October 10, 2007  SCHIP Marooned By President’s Veto When President Bush vetoed the SCHIP reauthorization bill in late September, few were surprised, as he had long said he would do just that. What was surprising was that, unlike the previous three vetoes of his presidency, this one was done behind closed doors and away from the cameras, as if this veto was much harder to explain and rather shameful. Interestingly, in an era where partisan bickering has been the norm, some of the strongest criticism to the President’s veto has come from respected members of his own party. Florida’s Congressional delegation has not voted consistently along majority party lines, either. Speaker Pelosi has scheduled the override vote for as late as possible, October 18. (by Andrew Leone, Florida CHAIN) Read more   TAKE ACTION: Tell Congress to Override and Save SCHIP Photo captions: 1. UM medical students protest SCHIP veto 2. Children in DC say no to President 3. Sen, Mel Martinez's aide, John Newstreet, discusses boss' pro-veto stance at Deltona town hall
	TAKE ACTION: Tell Congress to Override and Save SCHIP Without fanfare or cameras rolling, President Bush vetoed the State Children Health Insurance Program (SCHIP) bill before him. This bi-partisan legislation would provide $35 billion to fund the reauthorization and expansion of SCHIP. It would cover up to 10 million uninsured American children who are not poor enough to qualify for Medicaid, but whose families cannot afford private health insurance. Click here to tell Senators Martinez and Nelson and your Florida Representative to vote to give children health  coverage by overriding the President's veto. Read more and TAKE ACTION TAKE ACTION: Thank Florida Legislators for KidCare Addition   On October 5th, Florida House and Senate Budget Conferees voted to add $1.1 million in general revenue to the KidCare program.  This will allow an additional 5,000 children to enroll.  This is a temporary addition funding the program until the regular Session and to accommodate a successful outreach effort.  The full Legislature will have to adopt the Conference Report on Friday, October 12th before this becomes law, but it is hoped no one will object.  Some legislators must be thanked for this increase in a budget cutting session. (by Karen Woodall, Children's Defense Fund, Florida) Read more and TAKE ACTION
	OIG Report on Medicaid Reform Reaffirms Advocates Concerns   At the request of Dr. Andrew Agwunobi, AHCA Secretary, the Office of the Inspector General has produced a Florida Medicaid Reform report generally critical of the program’s implementation to date. Its conclusions reflect many of the concerns raised by advocates throughout the reform process: the speed with which the plan was designed and implemented, the lack of adequate information available to choice counselors to give enrollees appropriate advice, serious implementation problems with the Enhanced Benefit program, and the lack of population specific provisions. (by Andrew Leone, Florida CHAIN) Read more Advocates Score Important Victories In response to continued demands by advocates since before the roll out of Medicaid Reform in the pilot counties, it appears the Agency for Health Care Administration will implement two important changes. Beginning on January 2, choice counselors will have access to each of the reform plans’ Preferred Drug List (PDL). Until then, enrollees are compelled to choose among several managed care plans without the benefit of knowing what drugs each covers. The other news welcomed by advocates was AHCA’s intention to reinstate the long dormant Medical Care Advisory Committee (MCAC). (by Andrew Leone, Florida CHAIN) Read more Medicaid Chief Reports to Senate Health Policy Committee on Expansion Those interested on where Medicaid Reform is headed were eagerly anticipating Medicaid Director Tom Arnold’s report to the Florida Senate Health Policy Committee, on October 4th. Instead, Mr. Arnold laid out “Guiding Principles” that provide a number of hints but no certainties. (by Andrew Leone, Florida CHAIN) Read more

	PIP Sunsets? But It Will Rise Again After much backroom dealing and expenditure of political capital, Personal Injury Protection (PIP) was rescued from permanent sunset and allowed to be reborn during Florida’s legislative special session. As the newly agreed upon legislation will not take effect until January 1st, Florida drivers whose policies expired after October 1st will go three months without PIP and will have to buy separate coverage to protect themselves against lawsuits should they be involved in an accident. (by Andrew Leone, Florida CHAIN) Read more Clay County Health Department Caps Prenatal Care   Faced with an increasing number of pregnant women without insurance, the Clay County Health Department recently announced plans to cap its prenatal caseload. The health department previously provided care to low-income, uninsured women - including delivery - regardless of ability to pay. Clay County was one of the few remaining counties in northeast Florida to provide no-cost services to uninsured pregnant women. (by Carol Brady, NE Florida Healthy Start Coalition) Read more Children and Youth Cabinet Begins Work Aimed at Coordinating Departments   The new Florida Children & Youth Cabinet convened its first meeting Oct. 1, bringing together secretaries and heads of several state agencies that deal with children’s issues. Until now, state agency officials had little incentive to communicate with each other and map out cross-agency strategies that would improve the way publicly funded programs serve children. (by Alisa Snow, Snow Strategies) Read more
	Budget Balanced on Medicaid Services and Education Florida lawmakers have put the final touches on a plan to cut more than $1.1 billion from the budget with a final vote scheduled for Friday, October 12.  As forecast, most of the burden of the cuts will fall upon healthcare and education. These cuts would be shouldered primarily by hospitals and providers serving Medicaid consumers. In the long run, their losses are likely to be offset by increased costs to taxpayers and local communities, who are also mandated to cut their own spending. (by Andrew Leone, Florida CHAIN) Read more
	Medicare, Managed Care and the Paradigm Switch   The seminal image of our era may be that of people being bombarded by products offering the illusion of “choice.” No media is exempt from issuing this barrage of information that may only serve to confound consumers. This is particularly true with health care services and products, and even more so when these are aimed at seniors and baby-boomers fast becoming seniors. Medicare, the safety net established in 1965 to provide older Americans with adequate health care, has become a major arena in this. Advocates contend that refocusing Medicare from a program intended to provide health care services to one intended to provide the myriad of choices put before seniors are in the best interest of the managed care companies, not consumers.  Even a Bush Administration sympathetic to the industry recognizes that. (by Andrew Leone, Florida CHAIN) Read more
	Medicaid Waiver, Pharmaceutical Access, Film: Today's Key Florida Mental Health Issues Mental Health America Public Policy Council of Florida sees three issues that will have substantial impact on Mental Health Care soon: 1) The recently released GAO Vermont and Florida Medicaid Waivers report findings of mixed implications for beneficiaries - MHA will be exploring opportunities to bring the report to light and to provide Congress and HHS with suggestions for improving the public input process. 2) MHA's request for continued open access of the psychotropic medications to the Pharmaceutical and Therapeutic Committee on September 12 - the committee then made its recommendations to AHCA's Chief Pharmacist, who will, hopefully, include them in the State formulary. 3) Release of the movie, CANVAS - it contains a powerful message about how a family copes with a paranoid schizophrenic mother as seen through the eyes of a 12-year-old. (by Rick Wagner, MHA Greater Tampa Bay and MHA Public Policy Council of Florida) Read more
	A Swing and a Miss? Steering committee members of the Healthy Florida Alliance (HFA) decided in late September to pursue an increase on excise taxes for cigarette products during the Florida Legislature’s October 1-5 Special Session. Eventually, a champion for this effort emerged in Rep. Jim Waldman. During the initial House floor action on October 5, the House laid the House bill on the table and adopted the Senate bill, rendering Waldman's  amendment useless. He decided to retire his efforts for this Special Session, but has said that he would champion the bill again during the regular spring 2008 session. (by James Mosteller, American Heart Association) Read more
	Mental Health Awareness Month Celebrated in Broward Activities related to Mental Health Awareness Month planned by the Mental Health Association of Broward and the Alcohol, Drug and Mental Health (ADM) Planning Council of Broward included an exhibit of works related to the issue at the Broward County Governmental Center. Some of the works in the show Stigma Exposed” were inspired by the experiences of individuals affected by Medicaid Reform. (by Andrew Leone, Florida CHAIN) Read more Health Care Access Rights Town Hall Series Continues   Hispanic Health Initiatives and Florida CHAIN continued their series of Central Florida town hall meetings discussing issues of health care access. Events have already taken place in Orange, Seminole and most recently in Volusia County.  One more town hall will take place in Osceola on November 1. For more information visit Hispanic Health Initiatives at www.hispanichealthinitiatives.org or call 407/339-2001. (by Andrew Leone, Florida CHAIN) Read more

