STORAGE NAME: h1103b.BUC
DATE: 3/27/2025
1
FLORIDA HOUSE OF REPRESENTATIVES
BILL ANALYSIS
This bill analysis was prepared by nonpartisan committee staff and does not constitute an official statement of legislative intent.
BILL #: CS/HB 1103
TITLE: Services for Persons with Disabilities
SPONSOR(S): Kincart Jonsson
COMPANION BILL: None
LINKED BILLS: None
RELATED BILLS: None
Committee References
Human Services
17 Y, 0 N, As CS
Budget
26 Y, 0 N
Health & Human Services
SUMMARY
Effect of the Bill:
CS/HB 1103 expands the Intellectual Developmental Disabilities (IDD) Pilot Program to all individuals on the
Agency for Persons with Disabilities (APD) preenrollment list by October 1, 2025 and to all individuals with
developmental disabilities enrolled in a Medicaid wavier program by July 1, 2026. The bill clarifies the roles of APD
and the Agency for Health Care Administration (AHCA) in the IDD Pilot Program, emphasizing that AHCA is
responsible for managing the program.
The bill requires the Agency for Persons with Disabilities (APD) to increase transparency by posting reconciliation
reports and its iBudget preenrollment list online.
The bill mandates APD participation in transition planning activities with the Department of Children and Families
(DCF) for young adults with developmental disabilities who are also in the child welfare system.
The bill establishes the Statewide Family Care Council to coordinate with existing Local Family Care Councils.
Fiscal or Economic Impact:
There is an indeterminate fiscal impact on AHCA to extend the IDD Pilot Program. There is an insignificant fiscal
impact on APD for administrative support of the new Statewide Family Care Council.
JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
ANALYSIS
EFFECT OF THE BILL:
Services for Persons with Developmental Disabilities
The bill makes changes to APD functions related to its services for developmentally disabled individuals, including
expanding the IDD Pilot Program in three phases and making administrative changes to the program; increasing
transparency; requiring APD to participate in DCF’s transition planning activities for young adults with
developmental disabilities who are also in the child welfare system; establishing the Statewide Family Care Council
to coordinate with existing Local Family Care Councils; and providing Local Family Care Councils with more
responsibility.
Intellectual Developmental Disabilities Pilot Program
Over 22,000 individuals with developmental disabilities remain on APD’s preenrollment list, some of which have
been on for more than a decade, waiting for services. APD has and continues to struggle to move these individuals
off the list, even with increased funding provided by the Legislature.
JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
2
Consequently, in 2023, the Legislature created the Intellectual Developmental Disabilities (IDD) Pilot Program as
an alternative pathway for individuals with disabilities, limited to Medicaid Managed Care Regions D and I.
1 The
IDD Pilot Program is a voluntary, managed care initiative that delivers comprehensive services (including acute,
long-term care, and home- and community-based services specific for persons with developmental disabilities) to
individuals on the APD preenrollment list. APD’s involvement in the IDD Pilot Program, however, has kept
enrollment slow, despite interest by families.
IDD Pilot Program Expansion
The bill expands the IDD Pilot Program in three phases:
1. To all individuals on the APD preenrollment list residing in Statewide Medicaid Managed Care Regions D or
I immediately.
2. To all individuals on the APD preenrollment list by October 1, 2025.
3. To all individuals with developmental disabilities enrolled in a Medicaid waiver program (iBudget or Long-
Term Care) by July 1, 2026 giving them the option to move from the iBudget waiver and begin receiving
comprehensive services more quickly.
The bill places AHCA in charge of managing the IDD Pilot Program, reducing unnecessary delays tied to APD’s
involvement so that individuals and families who are interested in enrolling into the IDD Pilot Program may be
enrolled more quickly. The bill requires APD to transmit weekly client data files of clients who are eligible for
enrollment to AHCA. It requires AHCA to provide a call center to assist prospective enrollees and their families to
learn about and enroll into the IDD Pilot Program and requires AHCA to coordinate with APD and DCF to develop
partnerships with community-based organizations to disseminate information about the IDD Pilot Program to
providers and potential enrollees. (Section 4)
Developmental Disability Data Transparency
Currently, APD oversees home and community-based services (HCBS) for individuals with developmental
disabilities, including the iBudget waiver program. Transparency in funding reconciliation and waitlist
prioritization is limited.
The bill requires APD to post its quarterly reconciliation reports on its website within five days of submitting the
reports to the Governor and Legislature, and the current and total number of individuals in each preenrollment
priority category on its website, to be updated every five days. (Sections 1, 2)
Child Welfare Coordination
Some developmentally disabled children are in the child welfare system. Current law requires the Department of
Children and Families (DCF) and the Community-Based Care Lead Agencies (CBCs) to conduct transition plan and
multi-disciplinary staffing for children who need both waiver and extended foster care services. APD is not
currently required to participate in those meetings, resulting in the absence of a crucial coordination component.
