November 30, 2007 Florida CHAIN Launches New Website Florida CHAIN is proud to announce the completion of our new website. We invite you to visit www.floridachain.org. Sit back to watch the video on the homepage, find topics through the Search feature, easily gather information on health access issues, visit the links of other Florida health care advocacy organizations, and learn more about what Florida CHAIN has to offer.
	SCHIP Reauthorization and Resulting Coverage Expansion Still Within Reach The intensity and incredible challenges to getting a strong five-year SCHIP (State Children’s Health Insurance Program) reauthorization bill passed in Congress continue. Constant negotiations continue on yet another compromise bill. There is tremendous uncertainty as to what will actually happen next.  All this while, the Administration continues with negative claims and putting extreme pressure on members of Congress.  (by Linda Merrell and Karen Woodall, Florida Child Health Care Coalition)  Read more
	Challenges of Medicaid Reform’s Next Steps Illustrate Need to Proceed with Caution The notion that Florida should take a deep breath and delay further expansion of Medicaid Reform has gained significant traction in recent weeks. This follows the findings of the Inspector General for AHCA that data available is currently inadequate to allow legitimate evaluation of the impact, and that a number of serious concerns already identified remain unresolved. Nevertheless, proposals to expand Medicaid Reform will likely be under consideration in the 2008 Florida Legislative Session. (by Greg Mellowe, Florida CHAIN) Read more

	State Revenue Projections Drop Again. . . Are Deeper Budget Cuts Far Behind? An unanticipated drop in projected State tax revenue prompted the Florida Legislature to convene a Special Session in October. The reduction was mainly attributed the housing slump. Now, ironically, as more Floridians are impacted by the economic downturn, the State is less able to provide critical supports to residents when they need them most.  (by Greg Mellowe, Florida CHAIN)  Read more
	Proposed Rule Would Dramatically Increase Cost of Medical Records The Florida Board of Medicine (within the Department of Health) is currently considering a proposed rule change that would dramatically increase the cost of obtaining medical records from health care providers. This in turn would create a tremendous financial burden, especially for low-income Floridians.  (by Greg Mellowe, Florida CHAIN)  Read more

	Lawsuits Allege Former Broward Inmates Were Denied HIV/AIDS Meds in Jail “We don't know how to treat you.” According to the Miami Herald, that is what former Broward County jail inmate recalls being told by jail staff in response to his repeated requests for medications to treat his HIV.  As Kevin Sauve's health deteriorated, a judge finally ordered that he be released in order to get medical help.  Now out of jail, Sauve is one of two former Broward inmates filing lawsuits over denial of access to lifesaving HIV/AIDS medications while in the care of the County.  (by Michael Kahane, Bureau Chief, Southern Region, AIDS Healthcare Foundation)  Read more Medicare Drug Plans: Low-Income Seniors May Have Little Choice But To Choose The 2008 open enrollment period for Medicare Part D underway and will continue until December 31st. In the last issue of CHAIN Reaction, an article on open enrollment focused on the opportunity that 99% of Floridians have to save money in 2008 by switching to a prescription drug plan (PDP) with lower or no monthly premiums. However, the flip side of the same coin - the threat that many seniors face unaffordable increases in pharmacy costs if they DON'T change plans - warrants at least the same consideration.  (by Greg Mellowe, Florida CHAIN)  Read more
	A Time for Action on Mental Health Reform   The Florida Supreme Court has just issued a new report entitled “Constructing a Comprehensive and Competent Criminal Justice/Mental Health/Substance Abuse Treatment System: Strategies for Planning, Leadership, Financing, and Service Development.” And it means just that. The report was the result of a collective effort by key members of Florida’s judicial, executive, and legislative branches.  (by Richard B. Wagner, Chair of the MHA Florida Public Policy Council; and Scott F. Barnett, Mental Health America of Greater Tampa Bay, Inc.)   Read more Osceola Town Hall Meeting Gathers Diverse Interests to Spark Advocacy   On Nov. 1, Hispanic Health Initiatives, with Florida CHAIN, hosted a Town Hall meeting in Osceola County. Through the participants' diversity, consensus emerged regarding grave concerns over Medicaid Reform expansion; access to Medicaid Reform specialists; overcoming barriers to KidCare enrollment; and the need to expand SCHIP. (by Greg Mellowe, Florida CHAIN) Read more With Obstacle after Obstacle, Mother of Developmentally Disabled Children Says Look Elsewhere for Medicaid Reform Model Kendra Garcia knows what it’s like to receive Medicaid services for her three developmentally disabled children in an effective, courteous and time sensitive manner, from her experiences in North Carolina. But soon after her arrival two years ago, she found herself in a different sort of hurricane than the ones associated with the weather: Florida’s Medicaid Reform.  (by Andrew Leone) 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 Reauthorization and Resulting Coverage Expansion Still Within Reach The intensity and incredible challenges to getting a strong five-year SCHIP (State Children’s Health Insurance Program) reauthorization bill passed in Congress continue. Constant negotiations continue on yet another compromise bill. There is tremendous uncertainty as to what will actually happen next.  All this, while the Administration continues with negative claims and putting extreme pressure on members of Congress.   To counter the negativity and reinforce the positive aspects of SCHIP, the holidays provide a perfect chance to get a good message out to the media, write letters to the editor and thank you notes to members of the Congressional delegation who have been supportive.   Our core messages include the following:  We’re too close to turn back. We want to herald the leadership and the efforts Florida  has made toward the goal of securing health care coverage for children in need throughout the state. There are hundreds of thousands fewer uninsured children in Florida since SCHIP began. Florida’s SCHIP, Florida KidCare, continues to grow. Recently, the Florida Legislature during a special session, added $1.1 million to the current KidCare budget to enroll more income-eligible children following a major statewide outreach and enrollment effort. We thank those Florida congressional leaders who have championed children’s health coverage at the federal level, and we thank them for their hard work and commitment. All children should have health coverage. SCHIP, Florida’s KidCare, is a successful program that enjoys strong public support. Recent national polling reports 70-80% of voters in America support health insurance for all children. We want to reach our goal of ensuring all children in Florida are covered.  We have made huge gains – but Florida can’t do it alone. We look to the President and Congress to do their part as well to ensure we can move forward in coverage for hardworking families in Florida not backwards.   A lack of strong positive action on SCHIP reauthorization in Congress over the next few weeks threatens the hard work our state has done to cover children and families.   Currently there is strong bipartisan support to continue to improve the KidCare program and ensure more of Florida’s 700,000 uninsured children, 500,000 of which are potentially eligible for KidCare, receive health care coverage.  We’re too close to turn back now – we need a strong push from Capitol Hill to get a strong reauthorization through so that we can finish the job for Florida’s and America’s kids.    KidCare, Florida’s SCHIP, currently covers 1,373,969 uninsured children. This includes 229,223 of the Title XXI SCHIP non-Medicaid-eligible children in Florida. With a strong reauthorization of SCHIP by Congress, many more children will get the care they need, when they need it.   Thank you for all you and your organizations have been doing. Hopefully in a true effort to tell the good that has been done we can get out what this is all about.....providing health care coverage for uninsured children.   We hope you will continue to reach out to your members of Congress and thank those who have been working so hard to pass a good strong SCHIP reauthorization bill.   (Submitted by Linda Merrell and Karen Woodall, Florida Child Health Care Coalition)  Even Limited Feedback on Medicaid Reform Proves More than Enough for AHCA On November 7th and 8th, AHCA, the State agency overseeing Medicaid, conducted workshops with the stated intent of collecting feedback from health care providers and beneficiaries (consumers) in Jacksonville and Ft. Lauderdale regarding their experiences with the Medicaid Reform Pilot Program. In terms of providing an opportunity to provide feedback as a service to consumers, however, virtually nothing about them seemed to be designed with the consumer in mind. The workshops were held in hotels, during the day and, in at least one case, could not be reached via public transportation. Consumers also cited short notice and a general lack of awareness of the workshops as even more basic roadblocks to participation. Advocates for persons with disabilities also were quick to point out that, as has long been the case with AHCA communications regarding Medicaid Reform, appropriate outreach for and notice of the workshops was not provided to the disability community. Marc Dubin, Director of Advocacy for the Center for Independent Living of South Florida, summed up the problems in a letter to State officials: "As before, attendance