	Medically Needy Program Imposes Unrealistic Burdens on Participants One day in February 2000, Eileen Curras realized something was wrong. She was vomiting and feeling dizzy. After a couple of days, “I was hitting walls and walking like I was drunk,” she now recalls, “so I went to Jackson Memorial emergency room.” One thing was obvious; the 37 year old, widowed mother of a 4 year old had a serious neurological disorder. It was soon diagnosed as Multiple Sclerosis. Like millions of other Americans, Eileen had no insurance. (by Andrew Leone, Florida CHAIN) Read more

	CHAIN Reaction is a bi-weekly publication of Florida CHAIN (Community Health Action Information Network), a statewide consumer advocacy organization that works toward access to quality health care, empowering people to actively shape their world by participating in civic life and caring for each other’s well being.  Florida CHAIN: 6600 Cypress Road #508, Plantation, FL 33317   info@floridachain.org     www.floridachain.org
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SCHIP Marooned By President’s Veto When President Bush vetoed the SCHIP reauthorization bill in late September, few were surprised, as he had long said he would do just that. What was surprising was that, unlike the previous three vetoes of his presidency, this one was done behind closed doors and away from the cameras, as if this veto was much harder to explain and rather shameful.   Interestingly, in an era where partisan bickering has been the norm, some of the strongest criticism to the President’s veto has come from respected members of his own party. Utah’s senior senator, Orrin Hatch, a cosponsor of the original 1997 bill, said “The President is getting bad advice on this (SCHIP veto).”  Referring to inaccurate information about the SCHIP bill by its detractors, ranking Senate Finance Committee member, Republican Sen. Chuck Grassley of Iowa, said, “A lot of misinformation has been spread about this bill. But in Iowa, you can’t call a cow a chicken and have it be true.”   Florida’s Congressional delegation has not voted consistently along majority party lines, either.  Democrat Representative Kathy Castor, of Tampa, surprised many supporters when she voted against SCHIP in the House. According to the Tampa Bay Tribune, “Castor said her decision (on how to vote in the override effort) will depend on whether some of the bill's policies can be "ameliorated" and what "assurances can be made." She said that includes "undoing the harm" that would be done to the cigar industry. The proposed cigar tax hikes are projected to raise as much as $800 million, but Castor has doubts about that.”   Florida children’s advocates who have long seen Castor as a champion for their causes, were dismayed by her action calling it “a bad vote,” and have urged her to support the veto override.   On the Republican side, two House members, Representatives Bill Young and Pat Buchanan supported the bill. In an opinion piece on the Herald Tribune, Rep. Buchanan stated, “I grew up in a blue-collar home with five brothers and sisters, so I understand the challenges and pressures facing working families. The skyrocketing cost of health care is often unattainable for families who struggle to put food on the table, pay the bills and save whatever is left over for college or retirement.   That's why the Children's Health program is such a worthwhile investment. It gives kids from low-income families access to care and medicine.”   As it pertains to our state, Rep. Buchanan added, “Florida would receive $51 million more in 2008 to cover low-income children, according to the House Energy and Commerce Committee.”   In the upper chambers, Sen. Mel Martinez has been weighing in on the debate via a number of opinion pieces published in Florida papers. On a more recent one in the St. Petersburg Times, Martinez supports the President’s ideological aversion to the present bill, and foreseeing a failed override attempt, urges: “It is essential that we come together as Republicans and Democrats to talk about viable alternatives - something that would ensure the reauthorization of a SCHIP that expands, rather than diminishes, private health insurance coverage for children.”   The other Florida senator, Bill Nelson, is a strong backer of the bill.  Although the Senate appears to have enough votes to override the President’s veto, in the House SCHIP supporters need to pick up at least 15 additional votes. In an effort to pressure those representatives who are more likely to switch to yes votes, Speaker Pelosi has scheduled the override vote for as late a date as possible, October 18.   (submitted by Andrew Leone, Florida CHAIN) TAKE ACTION: Tell Congress to Override and Save SCHIP Without fanfare or cameras rolling, President Bush vetoed the State Children Health Insurance Program (SCHIP) bill before him. This bi-partisan legislation would provide $35 billion to fund the reauthorization and expansion of SCHIP. It would cover up to 10 million uninsured American children who are not poor enough to qualify for Medicaid, but whose families cannot afford private health insurance.  In Florida, the long term survival of KidCare, a program that could insure up to 500,000 Floridian children, is at stake. Click here to TAKE ACTION.    Florida's U.S. Senator Bill Nelson voted for SCHIP; Senator Mel Martinez voted against. Some Florida Republican House members voted in support of SCHIP; one Democrat voted against. They ALL need to hear from us.   Click here to tell Senators Martinez and Nelson and your Florida Representative to vote to give children health  coverage by overriding the President's veto - and that Americans of all political stripes overwhelmingly support SCHIP reauthorization and expansion. TAKE ACTION: Thank Florida Legislators for KidCare Addition   On Friday, October 5th, Florida House and Senate Budget Conferees voted to add $1.1 million in general revenue to the KidCare program.  This will allow an additional 5,000 children to enroll.  This is a temporary addition funding the program until the regular Session and to accommodate a successful outreach effort.  The full Legislature will have to adopt the Conference Report on Friday, October 12th before this becomes law, but it is hoped no one will object.    Children’s advocates were particularly happy that the Legislature added dollars to KidCare even in the midst of a budget cutting Special Session.  This is a testament to our collective work on helping them to understand the importance of this program and it hopefully reflects a new attitude toward covering uninsured children in Florida.   The following members who made this happen should be thanked. Click to email, or call them:      Rep. Aaron Bean  850/488-6920    Rep. Bill Galvano 850/488-4086     Rep. Loranne Ausley 850/488-0965     Senator Durrell Peaden  850/487-5000     Senator Ken Pruitt  850/487-5229     Rep. Marco Rubio  850/488-1450      This is also an opportunity to ask state legislators – especially Republicans – to assist with urging their colleagues in the US Congress to override President Bush’s veto of the SCHIP bill, as it would allow for expanding the federal dollars so that Florida, a state with the second highest number of uninsured children, will have the resources to begin covering more children.    (submitted by Karen Woodall, Children's Defense Fund, Florida)   OIG Report on Medicaid Reform Reaffirms Advocates Concerns   At the request of Dr. Andrew Agwunobi, AHCA Secretary, the Office of the Inspector General has produced a Florida Medicaid Reform report generally critical of the program’s implementation to date.   In a statement posted on the AHCA website, Dr. Agwunobi praised the quality of the report and expressed his belief that “it represents the type of independent, objective and thorough analysis I was seeking.”   Conclusions listed in the report’s executive summary are reflective of many of the concerns raised by advocates throughout the reform process. These include the speed with which the plan was designed and implemented, the lack of adequate information available to choice counselors to give enrollees appropriate advice, serious implementation problems with the Enhanced Benefit program, and the lack of population specific provisions. To this last point the report sates, “Beneficiary populations, such as the severely and persistently mentally ill and those with complex medical conditions, face unique and serious challenges in adapting to managed care as do the plans/Provider Service Networks serving them.”   Advocates have also been concerned with issues related to plan dis-enrollment data and complaint data. To this, the report states, “Of the 156 complaints, the largest category of complaint is “Other”, similar to the “Service-General” category in the BMHC database. This suggests a similar need for refinement of categories and staff training regarding category definitions.”   Of particular interest in the report are also the responses to an on-line anonymous survey by AHCA field staff where concerns about the reform implementation are discussed candidly. Some comments include, “From a choice perspective, some things were tested in production vs. prior to production, not the preferable way to do business. This is due to limited time frame to implement;” and “We may have thought we were ready, but the behavioral health providers, members, and advocates certainly were not. We as an Agency did not communicate openly and honestly about the true impact of Reform on them. I know it was not for them, however they provide the services.   Click here to read the OIG report.    (submitted by Andrew Leone, Florida CHAIN) Medicaid Reform Roundup: Advocates Score Important Victories In response to continued demands by advocates since before the roll out of Medicaid Reform in the pilot counties, it appears the Agency for Health Care Administration will implement two important changes to the program. Beginning on January 2nd, 2008, choice counselors will have access to each of the reform plans’ Preferred Drug List (PDL). Until such time as this change is implemented, Medicaid enrollees are compelled to choose among several managed care plans without the benefit of knowing what drugs each covers. Area 10 Medicaid official Rafael Copa broke the news to Florida CHAIN. “The health plans have already been notified and we are working on creating the necessary software. If everything goes according to plan, we will begin having the information available to callers after the first of the year,” he said.   The other news welcomed by advocates was AHCA’s intention to reinstate the long dormant Medical Care Advisory Committee (MCAC). The advisory body, though mandated by federal statute, has not met since 2000, and it must include consumers, advocates, providers and other stakeholders. According to information received by Anne Swerlick of Florida Legal Services, nominations are being requested at this time and a first meeting of the MCAC is expected by November 15. As indicated previously in CHAIN Reaction, parties interested in submitting nominations should contact Carla Sims at simsc@ahca.myflorida.com or 850-922-8447.   Medicaid Chief Reports to Senate Health Policy Committee on Expansion   Those interested on where Medicaid Reform is headed were eagerly anticipating Medicaid Director Tom Arnold’s report to the Florida Senate Health Policy Committee, on October 4th. There had been reports that on that day, Mr. Arnold was going to unveil which counties AHCA is planning to expand Reform to upon legislative approval.    Instead, Mr. Arnold laid out “Guiding Principles” that provide a number of hints but no certainties. Among the criteria, future expansion will be implemented in counties with capitated management experience and larger mandatory populations. Expansion will also be contingent upon the effect of expansion on the choice counseling contract and lessons learned from pilot counties.   Florida legislators approved Medicaid Reform in 2005 but mandated that it be implemented in pilot counties first and reserved the right to vote for possible expansion following a 2 year evaluation by the University of Florida.   (submitted by Andrew Leone, Florida CHAIN)     PIP Sunsets? But It Will Rise Again   After much backroom dealing and expenditure of political capital, Personal Injury Protection (PIP) was rescued from permanent sunset and allowed to be reborn during Florida’s legislative special session. Tallahassee observers attributed much of the credit to State Rep. Ellyn Bogdanoff.   