The bill requires APD participation in DCF’s transition planning for young adults with developmental disabilities in
extended foster care or transitioning from the child welfare system to ensure that have access to all of the services
they need. (Section 2)
Statewide and Local Family Care Councils
Local family care councils (FCCs) are councils located throughout the state that were created to educate and
empower individuals with developmental disabilities and their families. The Local FCCs have existed since 1993,
but lack a unified state level structure.
1
Region D includes Hillsborough, Polk, Manatee, Hardee and Highlands counties and Region I includes Miami-Dade and Monroe counties. The Agency for
Health Care Administration, New SMMC Regions, https://ahca.myflorida.com/var/site/storage/images/0/1/0/4/164010-1-eng-US/f96e21c2155c-
Florida_Regions_Map.png (last visited March 24, 2025). JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
3
The bill establishes the Statewide Family Care Council (Statewide FCC) to connect local FCCs and facilitate direct
communication between the local FCCs and APD. It directs the Statewide FCC to:
Review policy proposals and program recommendations from the local FCCs.
Advise APD on statewide policies, programs, and service delivery improvements based on the collective
recommendations of the local councils.
Identify systemic barriers to the delivery of services and recommend solutions to address those barriers.
Foster collaboration and the sharing of best practices and resources among the local FCCs, and
Submit an annual report to Governor, Legislature, and APD by December 1 of each year, which includes a
summary of local FCC findings, recommendations and an assessment of APD’s actions in response to
previous recommendations from the local FCC’s.
The bill also makes changes to the existing local FCCs by tasking them to:
Assist in providing information and coordinating outreach to individuals with developmental disabilities
and their families.
Convening family listening sessions to gather input on local service delivery challenges.
Holding public forums every 6 months to solicit feedback on actions the local FCCs have taken.
Sharing information with other local FCCs.
Identifying policy issues relevant to the community and family support system in the region, and
Submitting annual reports to the Statewide FCC detailing proposed policy changes, program
recommendations and identified service delivery challenges with their region, by September 1 of each
year.
To ensure that recommendations made by the local FCCs are addressed by APD, the bill requires APD to provide a
written response to the Statewide FCC’s annual report, including an action plan outlining steps taken or planned to
address the local FCCs’ recommendations. (Section 3)
The bill provides an effective date of July 1, 2025 (Section 5)
FISCAL OR ECONOMIC IMPACT:
STATE GOVERNMENT:
Expansion of the IDD Pilot Program to allow additional enrollees will have an indeterminate fiscal impact on AHCA,
to the extent the Legislature provides additional funding for the program in the General Appropriations Act. The
legislature may also authorize the movement of funds provided for the traditional waiver to the pilot program, if an
individual on the preenrollment list opts to receive services through the pilot program. This would not require an
additional appropriation, as APD reverts funds for the waiver each fiscal year.
Providing administrative support for the new Statewide Family Care Council and participating in child welfare
transition planning will have an insignificant fiscal impact on APD, absorbable within existing resources.
RELEVANT INFORMATION
SUBJECT OVERVIEW:
Agency for Persons with Disabilities
The Agency for Persons with Disabilities (APD) was created to serve the needs of Floridians with developmental
disabilities. APD works in partnership with local communities and private providers to assist people who have
developmental disabilities and their families. APD serves more than 60,000 individuals with autism, cerebral palsy,
spina bifida, intellectual disabilities, down syndrome, Prader-Willi syndrome, and Phelan-McDermid syndrome.
2
Florida Medicaid Program
2
Agency for Persons with Disabilities, About Us, https://apd.myflorida.com/about/ (last visited March 24, 2025). JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
4
Medicaid is the health care safety net for low-income Floridians. Medicaid is a partnership of the federal and state
governments established to provide coverage for health services for eligible persons. The program is administered
by AHCA and financed by federal and state funds. AHCA delegates certain functions to other state agencies,
including DCF, the Department of Health, APD, and the Department of Elderly Affairs.
The structure of each state’s Medicaid program varies and what states must pay for is largely determined by the
federal government, as a condition of receiving federal funds.
3 Federal law sets the amount, scope, and duration of
services offered in the program, among other requirements. The federal government sets the minimum mandatory
populations to be included in every state Medicaid program. The federal government also sets the minimum
mandatory benefits to be covered in every state Medicaid program. These benefits include physician services,
hospital services, home health services, and family planning.
4 States can add benefits, with federal approval.
Florida has added many optional benefits, including prescription drugs, adult dental services, and dialysis.
5
States have some flexibility in the provision of Medicaid services. Section 1915(b) of the Social Security Act
provides authority for the Secretary of the U.S. Department of Health and Human Services (HHS) to waive
requirements to the extent that he or she “finds it to be cost-effective and efficient and not inconsistent with the
purposes of this title.” Section 1115 of the Social Security Act allows states to implement demonstrations of
innovative service delivery systems that improve care, increase efficiency, and reduce costs. These laws allow HHS
to waive federal requirements to expand populations or services, or to try new ways of service delivery.