by people with disabilities was minimal, and no auxiliary aids or services were provided. In addition, printed materials were not provided in alternative formats. When asked, AHCA reportedly stated that they did not provide these services because no one had asked for them. In fact,?AHCA had once again issued announcements about the meetings without providing information about the availability of these services and again failing to provide information about whom to contact to ask for them." As a result of these obstacles, only one consumer enrolled in Medicaid Reform attended the Jacksonville beneficiary workshop, while about ten consumers attended in Ft. Lauderdale. Interestingly, a form was distributed to be used for providing written feedback, although meeting facilitators made it clear that it was only intended for use by those in attendance at the meeting. Thus, the effective consumer participation rate in these forums, the only ones announced by AHCA for this purpose, was less than 1/100th of one percent. By contrast, both of the workshops held for health care providers were filled to capacity. Although AHCA hoped to have a balanced discussion about both successes and challenges in the early going with Medicaid Reform, the vast majority of comments from attendees were strongly expressed complaints and concerns. Nevertheless, the long list of issues raised was shorter than it might have been, as consumers were not permitted to provide feedback on choice counseling, while providers were not permitted to provide feedback on the long delays in payments made by plans. Florida CHAIN and others have prepared a summary of the input provided at the workshops, and contrasted it with input collected earlier in the year by CHAIN at 4 consumer roundtables. The types of issues raised in both settings are strikingly similar, despite the fact they were conducted by different organizations and held several months apart.   In short, not only do serious concerns about access to and quality of care persist as Reform continues, concerns with the amount and clarity of communication from AHCA have also given rise to a general lack of trust in the system under Medicaid Reform. With respect to the issue of expanding Reform beyond the Pilot counties, the clear consensus was that, in light of all of the unresolved concerns, it is far too early to consider any such proposal. The summary will be posted at http://www.floridachain.org in the near future.   (Submitted by Greg Mellowe, Florida CHAIN)   State Revenue Projections Drop Again. . . Are Deeper Budget Cuts Far Behind? A previously unanticipated drop in the amount of tax revenue the State expects to collect prompted the Florida Legislature to convene a Special Session in October. The projected reduction in revenue was mainly attributed to lower sales and real-estate tax collections resulting from the housing slump. Those volatile revenue sources serve as the backbone of our State budget. So ironically, as more Floridians are impacted by the economic downturn, the State is less able to provide critical supports to residents when they need them most. The Legislature and Governor approved a total of $1.1 billion in cuts to the $71 billion State budget for the current fiscal year, which started last July l. More specifically, $421 million in cuts were to the Agency for Health Care Administration’s budget, with the majority taken from the Medicaid program. (That figure includes State funds as well as federal matching funds that won’t be tapped.) A significant portion of the Medicaid cuts were absorbed in long term care, but the majority pertained to health care services in Medicaid generally, particularly in payments for hospitals, physicians and pharmaceuticals. To achieve these savings, the Legislature of course eliminated or tightened restrictions on certain services already being provided. Of particular note is the fact that more than $32 million is to be saved by limiting State payments under Emergency Medicaid for hospital stays by undocumented immigrants to the first 2 days only. (Emergency Medicaid pays only for emergency care, and then only for persons otherwise eligible for Medicaid except for their immigration status.) The only exceptions will be for “medically complex, high acuity patients” with conditions such as “severe trauma, burns, and high-risk pregnancies.” The method for deciding what the State pays for in such cases need only include treatment for patients in intensive care or who would likely be re-hospitalized within 48 hours if discharged, according to the revised budget. It must be noted, however, the Legislature simultaneously increased funding for the KidCare program by $3.8 million, 70% of which is federal match, in response to increasing enrollment. The will allow 5,000 more uninsured children to obtain health coverage.   