According to the South Florida Sun-Sentinel, “The compromise (between House and Senate versions of) the legislation appeared in jeopardy Thursday when House Republicans amended the bill to impose caps on the fees attorneys could receive in auto accident cases. But lead House negotiator Rep. Ellyn Bogdanoff saved the day by returning to the original text of the bill.”   PIP guarantees a minimum $10,000 personal injury coverage, regardless of who is at fault in an automobile accident. Most advocates were concerned that the demise of PIP, in a state where 20% of residents have no health insurance, would have created sever hardship on consumers.   Major auto insurers, on the other hand, lobbied heavily to sunset the 36-year-old law, on the grounds that it fostered fraud.   According to the Sun-Sentinel, “Targeting fraud, the legislation creates a fee schedule for medical payments on injuries, limiting physicians to 200 percent of Medicare reimbursement rates and emergency-room doctors to 80 percent of their usual charges.”   As the newly agreed upon legislation will not take effect until January 1st, Florida drivers whose policies expired after October 1st will go three months without PIP and will have to buy separate coverage to protect themselves against lawsuits should they be involved in an accident.   (Submitted by Andrew Leone, Florida CHAIN) Clay County Health Department Caps Prenatal Care   Faced with an increasing number of pregnant women without insurance, the Clay County Health Department recently announced plans to cap its prenatal caseload. The health department previously provided care to low-income, uninsured women - including delivery - regardless of ability to pay.   Reduced funding and growth in uninsured residents prompted the move, according to local health officials.   The agency will step up efforts to screen pregnant women for Medicaid eligibility and adopt new measures to collect payment from the patients it sees. Pregnant women who do not qualify for Medicaid will be referred to the few local doctors who accept self-pay patients.   Clay County was one of the few remaining counties in northeast Florida to provide no-cost services to uninsured pregnant women. Health departments in Nassau and St. Johns Counties no longer operate prenatal clinics, referring instead to local obstetricians who accept Medicaid. Duval and Baker County offer prenatal services primarily to women who are covered by Medicaid.   Pregnant women who are not eligible for Medicaid must find a doctor or clinic willing to work out a payment plan.   Medicaid currently covers low income, uninsured women with incomes up to 185% of the federal poverty level (about $38,200 for a family of four) for their pregnancies.   Expanded eligibility levels - permitted under the federal-state program - were proposed during the last legislative session as part of the unsuccessful KidCare bill.   Statewide, Medicaid covers nine percent of all women age 15-44; however, nearly one-fourth of women in this age group remain uninsured in the state. (submitted by Carol Brady, Executive Director, Northeast Florida Healthy Start Coalition) Children and Youth Cabinet Begins Work Aimed at Coordinating Departments The new Florida Children & Youth Cabinet convened its first meeting Oct. 1, bringing together secretaries and heads of several state agencies that deal with children’s issues.   The inaugural meeting was kicked off by Gov. Charlie Crist, who endorsed the Cabinet concept that was approved by the Florida Legislature earlier this year.   "Serving on this panel is probably the most important thing you'll ever do," Crist said, according to the Tallahassee Democrat. "You're looking out for everyone's future."   Lt. Gov. Jeff Kottkamp serves as chairman of the Cabinet, which is made up of officials from state departments ranging from health to juvenile justice.   Department of Juvenile Justice Secretary Walt McNeil noted that a full quarter of the children who enter the juvenile justice system are coming from schools. This trend indicates that perhaps state officials should revisit “zero tolerance” policies that lead to the student expulsions.   Until now, state agency officials had little incentive to communicate with each other and map out cross-agency strategies that would improve the way publicly funded programs serve children.   For example, multiple state agencies including the Agency for Workforce Development have programs that offer subsidized childcare. These state agencies compete against each other for state funding. Perhaps a statewide strategic approach could stretch those dollars more effectively across more families.   According to Cabinet members, the state’s strict Sunshine Laws make it difficult for top-level agency officials to collaborate on cross-agency issues. Children’s advocates hope the new Cabinet will spark these sorely needed discussions.   The idea for the Cabinet came during the 2006 Florida Children’s Summit in Orlando. The Cabinet was created by a bill in the 2007 legislative session that was sponsored by Rep. Loranne Ausley and Sen. Nan Rich.   (submitted by Alisa Snow, consultant, Snow Strategies)   Members include: Lt. Governor Jeff Kottkamp Secretary Bob Butterworth, Department of Children and Families Secretary Walt McNeil, Department of Juvenile Justice Secretary Andrew Agwunobi, Agency for Health Care Administration Director Jane Johnson, Agency for Persons with Disabilities Director Monesia Brown, Agency for Workforce Innovation State Surgeon General Ana Viamonte Ros, Department of Health Commissioner Jeanine Blomberg, Department of Education Angela Orkin, Director of the Guardian Ad Litem Office Jim Kallinger, Chief Child Advocate Judy Schaechter, physician and professor at the University of Miami, Mailman Center for Child Development David Lawrence Jr., President of the Early Childhood Initiative Foundation at the University of Florida Donna Gay Lancaster, Executive Director of the Juvenile Welfare Board of Children’s Services Antonia Crawford, Chairman of the Early Learning Coalition Dick Batchelor, President of Dick Batchelor Management Group Ex officio members include the following: President Ken Pruitt, Florida Senate Speaker Marco Rubio, Florida House of Representatives Chief Justice Fred Lewis, Florida Supreme Court Attorney General Bill McCollum Chief Financial Officer Alex Sink Budget Balanced on Medicaid Services and Education   Florida lawmakers have put the final touches on a plan to cut more than $1.1 billion from the budget with a final vote scheduled for Friday, October 12.  As forecast, most of the burden of the cuts will fall upon healthcare and education.   According to the St. Petersburg Times, “Health and human services agencies would have nearly $480 million less to spend, primarily because they would get less in Medicaid reimbursement rates.” These cuts would be shouldered primarily by hospitals and providers serving Medicaid consumers. In the long run, their losses are likely to be offset by increased costs to taxpayers and local communities, who are also mandated to cut their own spending.   Sen. Lisa Carlton, budget committee co-chair, confirmed that education would also be hit as hard. “Hopefully, we have worked together in such way that minimizes the impact on services to people, especially in the Health and Human Services area. And I believe when you look in the final tally, the education cuts that we had to make have been very minimal compared to where we started out,” she said, according to newswire reports.   After staffers iron out the final appropriations, the budget will enter the mandatory 72-hour "cooling off period" before its likely passage on Friday.   The special session will continue through October 22 to cover the property tax issue.   Look for further information in CHAIN Reaction about specific healthcare cuts and who will be affected.   (submitted by Andrew Leone, Florida CHAIN)   Medicare, Managed Care and the Paradigm Switch   The seminal image of our era may be that of people being bombarded by products offering the illusion of “choice”. No media is exempt from issuing this barrage of information that may only serve to confound consumers.   This is particularly true with health care services and products, and even more so when these are aimed at seniors and baby-boomers fast becoming seniors. Medicare, the safety net established in 1965 to provide older Americans with adequate health care, has become a major arena in this informational paradigm.   When it all started it was quite simple: Social Security benefits, that seniors had come to rely upon since the New Deal, did not provide the financial resources needed to cover medical expenses. Private insurance plans were as relatively unaffordable then for people with fixed incomes as they are now. The government acted in the interest of its citizens and eventually passed the Medicare Act, creating a program that serves most of our older Americans.   Then came the paradigm switch, with a new era of glorifying open market competition and vilifying of government programs. Beginning in various stages in the 70’s and 80’s, we now live in its heyday. “Privatize” is its mantra, and private managed care companies reap the benefits.   The Part D Prescription Drug benefit, touted by its proponents as a means to make medicines available and affordable, is a case in point. According to a recent Medicare Rights article, “An analysis of federal data released by the Centers for Medicare & Medicaid Services by the private research firm Avalere Health in Washington computed an "enrollment weighted" average premium for the Medicare Part D marketplace.   The analysis found the top 10 prescription drug plans sponsors in Medicare have more than 80 percent of the people enrolled in stand-alone prescription drug plans, and among the top 10 plan sponsors, all have raised their premiums, with the exception of two, "CVS Caremark's SilverScript plan and First Health's Part D Premier plan," said Dan Mendelson, president of Avalere Health.   Meaning, unless seniors research dozens of competing plans and take advantage of the impending reenrollment period, the ones continuing to enjoy the greatest benefits from this will not be consumers, but prescription drug plans.   By the same token, one of the major areas of concern throughout the Medicare reform included the overwhelming number of plans and options seniors were being asked to assess before making a choice.   Instead of simplifying the issue, a South Florida Sun-Sentinel article indicates: “Medicare recipients who hoped for an easier time choosing a prescription drug plan or a health plan for 2008 did not get their wish. They will have even more plans to choose from, as insurers offer a record number of choices. Newly released lists from Medicare show that Broward County seniors can wade through 141 choices, up by 10 from this year, and Palm Beach County seniors face 130 choices, up by 15. That includes 58 drugs-only plans in Florida, up by one, as well as 83 HMO-style plans in Broward and 72 in Palm Beach County.”   Through it all, private plans appear to abuse their ability to increase margins, cut services, and skirt the law. In late August, for example, the Centers for Medicare and Medicaid Service (CMS) summarily terminated its contract with America’s Health Choice, citing the plan’s failure “to make services available to the extent that it posed an immediate and serious threat to the health of their members."   When it comes to profits, the sky is the limit. The Tampa Bay Tribune writes, “WellCare Health Plans made so much money on the new Medicare drug benefit in 2006 that the company has to pay back $99 million to the government, according to federal records. The Tampa-based plan is not the only company that found the Part D benefit more profitable than anticipated.   “Humana of Louisville, Ky., the largest Medicare contractor in Florida, must repay $720 million. Insurers owe about $4 billion overall in paybacks nationwide, WellCare said Monday, noting that its share of the total is "quite small."   Why is the federal government to be trusted more as a watchdog than an administrator of plans such as Medicare?   One of the major arguments in favor of privatizing Medicare services is that private companies are expected to run their operations more efficiently. Question is, what part of their operation?   