Florida operates under a Section 1115 waiver to use a comprehensive managed care delivery model for primary
and acute care services, the Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)
program.
6 Florida also has a waiver under Sections 1915(b) and (c) of the Social Security Act to operate the SMMC
Long-Term Care (LTC) program to provide long-term care services, including nursing facility and home and
community-based services, to individuals age 65 and over and individuals age 18 and over who have a disability.
7
The Florida Medicaid program covers over 4 million low-income individuals.
Statewide Medicaid Managed Care (SMMC) Program
Florida delivers medical assistance to most Medicaid recipients using a comprehensive managed care model, the
SMMC program. The SMMC program was intended to provide comprehensive, coordinated benefits coverage to the
Medicaid population, leveraging economic incentives to ensure provider participation and quality performance
impossible under the former, federally prescribed, fee-for-service delivery model.
The SMMC program has three components: the integrated Managed Medical Assistance (MMA) program that
provides primary care, acute care and behavioral health care services; the Long-Term Care (LTC) program
8 that
provides long-term care services, including nursing facility and home and community-based services; and the
dental component.
MMA: provides Medicaid covered medical services like doctor visits, hospital care, prescribed drugs,
mental health care, and transportation to these services.
9
LTC: provides Medicaid LTC services like care in a nursing facility, assisted living, or at home. To get LTC
you must be at least 18 years old and meet nursing home level of care (or meet hospital level of care if you
have Cystic Fibrosis).
10
3
Title 42 U.S.C. §§ 1396-1396w-5; Title 42 C.F.R. Part 430-456 (§§ 430.0-456.725) (2016).
4
S. 409.905, F.S.
5
S. 409.906, F.S.
6
S. 409.964, F.S.
7
Id.
8
The LTC program provides services in two settings: nursing facilities or home and community based services (HCBS) provided in a recipient’s home, an
assisted living facility, or an adult family care home. Enrollment in the LTC program is based on a clinical priority system and includes a wait list. The state is
approved for 62,000 recipients in the HCBS portion of LTC. In order to be eligible for the program, a recipient must be both clinically eligible under s. 409.979,
F.S., and financially eligible for Medicaid under s. 409.904, F.S.
9
Agency for Health Care Administration, Statewide Medicaid Managed Care, Health Plans and Programs, available at Florida State Medicaid Managed Care -
Health - Health Plans and Program (last visited Mar. 10, 2025).
10
Id. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
5
Dental: provides all Medicaid dental services for children and adults. All individuals on Medicaid must
enroll in a dental plan.
11
Services in SMMC are delivered by two types of managed care plans: traditional managed care organizations and
provider service networks (PSNs). Traditional managed care organizations, such as HMOs, are reimbursed as
prepaid plans – they are risk-bearing entities that are paid capitated rates (prospective, per-member, per-month
payments) by AHCA. PSNs are managed care plans controlled by health care providers, such as physician groups or
hospitals. Because health care practitioners and facilities did not previously operate managed care plans or use
capitated payment arrangements, SMMC allowed an alternative risk-bearing arrangement for PSNs.
AHCA contracts with managed care plans on a statewide and regional basis, in sufficient numbers to ensure choice.
The cyclical Medicaid procurement process ensures plans offer competitive benefit designs and prices. In addition,
plans compete for consumer choice: while Medicaid requires a basic benefit package, and regulates the adequacy of
plans’ provider networks, plans can add to their benefit packages and offer provider networks attractive to
Medicaid recipients when choosing a plan.
The SMMC program includes extensive statutory and contract requirements for plan accountability, including
network adequacy standards, financial accountability, provider compensation and prompt payment requirements,
encounter data, program integrity, transparency, and performance metrics.
12
Long-Term Care – Home and Community-Based Services
Federal Medicaid law establishes coverage for institutional care, such as nursing home care and residential
institutions for people with developmental disabilities, but does not allow federal dollars to be spent on alternatives
to such care. Those alternatives include home-based and community-based services designed to keep people in
their homes and communities instead of going into an institution when they need higher levels of care. This federal
spending limitation creates a bias toward institutional care, and toward acute care, rather than allowing the non-
acute supports that prevent institutionalization.
Florida obtained a federal waiver to allow the state Medicaid program to cover other kinds of long-term care
services for elders and people with disabilities, to prevent admission into a nursing home. Those non-institutional,
often non-acute, long-term care benefits are listed below.