Unfortunately, State economists last week forecasted that the already bad situation will get worse. Their revised forecast predicts that Florida will be another billion dollars in the red for this fiscal year, and an additional $l.5 billion dollar shortfall is anticipated for next year. To put this in context, this is the first time that Florida will have less money to spend during both of the two preceding budget years, according to the Orlando Sentinel. So another Special Session bringing even deeper cuts could be in the works, with State agencies now computing more worst-case scenarios. However, legislators previously banked $1.8 billion in budget reserves that could help ease the crunch. Nevertheless, some of the early signals are of concern.   Governor Charlie Crist told the Sentinel that he was “confident that the Legislature has the wonderful ability to find how we can do more with less. We'll help them along the way, and we'll get through it.” Senate President Ken Pruitt raised longer term concerns, also per the Sentinel: "Today's announcement just confirms the important fact that we cannot continue to rely on home sales and construction to fuel Florida's economy."   (Submitted by Greg Mellowe, Florida CHAIN) Proposed Rule Would Dramatically Increase Cost of Medical Records   The Florida Board of Medicine (within the Department of Health) is currently considering a proposed rule change[1] that would dramatically increase the cost of obtaining medical records from health care providers. This in turn would create a tremendous financial burden, especially for low-income Floridians.    Currently, when health care providers copy patient medical records, they can charge a maximum fee of: i) one dollar per page for the first 25 pages; and ii) 25 cents for each additional page. Under the proposed rule, these providers would be allowed to charge up to $l.00 for each and every page copied, regardless of the number of pages.   For example, the likely fee for copying 100 pages of medical records would jump from $44 to $100! For 300 pages of records, the fee would increase from $94 to $300! That $300 is only slightly less than half of an SSI recipient’s monthly income. In fact, the proposed rule provides for no exemption for anyone for any reason.   Under Florida law, government agencies may not charge more than 15 cents per page for copies of public records. Why should one's own medical records cost $1.00 per page? And although hospitals can already charge higher fees than other health care providers for copying records, at least that fee structure was formally approved by the Legislature. Why should a State agency be permitted to implement such a significant change via administrative action?   Some of the specific groups of Floridians that would be most affected by this proposed change include:   Seniors, who need their medical records for a variety of reasons: to access specialty health care, to apply for any number of programs and benefits and/or to facilitate placement in long-term care facilities. Low- or fixed-income seniors are among the most likely to need access to medical records, but among the least likely to be able to afford to do so.   People with chronic medical conditions, who have extensive health problems and often need their medical records in-hand when seeking care from specialists or other health care providers and facilities.   People with disabilities, including severe mental illnesses, who frequently amass a large volume of medical records due to the ongoing nature of their condition. Many receive treatment from multiple health care providers and need to have their medical records duplicated frequently. They often need to provide documentation of their status to various entities as well.   Low-income families, who are often required by third parties (including within the public sector) to produce medical records when enrolling children in school, day care or even a sports team; applying for insurance; etc.   Florida taxpayers, who will pay more for State agencies to conduct investigations in various types of cases, including hospital or doctor misconduct, Medicaid and Medicare fraud, and any criminal cases where medical records are at issue.   In short, the Board of Medicine should decline to adopt new rules that ratchet up medical record copying fees. The upheaval and unintended consequences for Floridians far outweigh the potential benefits to health care providers. An action alert will follow in the near future.   (Submitted by Greg Mellowe, Florida CHAIN) [1]  Section 64B8-10.003, Florida Administrative Code.       Lawsuits Allege Former Broward Inmates Were Denied HIV/AIDS Meds in Jail   “We don't know how to treat you.” According to the Miami Herald, that is what former Broward County jail inmate Kevin Sauve recalls being told by jail staff in response to his repeated requests for medications to treat his HIV.  As his health deteriorated, a judge finally ordered that Sauve be released in order to get medical help.  Now out of jail, Sauve is one of two former Broward inmates filing lawsuits over denial of access to lifesaving HIV/AIDS medications while in the care of the County.   