In another article, the Tampa Bay Tribune reports that WellCare has been cited again for problems in dealing with Medicare consumers. “The violations included some of the same sales practices the Tampa company was accused of in April, plus some new ones. For example, the report said the company failed to meet the 60-day deadline on appeals from members who were denied coverage in 40 percent of the cases studied.” How efficient is that? This appears to be an industry-wide problem. “WellCare has plenty of company on the Internet page that lists violations and requirements for correction. Humana of Louisville, Ky., the largest Medicare contractor in Florida, must write such plans for more than 300 violations.”   Advocates contend that refocusing Medicare from a program intended to provide health care services to one intended to provide the myriad of choices put before seniors are in the best interest of the managed care companies, not consumers.  Even a Bush Administration sympathetic to the industry recognizes that. According to the Sun-Sentinel, “Medicare officials had urged insurers to simplify things by reducing the number of drug and health plans, because some were offering multiple plans with virtually identical benefits. But the plans were not forced to do so and did not.”   Wonder why?   (submited by Andrew Leone, Florida CHAIN)   Medicaid Waiver, Pharmaceutical Access, Film: Today's Key Florida Mental Health Issues   The Mental Health America Public Policy Council of Florida believes there are three issues that will have substantial impact on Mental Health Care in the next couple of months:   First, on the request of members of Congress, the Government Accounting Office (GAO) recently examined public input in the state Medicaid waiver process. The recently released GAO’s final report looks specifically at waivers in Vermont and Florida. The report finds that the waivers have mixed implications for beneficiaries.  One process the GAO finds that both states provided opportunities for public input at the state level but the opportunities were limited by a lack of information. At the federal level, the GAO found that HHS did not provide for input.    The report concludes with the following statement:   Unless Congress and HHS take action in response to the matters for congressional consideration and recommendations to the Secretary that we presented in our July 2002 report - namely that Congress consider requiring the Secretary to improve public notification and input at the federal level and that the Secretary provide for an improved process -it appears likely that HHS will continue to approve waivers for comprehensive Medicaid demonstrations without adequate opportunity for public input.   As part of the its national coalition work, MHA will be exploring opportunities to bring the report to light and to provide Congress and HHS with suggestions for improving the public input process. Please email or call if you have any questions.   GAO Report: Medicaid Demonstration Waivers: Lack of Opportunity for Public Input during Federal Approval Process Still a Concern http://www.gao.gov/new.items/d07694r.pdf   Second, Mental Health America (Association) of Greater Tampa Bay presented its request for continued open access of the psychotropic medications to the Pharmaceutical and Therapeutic Committee on September 12, 2007.  Ten people/organizations were chosen to address the P & T committee.  The committee, in turn, made their recommendations to the Chief Pharmacist of AHCA who will, hopefully, include them in the State’s formulary.  In the past, the P&T’s recommendations have been accepted by AHCA.   Finally, there is a movie being released in N.Y. and Chicago on Oct. 12th and in Ft. Lauderdale, LA, and Phoenix on the 19th called CANVAS.  It has a powerful message about how a family copes with a paranoid schizophrenic mother as seen through the eyes of a 12-year-old.  MHA encourages everyone to go see the movie playing in the limited release theatres mentioned above.  If there’s a good showing, it will open in 200 more cities!!   (submitted by Rick Wagner President, MHA Greater Tampa Bay Chair, MHA Public Policy Council of Florida)   A Swing and a Miss?   Steering committee members of the Healthy Florida Alliance (HFA) met via phone in late September and decided to pursue an increase on excise taxes for cigarette products during the Florida Legislature’s Special Session C on the budget during the week of October 1st through October 5th.   Although the expectation for success was not high, the members of the HFA made the attempt to test the temperature in Tallahassee for the issue.  Ultimately, thought the reception was rather cold, the main objective of the strategy was to attempt to garner some media attention and raise the awareness on the effects of price increase and a potential decrease in youth and adult smoking.   In office after office Representatives and Senators from both parties extolled the merits of our efforts and their support for the goal of cutting tobacco usage but then politely refused to sponsor the measure.   Eventually, a champion for this effort emerged in Representative Jim Waldman (D, Coconut Creek) and the process for proper drafting and placement of the amendment began.   The call of the Special Session as set out by the Governor and Legislature allowed for adjustments to the budget.  The HFA language would have accomplished an adjustment at around $420 million for the remaining six months of the fiscal year.  However, the rules set forth for the special session focused on cutting the budget.    Since the constitution requires a balanced budget and the language of the proposed bill would change statutes as well as add revenue, any changes would have been valid only for the remainder of the fiscal year.    This parliamentary dance notwithstanding, Rep. Waldman was still willing to have an amendment drafted to the House implementing bill that would have achieved our goals.    During the initial House floor action on Friday, October 5th, Rep. Waldman was informed that the House would be laying the House bill on the table and taking up the Senate bill, thereby rendering his amendment useless.   He decided, at this point, to retire his efforts for this Special Session, but has said that he would champion the bill again during the regular session in the spring of 2008.     (submitted by James Mosteller, State Advocacy Director, American Heart Association)   To learn more about the Healthy Florida Alliance, visit www.healthyfloridaalliance.org   Mental Health Awareness Month Celebrated in Broward   Activities related to Mental Health Awareness Month planned by the Mental Health Association of Broward and the Alcohol, Drug and Mental Health (ADM) Planning Council of Broward included an exhibit of works related to the issue at the Broward County Governmental Center.   The exhibit’s curator, Chris Yoculan, worked with artists form a number of drop in centers to address, via a range of media, the theme of the show: “Stigma Exposed”. Some of the works were inspired by the experiences of individuals affected by Medicaid Reform.   As part of the opening event, on Monday October 8, a number of performers read through a list of well know historical and present day figures who have suffered from mental illness of various forms, including Albert Einstein, Princess Diana, Francis Ford Coppola and many others.   The Stigma Exposed works will be shown through October 13 at the Broward County Governmental Center, 115 S. Andrews Ave., Ft. Lauderdale.   (submitted by Andrew Leone, Florida CHAIN)   Works displayed during the "Stigma Exposed" event were created by artists from drop-in centers in Broward               Health Care Access Rights Town Hall Series Continues   Hispanic Health Initiatives and Florida CHAIN continued their series of Central Florida town hall meetings discussing issues of health care access. Events have already taken place in Orange, Seminole and most recently in Volusia County.  One more town hall will take place in Osceola on November 1. For more information visit Hispanic Health Initiatives at www.hispanichealthinitiatives.org or call 407/339-2001.   (submitted by Andrew Leone, Florida CHAIN) Damarys Melendez, of Vitas in Ormond Beach, listens to discussion on health care access at Deltona Town Hall meeting.      John Newstreet, aide to Florida Sen. Mel Martinez, lays out the senator's position in favor of SCHIP veto at Deltona town hall meeting. Josephine Mercado, HHI executive director, is at his left.                REAL STORIES FROM FLORIDA HEALTH CARE CONSUMERS   Medically Needy Program Imposes Unrealistic Burdens on Participants   One day in February 2000, Eileen Curras realized something was wrong. She was vomiting and feeling dizzy. After a couple of days, “I was hitting walls and walking like I was drunk,” she now recalls, “so I went to Jackson Memorial emergency room.” When the doctor examining her asked her to open her eyes, which she had been keeping closed because of the dizziness, “there was a gasp in the room” she says. “They told me ‘your eyes have a mind of their own’, because they were like a chameleon’s, one going one way, the other the other way.”  One thing was obvious; the 37 year old, widowed mother of a 4 year old had a serious neurological disorder. It was soon diagnosed as Multiple Sclerosis.   Like millions of other Americans, Eileen had no insurance, so staff at Jackson told her she might qualify for Medicaid under the Medically Needy program, and because she was essentially blind, they helped her with the paperwork. Within a month it was denied. Fearing she would not be able to get proper care and medicine, Curras returned to her native Puerto Rico, a territory of the United States, where the legislature had recently passed a health reform that classified her circumstances as catastrophic.   After fighting that bureaucracy, for three years she was able to get the therapy and medication she needed to control the disease. But there were big problems there too. “They don’t take the American with Disability Act (ADA) very seriously in Puerto Rico, so I couldn’t get transportation services, couldn’t get out of my house. I was stuck there,” she says. In addition, her relationship with her mother, who had been helping, deteriorated. And to make matters even worse, “my daughter was getting very depressed. She spoke only English. She was diagnosed with General Anxiety Disorder and other problems.”   Her choices were stark: fight the Puerto Rican system that is not very sympathetic to people who are disabled, or take her chances in Florida where her medicine and medical services were not guaranteed but at least she could provide herself and her daughter with better living conditions. She returned to Florida, this time to the Orlando area.   As a widow, Curras receives a total of $2,156 a month for her and her daughter in Social Security payments, too much to qualify for Medicaid. She does qualify for the Medically Needy program on condition that she spends, as part of her “share of cost” $1,369 a month. “How are we supposed to live on what is left? We have housing expenses, we need to eat.”   Finding the right care hasn’t been easy, either. “I haven’t been able to see a neurologist, for which I need a referral.  The only one anywhere near me here is in Jacksonville. I haven’t been able to afford the medicines,” she says, relying on a MS support group in Volusia for advice and other means of help.   She doesn’t drive, and relying on a wheelchair to get around she has found that even in Orlando public transportation is not very efficient. “I have had meetings with the LINKS (the Orlando Area public transit system) people to tell them half the time the lifts on the busses don’t work and that is against the law.”   Even thought the Medically Needy program may have been spared from being completely eliminated in the latest round of budget negotiations, it needs to be funded to a level where it is not just a program in name, but it actually can help those who, victims of catastrophic diseases or transplant survivors, need it to survive.   (Submitted by Andrew Leone, Florida CHAIN) Florida CHAIN Seeks Stories   Florida CHAIN welcomes contributions from health care consumers who are interested in sharing their experiences with readers of CHAIN Reaction. If you have a story to share, please contact Andrew Leone at 954/684-9895 or gregm@floridachain.org