SMMC Long-Term Care Mandatory Benefits
Services provided in an ALF Physical therapy
Hospice services Intermittent and skilled nursing
Adult day care Medication administration
Personal care Medication management
Home accessibility adaption Medical equipment and supplies
Behavior management Caregiver training
Home-delivered meals Respite care
Case management Personal emergency response system
Occupational therapy Transportation
Speech therapy Nutritional assessment and risk
reduction Respiratory therapy
iBudget Home- and Community-Based Waiver for Persons with Developmental Disabilities
Under federal law, Medicaid provides coverage for health care services to cure or ameliorate diseases; generally,
Medicaid does not cover services that will not cure or mitigate the underlying diagnosis, or social services.
However, people with developmental disabilities, while certainly requiring traditional medical services, need other
11
Id.
12
See, ss. 409.967, 409.975, 409.982, F.S. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
6
kinds of services to maintain their independence and avoid institutionalization. Home- and community-based
services (HCBS) are an alternative to institutionalizing people with developmental disabilities.
To obtain federal Medicaid funding for HCBS, Florida obtained a Medicaid waiver.
13 This allows coverage of non-
medical services to avoid institutionalization, and allows the state to limit the scope of the program to the number
of enrollees deemed affordable by the state.
14 In this way, the HCBS waiver is not an entitlement; it is a first-come-
first-served, slot-limited program.
The HCBS waiver program, called iBudget Florida, serves eligible
15 persons with developmental disabilities.
Eligible diagnoses include disorders or syndromes attributable to intellectual disability, cerebral palsy, autism,
spina bifida, Down syndrome, Phelan-McDermid syndrome, or Prader-Willi syndrome. The disorder must manifest
before the age of 18, and it must constitute a substantial handicap that can reasonably be expected to continue
indefinitely.
16
Unlike other Medicaid waiver programs, which are administered by AHCA, APD administers the iBudget program.
The iBudget program allocates available funding to clients, providing each one with an established budget with the
flexibility to choose from the authorized array of services that best meet their individual needs within their
community.
17 Individual waiver support coordinators assist each client with determination of his or her unique
needs and the coordination of necessary providers to provide those services.
The waiver services are delivered through a fee-for-service delivery model, which means that providers are
enrolled and reimbursed for services directly by the state agency, not a managed care plan. While providers and
individual waiver support coordinators each have a role in helping the iBudget enrollee assess and coordinate their
care, the program essentially operates with no comprehensive care management in the traditional sense. The HCBS
services are not integrated with acute medical services or behavioral health services, which are administered
separately by AHCA.
As of December 1, 2024, 35,640 individuals were enrolled in the iBudget waiver program.
18
iBudget Waiver Benefits
The iBudget Waiver provides the following home and community-based benefits:
19
iBudget Home and Community-Based Benefits
Adult day training services Social services
Family care services Specialized therapies
Guardian advocate referral services Supported employment
Parent training Supported living
Personal care services Training, including behavioral analysis services
Recreation Transportation
Residential facility services Other habilitative and rehabilitative services as
needed Respite services
iBudget waiver benefits also include Medicaid coverage for medical, non-HCBS services, administered by AHCA.
The vast majority of Medicaid recipients receive services through the SMMC managed care model, in which the
recipient can choose from different health plans – including HMOs and PSNs – to provide their care. However,
13
Florida Developmental Disabilities Individual Budgeting Waiver (0867.R02.00), March 4, 2011, authorized under s. 1915b of the Social Security Act.
14
The waiver also waives income eligibility requirements for the program, allowing the state to disregard household income and consider each waiver
applicant as a ‘family of one’.
15
The HCBS wavier retain the Medicaid requirement that enrollees be low-income, but measures only the developmentally disabled person’s income; not the
income generated by the whole household.
16
S. 393.063(11), F.S.
17
Id.
18
Agency for Persons with Disabilities, Quarterly Report on Agency Services to Floridians with Developmental Disabilities and Their Costs, Second Quarter Fiscal
Year 2024-25 (October, November, December), on file with the Human Services Subcommittee.
19
S. 393.066, F.S. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
7
under current law, using the managed care model is an option for iBudget enrollees; not a requirement. iBudget
participants can opt to use the traditional fee-for-service model of service delivery.
20
Because clinical services and home- and community-based services are provided by two different programs in two
different state agencies, these services are not integrated or managed as a whole service for the individual.
iBudget Waiver Preenrollment List
Because the waiver program covers a limited number of people (based on the amount appropriated by the
legislature each year), APD maintains a preenrollment list, or waitlist, of people who would like to enroll in the
waiver. As of December 1, 2024, 21,471 individuals were on the preenrollment list to receive services.
21
As people leave the program or as new funding becomes available, APD is expected to enroll people from the
preenrollment list in a statutory order of priority in seven categories, described below.
