;
The Children’s Multidisciplinary Assessment Team; BILL: SPB 2518 Page 13
The Medical Foster Care Program;
The Title V program for children and youth with special health care needs;
The Safety Net Program;
The Networks for Access and Quality;
Child Protection Teams and Sexual Abuse Treatment Programs established under s. 39.303,
F.S.; and
The State Child Abuse Death Review Committee and local child abuse death review
committees established in s. 383.402, F.S.
The bill also updates the statutory reference for the newborn screening program to include s.
383.145.
Section 12 amends s. 391.026, F.S., relating to powers and duties of the DOH to end the
department’s responsibility for oversight of the CMS Managed Care Plan June 30, 2024, and
remove the related obsolete responsibilities, including:
Establish reimbursement mechanisms for the network/plan;
Establish standards and credentialing for providers in the network/plan;
Serve as a provider and principal case manager for children with special health care needs
under Medicaid and the Children’s Health Insurance Program (CHIP);
Establish a grievance resolution process;
Maintain program integrity; and
Receive and manage health care premiums, capitation payments, and other funds for the
network/plan;
Additionally, the bill authorizes the DOH to administer the Medical Foster Care program,
including:
Recruitment, training, assessment, and monitoring for the program;
Monitoring access and facilitating admissions of eligible children and youth to the program
and designated Medical Foster Care homes; and
Coordination with the Department of Children and Families and the Agency for Health Care
Administration, or their designees.
Section 13 repeals s. 391.028, F.S., removing prescriptive requirements for management and
administration of the CMS program.
Section 14 amends 391.029, F.S., outlining individuals who are eligible to receive CMS program
services, to:
Clarify a high-risk pregnant female enrolled in Medicaid is eligible when receiving services
through a Regional Perinatal Intensive Care Centers (RIPCC);
Update terminology to include “children and youth” in place of “children;” and
Update terminology for CMS Managed Care Plan.
Section 15 amends s. 391.0315, F.S., to retitle the section from “Benefits” to “Safety net
programs”, to remove the requirement to provide benefits comparable to Medicaid managed care
plans, and to authorize the DOH to provide additional specialized services through the CMS
program. BILL: SPB 2518 Page 14
Sections 16 repeals s. 391.035, F.S., effective January 1, 2025, to remove the requirement for the
DOH CMS program to establish provider qualifications for the CMS network/plan.
Section 17 repeals s. 391.037, F.S., effective January 1, 2025, to remove provisions that specific
licensed physicians who are providing private-sector services to clients of the DOH are not in
violation of s. 112.313(7), F.S., regarding conflicting employment, if certain conditions are met.
Section 18 repeals s. 391.045, F.S., effective January 1, 2025, to remove the obsolete
requirements relating to the DOH reimbursement of health care providers through the CMS
network/plan.
Section 19 repeals s. 391.047, F.S., effective January 1, 2025, to remove obsolete requirements
for the DOH to comply with s. 402.24, F.S., regarding third-party liabilities.
Section 20 repeals s. 391.055, F.S., effective January 1, 2025, to remove the service delivery
requirements for the CMS network/plan.
Section 21 repeals s. 391.071, F.S., effective January 1, 2025, to remove the quality of care
requirements for health care providers that participate in the CMS program.
Section 22 amends s. 391.097, F.S., effective January 1, 2025, which authorizes the DOH to
initiate, fund, and conduct research to improve the delivery of CMS program services to remove
inclusion of the CMS network/plan.
Section 23 repeals ss. 391.221 and 391.223, F.S., eliminating the CMS Statewide Network
Advisory Council and Technical advisory panels.
Section 24 requires the transfer of all duties, authority, functions, obligations, and resources for
operations of the CMS Managed Care Plan be transferred from the DOH to the AHCA, effective
July 1, 2024. The DOH will retain responsibility for conducting clinical eligibility screening for
children with special health care needs. The bill also directs the DOH CMS Program to assist the
AHCA in developing requirements for the new specialty plan procurement and contracts.
Section 25 amends s. 409.974, F.S., relating to eligible Medicaid plans, to reflect the transition
from the Children’s Medical Services Network at the DOH to the CMS Managed Care Plan at
the AHCA. The DOH must competitively procure one or more vendors to provide services for
children with special healthcare needs who are enrolled in Medicaid and for children with special
healthcare needs who are enrolled in CHIP with services to begin by January 1, 2025. The DOH
CMS Program must:
Transfer all operations of the managed care contracts to the ACHA beginning July 1, 2024;
Assist the AHCA in developing specifications for the procurement contracts;
Conduct clinical eligibility screening for children with special health care needs who are
eligible for or are enrolled in Medicaid or Children’s Health Insurance Plan (CHIP); and
Provide ongoing consultation to the AHCA in the care of children with special health care
needs.
BILL: SPB 2518 Page 15
The bill also removes language that exempted the Children’s Medical Services Health Plan from
procurement requirements for managed care plans in ch. 409, F.S.
Section 26 amends s. 409.166, F.S., to allow the adoptive parents of a child covered under CMS
programs to also receive adoption assistance. The bill also amends s. 409.166, F.S., to replace
the specific reference to the Children’s Medical Services Network services with a broader
reference to plans that serve children and youth with special healthcare needs under KidCare and
Medicaid (parts II and III of ch. 409, F.S.).