State Events & Notices
     North Florida
     Central Florida
     East Central Florida
     West Central Florida
     Southwest Florida
     Southeast Florida
     Florida Audio & Web Events 
     Statewide Notices
National Events & Notices
     Conferences & Events 
     Audio & Web Events 
     National Notices
     Campaigns & Initiatives

STATE EVENTS & NOTICES

NORTH FLORIDA  

CENTRAL FLORIDA

WEST CENTRAL FLORIDA 

Events

A day dedicated to the health of women and girls. Information, lectures, entertainment, testing and screenings for blood pressure, bone density, diabetes, For more information: 954/357-7800 or www.broward.org/statuswomen

Breast and Ovarian Cancer: Prevention, Diagnosis and Treatment
October 12   9:30 am-4:00 pm Jackson Memorial Hospital’s Diagnostic Treatment Ctr

Notices

FLORIDA AUDIO CONFERENCES AND WEBCASTS

STATEWIDE NOTICES  

Human Services Coalition (HSC) is partnering with the national nonprofit AmeriCorps program Public Allies to develop young diverse leaders in Miami-Dade County. HSC will kickoff the Public Allies program in October, placing 15 local men and women between the ages of 18 and 30 to work with nonprofits as apprentices for 10 months.  During that time, the Allies will participate in leadership and professional skills training and work on a team service project. They will also facilitate community dialogues about local issues. Each Ally will receive full health benefits, a monthly stipend of $1500 and $4,700 at the end of the program to help fund their education.  The project is also funded in part by Allegany Franciscan Foundation and The Children’s Trust. HSC will recruit applicants for the 15 positions over the summer and look for partner organizations to host each Ally. For more information about becoming an Ally or hosting one, contact 305-576-5001 x32.

NATIONAL EVENTS & NOTICES

CONFERENCES AND EVENTS 

Communities Joined in Action Stepping Up to Achieve Healthcare Success: Locally to Nationally
Oct 22-23    Washington, DC

Conference Objectives: Show national & state policy makers the power of community collaboratives to be part of healthcare reform solutions; Learn to Play the 3-Tier Chess Game - to get the community “voice” in national, state and local health policy decision-making; Learn the Eight Critical Activities to build an integrated & sustainable delivery system in your community; Learn how to produce Outstanding Outcomes in your community; Network with peers from across the country and share successes and challenges; Engage with national experts about health policy proposals that will emerge during the upcoming political elections; Dialogue with Washington D.C. experts and Congressional staff about how Congress plans to develop a national policy agenda on health in 2008 in support of community health collaboratives.