22
Category Description
1 Crisis, as defined by APD
2
Individuals:
From the child welfare system with an open case who are either:
o Transitioning out of the child welfare system at the finalization of an adoption, a reunification with
family members, a permanent placement with a relative, or a guardianship with a nonrelative; or
o At least 18 years but not yet 22 years of age and who need both waiver services and extended foster
care services; or
18-21 years old who chose not to remain in extended foster care
3
Individuals:
Whose caregiver has a documented condition that is expected to render the caregiver unable to provide care
within the next 12 months and for whom a caregiver is required but no alternate caregiver is available
At substantial risk of incarceration or court commitment without supports;
Whose documented behaviors or physical needs place them or their caregiver at risk of serious harm and
other supports are not currently available to alleviate the situation; or
Who are identified as ready for discharge within the next year from a state mental health hospital or skilled
nursing facility and who require a caregiver but for whom no caregiver is available or whose caregiver is
unable to provide the care needed.
4
Individuals whose caregivers are 60 years of age or older and for whom a caregiver is required but no alternate
caregiver is available
5
Individuals expected to graduate from high school within the next 12 months who need support to obtain a
meaningful day activity, maintain competitive employment, or attend postsecondary education
6 Individuals age 21 or older who do not meet the criteria for Categories 1-5
7 Individuals under age 21 who do not meet the criteria for Categories 1-4
As of December 1, 2024, 21,471 individuals were on the preenrollment list waiting for a slot to open in the iBudget
waiver.
23
iBudget Waiver Enrollment Trends
Historically, despite the utilization management tools authorized in law and the entitlement flexibilities provided
by the federal waiver, and despite legislative funding increases, APD has frequently been unable to manage the
waiver program within the budget appropriated by the legislature, resulting in significant deficit spending. For
20
S. 409.972(1)(e), F.S. AHCA policy is to enroll iBudget participants in managed care; enrollees may then choose to opt out.
21
Agency for Persons with Disabilities, Quarterly Report on Agency Services to Floridians with Developmental Disabilities and Their Costs, Second Quarter Fiscal
Year 2024-25 (October, November, December), on file with the Human Services Subcommittee.
22
S. 393.065(5), F.S.
23
Agency for Persons with Disabilities, Quarterly Report on Agency Services to Floridians with Developmental Disabilities and Their Costs, Second Quarter Fiscal
Year 2024-25 (October, November, December), on file with the Human Services Subcommittee. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
8
example, the legislature made retroactive appropriations to address APD deficits that occurred in FY 17-18
($56,895,137), FY 18-19 ($107,848,988), and FY 19-20 ($133,505,542). See Sections 30, 30, and 29, respectively, of
the respective General Appropriations Acts in those years.
Despite this deficit spending, the legislature maintained its commitment to pulling people off the waitlist and
appropriated additional funding for that purpose totaling $217,302,620 from 2017-2022. In that time, and despite
deficit spending, there was only a minor increase in net enrollment, as indicated by the chart below.
24
Conversely, in recent years APD moved to the other extreme. Now, APD stays within its annual appropriation but
fails to spend significant amounts of its budget, even when directed by the legislature to enroll more people and
reduce the preenrollment list. Instead, APD has been reverting appropriations back to the state, as indicated by the
table below.
APD General Revenue Reversions
FY 2019-20 – FY 2023-24
Fiscal Year Amount Reverted (GR)
2019-2020 $-11,287,781
2020-2021 $-983,836
2021-2022 $-39,567,230
2022-2023 $-59,135,133
2023-2024 $-73,676,927
TOTAL
$184,650,907 GR
$246,877,270 Fed
$431,528,177
As noted above, APD is not spending the appropriations made by the legislature for pulling people off the
preenrollment list and enrolling them in iBudget. The chart below compares recent funding increases to APD
spending.
25
24
Florida Community Care, presentation to the House Health and Human Services Subcommittee, February 11, 2025.
25
Data extracted from APD HCBS Surplus-Deficits Reports for this time period. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
9
Specifically, in 2024 the legislature directed APD to enroll all the people on the preenrollment list from Categories
3, 4, and 5 – 400 people – and appropriated an additional $38.8 million for this purpose.
26 As of this month, APD
has only enrolled 56 of those people individuals, as illustrated by the following table. Some of those people went
into crisis status before being enrolled.
Implementation of Directive to Enroll Categories 3-5 in Fiscal Year 2024-2025
Status of
Enrollment Group
(7/1/24 – 2/1/25)
Category 3:
Intensive
Needs
Category 4:
Caregiver
over 60
Category 5:
Transition
from School
TOTALS
Row 1
Individuals in Waitlist
Categories 3-5 (June 2024)
198 158 44 400
Row 2
Row 1 #
Moved into iBudget
5 28 23 56
Row 3
Row 1 # APD Sent to AHCA
for IDD Pilot Enrollment
0 0 0 0
Row 4
Row 1 #
No Longer APD Clients
28 9 1 38
Row 5
Row 1 # No Longer on
Waitlist (Crisis Enrollment,
ICF Admission, Other)
3 13 9 25
Row 6
Row 1 #
Still on the Waitlist
162 108 11 281
Current projections indicate APD will revert $ $32,676,653 (GR) of its FY 2024-25 appropriation.