Section 27 amends s. 409.811, F.S., to rename “Children’s Medical Services Network,” to
“Children’s Medical Services Managed Care Plan.”
Sections 28 through 34 amend ss. 409.813, 409.8134, 409.814, 409.815, 409.8177, 409.818,
and 409.912, F.S., respectively, to make technical changes to replace obsolete references to
“Children’s Medical Services Network” with a broader term referencing plans that serve children
and youth with special needs under KidCare and Medicaid (parts II and III of ch. 409, F.S.).
Section 35 amends s. 409.9126, F.S., deleting the requirement that Medicaid-eligible children
diagnosed with HIV/AIDS must be served through the Children’s Medical Services Network.
Sections 36 through 38 amend ss. 409.9131, 409.920, and 409.962, F.S., respectively, relating
to Medicaid overpayments, Medicaid fraud, and Medicaid eligible plans, and deletes references
to Children’s Medical Services Network.
Section 39 provides that except as otherwise expressly provided in the bill the bill takes effect
July 1, 2024.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
None. BILL: SPB 2518 Page 16
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
None.
C. Government Sector Impact:
Area Agency on Aging
The bill assists the Department of Elder Affairs and the Area Agency on Aging in
avoiding year-end surpluses and deficit challenges, by allowing unexpended state funds
for the AAAs to be carryforward from one fiscal year to the next. These projections are
difficult due to multiple, uncontrollable factors including care plan fluctuations due to
changing client care needs, acute care episodes, client attrition, and the financial impact
of Adult Protective Service referrals from the Department of Children and Families
(DCF).
Department of Children and Families:
Independent Living Services Expansion
Extended Guardianship Assistance Program (EGAP) and extended Adoptions Subsidies
(EMAS)
By lowering the age from 16 to 14 for a child who is adopted or placed in permanent
guardianship, the DCF projects 1,332 more young adults will become eligible for this
benefit when the child is between ages 18 to 22. The DCF applied a 30 percent
participation rate EGAP and EMAS which results in a projected increase of 400 young
adults. The average monthly financial assistance for these programs is $670.
Projected annual cost: $3,216,000.
Extended Postsecondary Services and Support (PESS)
By lowering the age from 16 to 14 for a child, who is adopted or placed in permanent
guardianship, the DCF projects 351 more young adults will become eligible for PESS
when the child is between ages 18 and 22. The DCF applied a 20 percent participation
rate to the new eligible population which results in an increase of 71 young adults in
PESS. The financial assistance payment for PESS is $1,720 per month. Projected annual
cost: $1,465,440.
Aftercare Services
The DCF projects that 1,835 young adults will be eligible for Aftercare Services. The
department applied a 15 percent participation rate which results in a projected BILL: SPB 2518 Page 17
participation of 275 young adults. The average monthly financial assistance provided for
Aftercare Services is $1,039. Projected annual cost: $3,428,700
Services Expanded Funding
Increase
Extended Adoption and Guardianship Assistance
Payments
$3,216,000
Postsecondary Education Services and Support (PESS) $1,465,440
Aftercare Services $3,428,700
Total $8,110,140
SPB 2500 authorizes $8,110,140 in recurring funds from the General Revenue Fund to
the DCF to support the expansion of independent living services.
46
Expansion of the Adoption Benefits Program
According to the DCF Fiscal Year 2024-2025 Agency Legislative Budget Request, the
department estimates a recurring fiscal impact to increase the lump sum adoption benefit
program monetary awards. The DCF requests that program awards be increased from
$10,000 to $25,000 for adoptions of a child in the child welfare system, or from $5,000 to
$10,000 for children who do not meet certain criteria.
47
The number of adoptions
projected for Fiscal Year 2024-2025 is 425 for a total annual cost is $10,625,000.
Considering DCF’s current base budget of $8,377,470, total additional funding needed is
approximately $2,250,000.
SPB 2500 authorizes $2,250,000 in recurring funds from the General Revenue Fund to
the DCF to support the increase in the amount of adoption benefit program monetary
awards.
48
VI. Technical Deficiencies:
None.
VII. Related Issues:
None.
VIII. Statutes Affected:
This bill substantially amends the following sections of the Florida Statutes: 39.6225, 49.166,
381.4019, 381.402, 391.016, 391.021, 391.025, 391.026, 391.029, 391.0315, 391.097, 409.1451,
409.166, 409.1664, 409.811, 409.813, 409.8134, 409.814, 409.815, 409.8177, 409.818, 409.912,
409.9126, 409.9131, 409.920, 409.962, 409.974, 430.204, and 430.84.
46
SPB 2500, Specific Appropriations 330, 331, and 332.
47
The Department of Children and Families Agency Legislative Budget Request for Fiscal Year 2024-2025.
48
SPB 2500, Specific Appropriation 326. BILL: SPB 2518 Page 18
This bill repeals the following sections of the Florida Statutes: 391.028, 391.035, 391.037,
391.045, 391.047, 391.055, 391.071, 391.221, and 391.223.
IX. Additional Information:
A. Committee Substitute – Statement of Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
None.
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.