SOPHE 58th Annual Meeting - Partnerships to Achieve Health Equity  
Oct 31–Nov 3   Alexandria, VA
Abstracts are now being accepted online for workshops, symposia, oral presentations, and posters for Society for Public Health Education's 58th Annual Meeting. SOPHE is pleased to be partnering with CDC's Racial and Ethnic Approaches to Community Health (REACH) program and Eta Sigma Gamma for its 40th Annual Meeting.  Sub-themes include health systems change; social determinants of health and transdisciplinary approaches to health education; health communications, health literacy and technology; cultural competence in bridging differences, and; evaluation and dissemination of evidence-based approaches. For more information, contact lvillejo@mdanderson.org

2007 American Public Health Association Annual Meeting & Exposition

Nov 3-7   Washington, D.C.
The is the oldest and largest gathering of public health professionals in the world, attracting more than 13,000 national and international physicians, administrators, nurses, educators, researchers, epidemiologists, and related health specialists. APHA's meeting program addresses current and emerging health science, policy, and practice issues in an effort to prevent disease and promote health.

Creating a Culture of Wellness

Nov 27-29   Washington, DC

The U.S. Department of Health and Human Services’ Office of Disease Prevention and Health Promotion and the Centers for Disease Control and Prevention (CDC) will host this 2007 National Prevention and Health Promotion Summit. This groundbreaking event will unite health professionals, business entrepreneurs, and government leaders at all levels who are dedicated to health promotion, chronic disease prevention, health preparedness, birth defects, disabilities, genomics, and wellness.

National Congress on the Uninsured: From Practical Local and Regional Solutions to State and National Health Reform

Dec 10-12   Washington, DC

The challenge of the un- and underinsured in America puts great social and economic stress on the nation's health system. The goals of The National Congress are to: define the issue; identify and assess various federal and state health reform proposals; analyze the roles of Medicare, Medicaid and SCHIP in expansion of coverage; describe and compare various international approaches to the issue; identify voluntary, charitable initiatives across the country to address the issue at the local level and assess current obligations and practices of healthcare providers to render care to uninsured patients.

Health Action 2008 
Jan 24-26   Renaissance Mayflower Hotel, Washington DC

Families USA’s Health Action 2008 kicks off a year in which health care will be at the center of the national conversation. Learn and share strategies with other advocates around the country and to recharge for the year ahead.

ACHI’s 2008 Spring Training for Health Champions

Conference Dates: March 5-7, 2008  Atlanta

Topic Tracks: Minimizing Chronic Disease: Strategies for Social Determinants; Maximizing Coverage: Proven Programs and Innovative Proposals; Harnessing Data: Health Assessments to Health Outcomes; Delivering Community Benefit: Management Tools and Community Strategies (co-sponsored by Catholic Health Association and VHA, Inc.); Breaking Silos: Public Health and Health System Partnerships

National Initiative for Children's Healthcare Quality (NICHQ) Annual Forum for Improving Children's Health Care 

March 19-21   Miami

This event is for people committed to eliminating the gap between what is and what can be in health care for all children.  The Forum will feature breakout sessions and in-depth workshops, in four tracks, focused on NICHQ's Improvement Agenda: Assessing, Preventing and Treating Childhood Obesity; Providing Seamless, Evidence-based, Family-Centered Care for Children with Chronic Conditions; Purging Harm from Children’s Health Care; Profound Knowledge: Methods and Tools for Improvement and Innovation. Improvement processes/programs in all of these areas should address disparities and include parents/families.

Active Living Research Conference Seeks Abstracts

April 9-12 Washington DC

The theme of this year's conference is "Connecting Active Living Research to Policy Solutions." Abstracts on all topics related to active living policies and environments are welcome. In addition to policy-relevant research, Active Living Research welcomes abstracts about children and adolescents at greatest risk for obesity—African-American, Latino, Native American, Asian-American and Pacific Islander children and adolescents living in low-income communities.

National Hispanic Medical Association 12th Annual Conference
April 17-20   Washington, DC
Policy, research, medical and clinical presentations focused on improving the health of Hispanics. Conference Goals are to: provide clinical updates on diabetes, cancer, HIV/AIDs, obesity, cardiovascular disease, asthma, Alzheimer’s disease, and renal disease; increase awareness about cultural competence, literacy, language services and medical care delivery to Hispanics; increase knowledge about Federal and State health policies that impact Hispanics; develop skills for health professionals in academic medicine, research, private sector and government; and make recommendations targeted at Hispanics for the national health policy agenda in the U.S. Expected: 100 Exhibitors; 200 Hispanic Medical Students; 700 Physicians; 140 Speakers/panelist/keynote speakers.

AUDIO AND WEB EVENTS    

 
October 
 
"Talk About Prescriptions" Month: October
National Council on Patient Information and Education
(301) 656-8565
ncpie@ncpie.info   www.talkaboutrx.org

Healthy Lung Month: October
American Lung Association
(800) LUNG-USA (586-4872)
info@lungusa.org   www.lungusa.org

Let's Talk Month: October
Advocates for Youth
(202) 419-3420
tom@advocatesforyouth.org   www.advocatesforyouth.org

National Breast Cancer Awareness Month: October
National Breast Cancer Awareness Month Board of Sponsors
nbcamquestions@yahoo.com  www.nbcam.org

National Family Sexuality Education Month/Let's Talk: October
Planned Parenthood Federation of America
(212) 541-7800
education@ppfa.org   www.plannedparenthood.org

National Child Health Day: October
U.S. Department of Health and Human Services
Maternal and Child Health Bureau
(301) 443-2170
www.mchb.hrsa.gov

National Mammography Day: October 19
American Cancer Society
(800) ACS-2345   www.cancer.org
 
November 
 
American Diabetes Month: November
American Diabetes Association
(800) DIABETES (342-2383)
askada@diabetes.org   www.diabetes.org

Diabetic Eye Disease Month: November
Prevent Blindness America
(800) 331-2020
info@preventblindness.org   www.preventblindness.org

Lung Cancer Awareness Month: November
Lung Cancer Alliance
(800) 298-2436
info@lungcanceralliance.org   www.lungcanceralliance.org

National Alzheimer's Disease Awareness Month: November
Alzheimer's Association
(800) 272-3900
info@alz.org  www.alz.org

National Family Caregivers Month: November
National Family Caregivers Association
(800) 896-3650
info@thefamilycaregiver.org  www.thefamilycaregiver.org

National Healthy Skin Month: November
American Academy of Dermatology
(888) 462-DERM (3376)
mediarealtions@aad.org   www.aad.org

National Hospice Palliative Care Month: November
National Hospice and Palliative Care Organization
(703) 837-1500
jradulovic@nhpco.org   www.nhpco.org

Pancreatic Cancer Awareness Month: November
(877) 272-6226
information@pancan.org  www.pancan.org

Prematurity Awareness Month: November
March of Dimes Birth Defects Foundation
(888) MODIMES (663-4637)
askus@marchofdimes.com  www.marchofdimes.com

Prematurity Awareness Day: November 13
March of Dimes Birth Defects Foundation
(888) MODIMES (663-4637)
askus@marchofdimes.com  www.marchofdimes.com

Great American Smokeout: November 15
American Cancer Society
(800) ACS-2345
www.cancer.org

Gastroesophageal Reflux Disease Awareness Week: November 18-24
(888) 964-2001
iffgd@iffgd.org  www.aboutgerd.org

December

World AIDS Day: December 1
Joint United Nations Programme on HIV/AIDS
unaids@unaids.org   www.unaids.org/en/default.asp

New listings, in order of submission deadlines

Partners Investing in Nursing's Future, a collaborative initiative of the Robert Wood Johnson Foundation and the Northwest Health Foundation, addresses nursing issues at the community level through funding partnerships with local and regional foundations.  Proposals will be evaluated for:  foundation capacity for and commitment to addressing nursing issues; scope and strength of the partnership between the local foundation and its partners; innovativeness and strength of the  project design; potential impact of the project in the local or regional area beyond individual institutions; and likelihood of project sustainability.

The Humana Foundation
Proposals accepted: Nov 1-June 15

The Humana Foundation supports nonprofit organizations in communities where the company has facilities in states including Florida. The Foundation is committed to serving the needs of children, families, and seniors in their quest to build healthier lives and communities. Special consideration is given to proposals that focus on the following areas: health and fitness efforts that lead to better lifestyles; literacy activities that lead to improved health experiences; and the development of technology, tools, and resources that lead to healthy communities.