27
Intellectual and Developmental Disabilities (IDD) Pilot Program
26
Categories 1 and 2 are already prioritized by APD.
27
APD HCBS Waiver Monthly Surplus-Deficit Report for Waiver Program Expenditures FY 2024-25, Feb. 2025, on file with the Human Services Subcommittee.
$-
$20,000,000
$40,000,000
$60,000,000
$80,000,000
$100,000,000
$120,000,000
$140,000,000
Jun-22 Dec-22 Jun-23 Dec-23 Jun-24 Dec-24
Comparing Waitlist Funding vs Spending
Waitlist Funding Appropriated Waitlist Funding Spent
Linear (Waitlist Funding Appropriated)Linear (Waitlist Funding Spent) JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
10
In 2023, the Legislature created the IDD Pilot Program in SMMC Region D (Hardee, Highlands, Hillsborough,
Manatee and Polk counties) and Region I (Miami-Dade and Monroe counties).
28 This established a managed care
model for integrating medical care and HCBS for persons with intellectual and developmental disabilities, as an
alternative to the iBudget model. To obtain federal Medicaid funding for the IDD Pilot Program, Florida obtained a
Medicaid waiver in April 2024.
29
Eligibility
The IDD Pilot Program is available to individuals who:
Are Medicaid-eligible and 18 years of age or older
Have been assigned to categories 1 through 6 on the iBudget preenrollment list, and
Reside in a pilot program region.
The IDD Pilot is only available to people on the iBudget preenrollment list, not iBudget enrollees; and is not
available statewide. This is a voluntary option for people in the pilot regions; there is no requirement to enroll in
the pilot program.
Currently, enrollment is capped at 600 participants.
Enrollees are allowed the opportunity to disenroll from the IDD Pilot Program and enroll in any appropriate
existing Medicaid waiver program if any of the following conditions occur:
At any point during the operation of the IDD Pilot Program, an enrollee declares an intent to voluntarily
disenroll, provided that he or she has been covered for the entire previous plan year by the IDD Pilot
Program.
AHCA determines the enrollee has good cause to disenroll.
The IDD Pilot Program ceases to operate.
Benefits
Current law requires the following benefits for the pilot program, delivered through a single, integrated model of
care:
All the medical care benefits covered in the SMMC program, as described in s. 409.973, F.S., including
access to prepaid dental plans;
All the long-term care benefits covered in the SMMC program, as described in s. 409.98, F.S.; and
All the HCBS covered in the iBudget program, as described in s. 393.066, F.S.
Additionally, each enrollee must have a Care Coordinator. AHCA’s contract with the plan requires a ratio of one IDD
Care Coordinator per 18 enrollees; this 1:18 staffing ratio varies significantly from the 1:60 staffing ratio required
for long-term care.
As with other SMMC programs, AHCA negotiates for expanded benefits from the plans. These are benefits plans
offer without cost to the state: the costs are not built into the managed care capitated rate. Rather, plans offer these
benefits to attract enrollees and increase quality; some expanded benefits can prevent medical decline and the
need for catastrophic medical care.
Administration
Current law requires AHCA to administer the pilot program using a managed care model. AHCA must contract with
a Medicaid managed care plan currently under contract with AHCA to provide long-term care services. Experience
providing HCBS to a population requiring significant care coordination is thereby a predicate for obtaining the
28
AHCA competitively procures plans in the SMMC program by region; there are nine SMMC regions.
29
Florida Comprehensive Intellectual Developmental Disabilities Managed Care Pilot Program (2346.R00.00), April 1, 2024, authorized under s. 1915b of the
Social Security Act. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
11
contract. Similarly, current law requires the plan to have experience serving similar populations and have
contracts in place with providers who serve persons with developmental disabilities, among other requirements.
Under the IDD Pilot Program, AHCA is responsible for:
Negotiating with and selecting qualified plans to participate in the pilot program;
Making capitated payments for to managed care organizations for comprehensive coverage under the pilot
program; and
Evaluating the feasibility of statewide implementation of the capitated managed care model used by the
pilot program to serve individuals with developmental disabilities.
Under the IDD Pilot Program, APD is responsible for:
Approving a needs assessment methodology to determine functional, behavioral, and physical needs of
prospective enrollees.
Providing a consultative resource for AHCA in the development of policy for the pilot program.
Implementation
In November 2023, AHCA issued an Invitation to Negotiate for each region participating in the IDD Pilot Program
and awarded a contract to Florida Community Care (FCC), a SMMC Long-Term Care plan, in February 2024. In
August 2024, APD began identifying individuals potentially eligible for enrollment.
Enrollment is increasing, but slowly and irregularly. This appears to be due in part to the fact that communication
regarding the program to people on the preenrollment list and their families is exclusively performed by APD,
rather than AHCA or FCC. APD issued one mailing effort in August 2024 advising families of the new pilot option.