National AIDS Fund: Southern REACH
Application deadline: Nov 16

Southern REACH (Regional Expansion of Access and Capacity to Address HIV/AIDS), a new grantmaking initiative of the National AIDS Fund, will support community-based organizations (CBOs) in nine southern states including Florida to strengthen community capacity to address HIV/AIDS among marginalized, at-risk, and underserved populations. Grants will be provided to CBOs that have the demonstrated ability to reach priority populations with HIV prevention and care services or to lead policy and advocacy efforts that will impact priority populations.  

Improving Health and Educational Outcomes of Young People

Application deadline: Nov 21
The purpose of the program is to improve the health and well-being of youth and prepare them to be healthy adults.

Continuing listings, in order of submission deadlines 

American Psychiatric Foundation Seeks Applications for Advancing Minority Mental Health Awards

Deadline: Nov 1

Allegany Community Outreach Grants
Deadline:  March 1
ACOR is a grant program of Allegany Franciscan Ministries, Inc.  It provides short-term support to local community projects. The grant award range is $1,000-$5,000; limited numbers of grants. Priority to organizations for projects that strive to: improve the health, wellness and quality of life through a holistic approach to education or direct service; bring about systemic change and promote self-sufficiency; benefit a disenfranchised segment of society; Sponsoring organization strives to incorporate the viewpoint and participation of individuals who are direct recipients of its services (e.g. service recipients are represented on the governing board).

Tobacco Policy Change: A Collaborative for Healthier Communities and States

Application deadline for implementation grants: March 14

Tobacco Policy Change: A Collaborative for Healthier Communities and States, a national initiative of the Robert Wood Johnson Foundation, provides resources for local, regional, and state-based organizations and tribal groups to advocate for effective policies that decrease tobacco use and exposure. This initiative is issuing a special solicitation that will build on previous success in attracting new partners whose constituencies are most directly affected by tobacco use and exposure. Grantees are expected to apply their advocacy skills and experience to advance tobacco and other public health policies in their communities. Organizations from Florida are able to apply.

New Funding Opportunities to Accelerate Breast Cancer Research
Application deadlines: Various
Susan G. Komen for the Cure has announced the introduction of new types of research grant awards and the deployment of an upgraded online grants application process.

Fulbright Scholar Award

Multiple deadlines
Applications continue to be accepted for some Fulbright Scholar awards for lecturing, research or combined lecturing/research awards in public health during the 2008-2009 academic year.  Faculty and professionals in public health may apply for awards specifically in their field, as well as one of the many "All Discipline" awards open to any field. 

Donors Forum of South Florida on-line database
The new online searchable Donors Forum of South Florida database has up-to-date information about funders in South Florida. This resource— which is also available in hard copy — presents continuously updated information about the giving interests and procedures of funders with a track record of investing in the South Florida area and working collaboratively with others. To order, email leot@donorsforumsf.org or call 305/371-7944. 

Directory Of Health Policy Fellowships

This Kaiser directory contains new listings for undergraduates, graduate students and professionals searching for summer, school-year, or post-doctoral positions.

Florida CHAIN Website Resources

Organizations and Services

Manuals, Guides and Toolkits

Technology and Audio Visual Materials

     Audioconferences and Webcasts

     Media Programming

     Web Sites, Web Features

     Videos and Films

Periodicals and Books

Reports and Studies

     New Listings

        New Listings: Medicaid

        New Listings: SCHIP

        New Listings: Medicare

        New Listings: Federal Budget

        New: Health Insurance, Health Care Costs

        New: Health Equity Issues

        New: Other Health Issues

     Florida Reports

     Medicaid

     SCHIP

     Medicare

     Federal Budget/Health Care

     Health Insurance, Health Costs, Health Care Reform

     Health Equity Issues

     Other Health Issues

FLORIDA CHAIN WEBSITE RESOURCE UPDATE

Florida CHAIN has advocacy tools available online.

Florida CHAIN has updated its website to include more comprehensive and organized information on Medicaid Reform. Click here to view our fact sheet, PowerPoint, and Medicaid Roundtable video clips. Other available resources include Georgetown studies on Medicaid Reform and contact information of members of the Medicaid Reform Advocates Coalition.  

The Florida CHAIN web site now includes resource information in Spanish.

SFCCC works to reduce the cancer burden and cancer disparities in Southeast Florida, including Broward, Indian River, Martin, Miami-Dade, Monroe, Okeechobee, Palm Beach and St. Lucie counties. The SFCCC includes representatives from more than 60 public and private organizations, agencies and health care providers, as well as cancer survivor and advocacy groups. SFCCC aims to increase awareness about cancer prevention, early detection, and treatment among populations at high risk. The Collaborative meets quarterly at various locations in the region.

MANUALS, GUIDES, TOOLKITS

Newly posted resources are at the top of the list.

Built with funding from the American Hospital Association and expert guidance from a 35-member ACHI working group, this will be online in November 2007.  The Toolkit, a member service of the Association for Community Health Improvement, available to members of the American Hospital Association and the Society for Healthcare Strategy and Market Development, is a hands-on guide for both novice and experienced practitioners seeking to design, conduct and use assessments to improve the health of their communities.

Toolkit: Medicare Private Fee-for-Service Plans

The toolkit contains links to resources on general information about Medicare private fee-for-service plans, advantages and incentives of using the plans and the difficulties that beneficiaries have faced with the plans, including enrollment fraud. The toolkit also includes a list of experts and Web sites for further information on the plans. (7/12/07, Alliance for Health Reform)

Medicare Advantage Tutorial on the basics of Medicare Advantage and types of MA plans, as well as trends in MA enrollment, characteristics of beneficiaries and the impact of MA plans on traditional Medicare. And an updated  Medicare Health and Prescription Drug Plan Tracker with MA plan enrollment data for June, containing local, regional and national data on MA plans and stand-alone Medicare prescription drug plans. (7/17/07, Kaiser Family Foundation)

Race Matters 

This toolkit was created to help advocates and leaders address race and power structures within their work to help create equitable opportunities for all.  (Voices for America's Children and The Annie E. Casey Foundation)

A Patient-Centered Guide to Implementing Language Access Services in Healthcare Organizations

The guide was created to assist health care organizations in better serving their clients with limited English proficiency and decrease disparities in access to health care. (DHHS Ofc. of Minority Health)

Helping Pediatric Practices Implement Parental Depression Screening
A new online manual helps pediatric clinicians successfully screen parents for depression, discuss with them the impact depression can have on their children, and refer parents for counseling. Rates of major depression peak during women's childbearing years. Research has shown that maternal and paternal depression can affect parenting behaviors and, ultimately, harm children's health and development. Because pediatricians have frequent contact with parents, they have opportunities to screen for depression and intervene when necessary. Accumulating data about the adverse effect of parental depression on child health, development, and behavior have provided an impetus among pediatric practices for changing clinical care.

The Basics of Medicare and Medicaid
The primers help explain Medicaid and Medicare, including an overview, how they work, who they serve and how they are funded. The Medicare primer is new, and the Medicaid primer has been updated with the most current information (Kaiser Family Foundation, "The Basics of Medicare and Medicaid," (3/19/07, Kaiser Family Foundation)

Medicare Rights Center Part D appeals manual
This free, comprehensive, easy-to-understand guide is for advocates who help people with Medicare get the drugs they need.This 25-page manual offers a complete overview of the entire appeals process, real-life case examples from MRC's Client Services department, a glossary of important Part D appeals terms, a sample appeals protocol for advocates, and links to important resources and documents. All in consumer-friendly language

Five Guidelines for Developing Customer-Friendly Websites
This new Covering Kids & Families publication is intended to help state agencies and other organizations do a

better job of helping people find information on the Web about Medicaid, SCHIP and other government services by producing a customer-friendly site.

Amigos en Salud Online Disparities Toolkit
Pfizer has created a free toolkit to help community health centers reduce racial health disparities. The program, called Amigos en Salud/Friends in Health, involves training community health workers to be a bridge between minority communities and the healthcare system. 

Reducing Racial and Ethnic Disparities: A Quality Improvement Initiative in Medicaid Managed Care ToolkitCenter for Health Care Strategies
The toolkit examines the experiences of a workgroup - comprising 10 Medicaid health plans and a state primary care case management association - that adopted strategies to identify and address racial and ethnic health disparities in birth outcomes and immunizations, asthma care and diabetes care. (January 2007)

New/Updated Resources Medicare Drug Plan Resources
In advance of the 2007 Medicare drug plans open enrollment period beginning Nov. 15, Kaiser Family Foundation has issued a series of new and updated resources based on ongoing research including consumer surveys:

Updated fact sheet providing state-specific data about Medicare drug plan options for 2007, including stand-alone drug plans and Medicare Advantage plans, and information on premiums, gap coverage, and availability to beneficiaries who qualify for full low-income assistance.

Updated Medicare Prescription Drug Benefit fact sheet, with a revised estimate that 4 million people will be affected by the coverage gap in 2006, as well as current enrollment and low-income subsidy participation and updated Medicare per capita drug spending.

Updated Talking About Medicare online consumer guide, reflecting 2007 benefit changes, to help people with Medicare and their families understand options and make decisions based on their personal situations; includes information about financial assistance for those with limited incomes, supplemental insurance options, and Medicare Advantage.

The Medicaid Matters web site is a resource for people working across the country to protect Medicaid, the health insurance that 50 million rely on. It stores a ready-to-use toolkit of messages, materials and dissemination ideas. Users are able to download, at no cost, tested messages emphasizing the importance of Medicaid and the threat now facing the program. Messages are enhanced by high quality, full color photography. One set of materials is designed to be ready to print. Once downloaded, they can be forwarded to any print house or copy shop without any further formatting. The second set of materials is designed so that components of the product can be adapted to suit the needs of that organization or constituency that wishes to use them.

TECHNOLOGY AND AUDIO/VIDEO RESOURCES

Videos and Films

Covering Kids & Families Video
Parents' Action for Children, a 2006 national supporter, has created a flash animation video in partnership with Covering Kids & Families that promotes the availability of low-cost and free health care coverage for eligible families. Parents’ Action for Children plans to promote the video to their membership of more than 35,000 parents across the country who are working to improve the lives of children and families in their communities. View the video today! For more information, contact 202/338-7227 or coveringkidsandfamilies@gmmb.com  

PERIODICALS AND BOOKS

This Commonwealth Fund bimonthly newsletter describes innovative state health programs from across the country. It is intended to help policymakers, administrators, and researchers as they work to stretch health care dollars and meet the needs of their residents.

REPORTS AND STUDIES

New Listings

New Listings: Medicaid

New Listings: Medicare

1-800-Medicare: Caller Satisfaction and Experiences

Caller satisfaction with 800-Medicare, the Centers for Medicare & Medicaid Services’ customer service number for people with Medicare, has fallen 13 percent in the past three years, from 84 percent in 2004 to 71 percent in 2007, according to a report released by the Department of Health and Human Services last week. (Sept 2007, Office of Inspector General, Department of Health and Human Services)

A new study finds that a growing number of inpatient rehabilitation hospitals and units are inappropriately denied Medicare payment for care provided to their patients. A high rate of these payment denials are successfully overturned with findings that the care questioned was in fact medically appropriate. But the administrative red tape required to set things straight drains hospital resources resulting in less funds available for patient care. (Oct 2007, American Hospital Association)

New Listings: Federal Budget

New Listings: Health Insurance, Health Costs

New Listings: Health Equity Issues 

We Can Do Better ­ Improving the Health of the American People
The United States spends more on health care than any other nation in the world, yet it ranks poorly on nearly every measure of health status. How can this be?...The two-part answer is deceptively simple - first, the pathways to better health do not generally depend on better health care, and second, even in those instances in which health care is important, too many Americans do not receive it, receive it too late, or receive poor-quality care. (9/20/07, New England Journal of Medicine) 

Consumer-Directed Health Care and the Disadvantaged

Broad adoption of "consumer-directed health care" would probably widen socioeconomic disparities in care and redistribute wealth in "reverse Robin Hood" fashion, from the working poor and middle classes to the well-off. Racial and ethnic disparities in care would also probably worsen. (9/18/07, Medscape Today)

Racism's Toll May Be Physical
Statistically, black males in America are at increased risk for just about every health problem known. African Americans have a shorter life expectancy than any other racial group in America except Native Americans...Now researchers are beginning to examine discrimination itself. Racism, more than race, may be cutting black men down before their time. (9/24/07, Los Angeles Times)

Effect of Race on Asthma Management and Outcomes in a Large, Integrated Managed Care Organization
Even in a health care setting that provides uniform access to care, black race was associated with worse asthma outcomes, including a greater risk of ED visits and hospitalizations. This association was not explained by differences in SES, asthma severity, or asthma therapy. (9/24/07, Archives of Internal Medicine)  

Scientifically Correct Racism: Health Studies' UnintenGroups ded Effects against Minority

The paper is mainly concerned with how normal science and health practices can become an instrument for justifying racism and reproducing it in our societies. The examples demonstrate that even when all forms of explicit racism are avoided, health communication can have identifiable racist consequences in people's lives. (Language and Intercultural Communication, Vol. 7, No. 2, 2007)

Stress of Racism May Advance Black Infant Mortality Rates

For decades, health experts have tried to determine why African-American babies are twice as likely to die as White infants. A new series of studies from the Joint Center for Political and Economic Studies' Health Policy Institute, along with a small but growing number of neonatologists nationwide, suggests that the stressful effects of racism play a role. (9/29/07, McClatchy Newspapers)

New Listings: Other Health Issues

Waving Cautionary Flags: Florida’s Experience with Medicaid Reform: Reactions from Doctors and Patients

The latest briefing paper on Florida's Medicaid reform programs shows one out of four physicians are declining to participate and those who remain are seeing fewer patients. View the briefing paper  Or view a presentation of the research.  (May 2007, Georgetown University Health Policy Institute, released by the Jessie Ball duPont Fund, The Community Foundation in Jacksonville and United Way of Northeast Florida)

Florida Children’s Action Agenda 2007/2008 Available Online
Florida state Senators Nan Rich and Durell Peaden and Representatives Loranne Ausley and J.C. Planas have released the final recommendations of the 2006 Florida Children’s Summit.  The Summit participants learned a lot, and the next Summit in Fall 2008 will reflect that.  In 2008 they will spend substantially more time in workshops hashing out recommendations and will secure experienced workshop facilitators who are knowledgeable about the topics they are facilitating.  Also, they will institute a process to ensure that when leaving the 2008 Summit - or very shortly thereafter - all will know the Summit recommendations. 

Miami-Dade and Monroe County 2006 Health Profiles
Health Council of South Florida has released downloadable Health Profiles that provide answers to 10 commonly asked questions about county demographics, health needs, and resources.

Florida Health Insurance Coverage of Children 0-18 (2004-2005)
Kaiser Family Foundation has released information about this on-line resource. 

Medicaid Changes: What will they mean for Broward and Duval counties, and beyond?
This document is Briefing #1 by researchers at Georgetown University’s Health Policy Institute engaged in a two-year evaluation of the Medicaid reform pilot counties for both Florida counties. The evaluation is assessing how these changes affect Medicaid beneficiaries’ ability to access needed care as well as the impact on community health providers.(September 2006, Georgetown University Health Policy Institute)

Report looks at uninsured in Florida
This report from the Research Institute on Social and Economic Policy at FIU documents and breaks down Florida's uninsured figures, finding 18.5% of the total Florida population uninsured. The report looks at employment and industry data related to lack of coverage, and proposes a partial solution.

Health Insurance, Health Costs

Health Equity Issues

Key Facts: Race, Ethnicity and Medical Care, 2007 Update

This updated quick reference source on health disparities presents the best available data and analysis, ncluding data on the uninsured and access to care by race/ethnicity as well as information about the isproportionate effect that specific conditions such as diabetes, HIV/AIDS, and asthma have on racial and thnic minority populations in the U.S. New in the 2007 Key Facts are demographic data on the racial/ethnic minority population in each state and the U.S. territories. This edition of Key Facts also includes data from the National Healthcare Disparities Report, examining changes in health care disparities over time.  (Jan 2007,

Kaiser Family Foundation)