30
Families were required to fill out and mail back an interest form to APD; neither APD or AHCA provided an online
method of expressing interest. APD then engaged in a process to contact the interested person to verify eligibility,
obtain another federal form, and conduct an assessment of the person’s needs. Only at that point would APD send
AHCA information on the interested person; then AHCA sent FCC the enrollment file.
31
It appears that at no time did the person or their family receive one-on-one, specific information on the program or
how it worked until FCC received the enrollment file. In addition, it appears that APD’s August letter of interest
form was the only point of initial communication: there is no periodic or repeated communication to eligible
persons about this option.
32 This is in contrast to the current method of enrollment in SMMC plans, which involves
extensive online and mailed information, in addition to a call center.
33
The assessment APD conducts for the prospective enrollee is the “Questionnaire for Situational Information” (QSI)
authorized by s. 393.0662, F.S. APD conducts this assessment for iBudget enrollees based on its obligation to do so
within the federal terms and conditions of the iBudget waiver approval.
34 However, the terms of the iBudget waiver
do not govern the waiver for the IDD Pilot program. Under AHCA’s contract with the plan, the assessment is to be
done by the plan, and must be conducted within 5 days of enrollment. APD does not have a similar deadline, and it
appears that waiting for APD to conduct the QSI may be contributing to delays in enrollment.
Since October, over 600 people have expressed interest in the pilot program; however, APD had sent files to AHCA
on half that number by early February, as indicated by the graph below.
35
30
This correspondence also included information on the option to enroll in iBudget pursuant to the legislature’s funding increase that year, which may have
generated confusion.
31
Florida Community Care, presentation to the House Health and Human Services Subcommittee, February 11, 2025.
32
Id.
33
See, e.g., Agency for Health Care Administration, “Enrolling in A Health Plan”, https://www.flmedicaidmanagedcare.com/health/enroll (last viewed March
24, 2025).
34
Email from APD staff, March 10, 2025, on file with the Human Services Subcommittee.
35
Florida Community Care, presentation to the House Health and Human Services Subcommittee, February 11, 2025. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
12
As of March 15, 2025, 364 individuals have enrolled in the IDD Pilot Program.
Once the individual is enrolled, FCC then conducts the comprehensive assessment required by its contract with
AHCA and the federal terms and conditions for the pilot waiver approval. FCC data indicates 83 percent of
enrollees receive this assessment within five days of enrollment, as indicated by the chart below.
Once the assessment is complete, the plan can initiate services. FCC data indicates the plan initiates services for the
enrollee within seven days of enrollment for 56 percent of enrollees. Notably, for both assessment and service
initiation purposes, FCC is unable to locate the enrollee in seven percent of cases. This may point to flawed or out-
of-date data transferred from APD.
Assessment
within 5
Days -83%
Member
Choice-
9%
Unable to
Locate-7%
Plan Error
1%
Other
17%
Comprehensive Assessment within 5 Days (Nov 2024-Jan 2025) JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
13
Expanded Benefits
AHCA negotiated a significant array of expanded benefits in the pilot program, not offered under the iBudget
waiver. In the time since enrollment began, FCC tracked expanded benefit use and provided data on the most
commonly-used expanded benefits, as noted in the chart below.
36
iBudget Waiver Preenrollment List and Quarterly Reconciliation Reports
Clients seeking iBudget Florida waiver enrollment are assigned a preenrollment category on the iBudget
preenrollment list, based on their individual circumstance as delineated in s. 393.065(5). APD no longer posts this
list, or data derived from it, on its website.
Section 393.0662 requires APD, in consultation with AHCA, to provide a quarterly reconciliation report of all home
and community-based services waiver expenditures from AHCA’s claims management system with service
36
FCC data on expanded benefits utilization, March 14, 2025,
Service
Initiation
Within 7 days
56%
Member
Choice
32%
Unable to
Locate -8%
Plan/Provider
Error-4%
Other
44%
Service Initiation Time Nov 2024 -Jan 2025
IDD Pilot Utilization of Expanded Benefits
Healthy Grocery Card for Caregivers
Gym Memberships
Cooking at Home Catalog - Air Fryer
Hygiene and Wound Care Kit
Legal Guardianship - Initial
Cellular Phone Services
DME Services and Supplies: Blood Pressure Device
Recreational Therapy
Cooking at Home Catalog - Pot and Pan Set
Dental Desensitization Kits
Legal Guardianship - Maintenance
Cooking at Home Catalog - Blender JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
14
utilization from APD’s Allocation, Budget and Contract Control system to the Governor and Legislature. APD does
not post this report on its website.
Current law does not require APD to post any data concerning the preenrollment list or the quarterly
reconciliation reports on its website.
Child Welfare Coordination
Transition Plans
Some children in out-of-home care do not receive a permanent placement and age out of the child welfare system.
Current law requires the Department of Children and Families (DCF) and the appropriate community-based care
lead agency (CBC) to assist an older foster youth to develop a transition plan during the year after his or her 16
th
birthday. A transition plan targets the state’s independent living programs to help older foster youth access
housing, health insurance, financial literacy, a driver’s license, workforce support, and employment services.
37 DCF
must regularly review the transition plan, and the court must approve it before the older youth’s 18
th birthday.
38
Extended Foster Care
The permanency goal for a young adult who chooses to remain in care past his or her 18th birthday is to transition
to independence. To this end, current law gives these young adults the option to remain in DCF care under judicial
supervision as long as they participate in a qualifying self-sufficiency activity (e.g., pursuing a high school diploma,
GED, postsecondary education, vocational education, workforce development programs, or maintaining
employment for at least 80 hours a month). However, the young adult may be excused from the self-sufficiency
activities if the young adult documents a physical, intellectual, emotional, or a psychiatric condition that limits the
young adult’s full-time participation.
39
As long as the young adult remains in extended foster care, the CBC must provide regular case management
reviews, which includes at least monthly face-to-face meetings with the case manager.
40 In addition, current law
requires DCF or the appropriate CBC to convene a multidisciplinary staffing to discuss one or more important life
decisions in a child’s life which are so complex that they believe a multidisciplinary staffing is necessary to ensure
the best interests of the child.
41
Judicial Review of Extended Foster Care
While the young adult is in extended foster care, the dependency court retains jurisdiction over the young adult’s
case. The presiding judge must ensure that DCF and the CBC provide services and must coordinate with other
agencies who are involved with implementing the young adult’s case plan, individual education plan, and transition
plan.
42 The court must review the status of the young adult at least every 6 months with a permanency review
hearing at least annually.
43
For each review hearing, DCF and the CBC must prepare and submit a case plan progress report to the judge and
propose modifications to the court as necessary.
44 If the presiding judge believes that the young adult is entitled to
additional services to achieve his or her case plan goals, the judge may order DCF to arrange for the provision of
any identified services.
45
37
Ss. 39.6035, 409.14515, F.S.
38
S. 39.6035(3)-(4), F.S.
39
S. 39.6251(2)(e), F.S.
40
S. 39.6251(7), F.S.
41
S. 39.4022(5)(a), F.S. A multidisciplinary team is an integrated group of individuals which meet to collaboratively develop and attempt to reach a consensus
decision on the most suitable out-of-home placement, educational placement, or other specified important life decision that is in the best interest of the child.
s. 39.4022(2)(c), F.S.
42
S. 39.6251(8), F.S.
43
S. 39.6251(8), F.S., s. 39.701(4), F.S.
44
S. 39.701(4)(a), F.S.
45
S. 39.701(4)(d), F.S. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
15
For a young adult with developmental disabilities, extended foster care ends on his or her 22
nd birthday, when the
young adult achieves permanency, or when the young adult knowingly and voluntarily withdraws consent to
participate in extended foster care.
46 However, DCF may not close the dependency case, and the dependency court
may not terminate jurisdiction, until the young adult attends the final hearing (or offers informed written consent
to waive right of personal appearance).
47
Family Care Councils
In 1993, the Legislature established fifteen Family Care Councils (FCCs) which represent each service area of the
Agency for Persons with Disabilities to advise the agency on the needs of self-advocates and their families. The
primary functions of the local FCCs are to:
Assist in providing information and outreach to families;
Review the effectiveness of service programs and make recommendations with respect to program
implementation;
Advise the agency with respect to policy issues relevant to the community and family support system in the
local area; and
Meet and share information with other local family care councils.
48
Each local FCC must have between 10 and 15 members. Members of each FCC must be recommended by a majority
vote of the local FCC and then appointed by the Governor.
49
RECENT LEGISLATION:
YEAR BILL # HOUSE SPONSOR(S) SENATE SPONSOR OTHER INFORMATION
2023 SB 2510 Appropriations Appropriations Became law on July 1, 2023.
BILL HISTORY
COMMITTEE REFERENCE ACTION DATE
STAFF
DIRECTOR/
POLICY CHIEF
ANALYSIS
PREPARED BY
Human Services Subcommittee 17 Y, 0 N, As CS 3/18/2025 Mitz Mitz
THE CHANGES ADOPTED BY THE
COMMITTEE:
Click or tap here to enter text.
Budget Committee 26 Y, 0 N 3/27/2025 Pridgeon Smith
Health & Human Services
Committee
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THIS BILL ANALYSIS HAS BEEN UPDATED TO INCORPORATE ALL OF THE CHANGES DESCRIBED ABOVE.
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46
S. 39.6251(5), F.S.
47
S. 39.701(e), F.S.
48
S. 393.502(7), F.S.
49
S. 393.502(2)(a), F.S. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
16