Sauve’s lawsuit against Broward Sheriff Al Lamberti and Armor Correctional Health Services, the company hired to provide medical care to Broward County inmates, claims that the denial of necessary medications to treat his serious illness amounts to a violation of his civil rights.   According to the Miami Herald: “The lawsuit alleges that it was the practice of Armor and BSO to refuse the medications 'as a cost-saving method of administering medical care' -- a policy that shows 'deliberate indifference' to the medical needs of those who are detained in the jail system.”   Sauve’s case has called into question the quality of medical care received by those being detained—not just in the Broward County jail system, but also in government facilities across the country. The consequences of being denied medical care for patients who are HIV positive can be dire.    “If patients are not able to take their ‘drug cocktail,’ their immune system is not able to provide an adequate level of defense against pathogens,” said Dr. Homayoon Khanlou, Chief of Medicine for AIDS Healthcare Foundation, the nation’s oldest and largest non-profit HIV/AIDS healthcare, research, prevention and education provider.  AHF operates Positive Healthcare, provider of Medicaid disease management services for nearly 8,000 people living with HIV/AIDS in Florida.   “Off their medications, patients can quickly develop pneumonia, diarrhea, meningitis.  They may even die,” added Dr. Khanlou. An interruption in the provision of HIV/AIDS meds can also lead to drug-resistance – a serious consequence when one has a life-threatening condition.   Government-run institutions, such as jails, have an obligation to provide medical care to those in their charge.  Whether patients like Sauve are being denied vital services in Broward jails out of ignorance, or because of something more sinister—such as a way to cut costs, as Sauve’s suit alleges—“We don’t know how to treat you” is not an appropriate or acceptable response.    AIDS Healthcare Foundation—and many others in the community—will continue to monitor the outcome of the suit and work to ensure that no one living with HIV in Florida is denied the medical care they need.   (Submitted by Michael Kahane, Bureau Chief, Southern Region, AIDS Healthcare Foundation) Medicare Drug Plans: Low-Income Seniors May Have Little Choice But To Choose The 2008 open enrollment period for Medicare Part D prescription drug plans is underway and will continue until December 31st. In the last issue of CHAIN Reaction, an article on open enrollment focused on the opportunity that 99% of Floridians have to save money in 2008 by switching to a prescription drug plan (PDP) with lower or no monthly premiums. However, the flip side of the same coin, namely the threat that many seniors face  unaffordable increases in pharmacy costs if they DON'T change plans, warrants at least the same consideration. A report issued by the Kaiser Family Foundation found that, if all seniors stayed with their current PDP in 2008, their monthly premiums would increase by an average of 17%, from $27.39 to $31.99.  Almost one fifth would face increases of more than $10 per month. Of even greater concern is the fact that the majority of low-income Medicare consumers (i.e., income less than $1,540 monthly for a 2-person family) currently enrolled in "zero-premium" PDPs MUST change plans in order to avoid premiums in 2008. The problem is more severe in Florida than in most other states, where 8 out of the 10 zero-premium drug plans (including the 2 with the most consumers enrolled) increased premiums too much to continue to qualify to participate in the program.   Approximately 312,000 Florida seniors are affected by this. Although 6 new plans will offer zero-premium drug coverage to eligible Floridians next year (a total of 8 out of 58 PDPs), making abrupt changes to different plans covering different medications may also cause serious problems, especially for medically fragile seniors. Some information sources are encouraging seniors who are changing plans to do so by December 7, in order to be sure that no hiccup in coverage occurs. However, it seems even more important to avoid making a wrong or arm-twisted choice. Another negative byproduct of increased choice among PDPs is widespread pressure from an onslaught of aggressive plan sales agents who receive commissions for every senior they convince to sign up. Recent Congressional hearings have highlighted the abusive practices of some plans, including enrolling people who didn't know what they were signing. Helping consumers make informed choices among plans clearly cannot be a priority for these agents. Yet consumers who are persuaded to sign up for the wrong plan are stuck, unless they can convince the federal Center for Medicaid and Medicare Services (CMS) that they either were deceived by an agent or are getting improper care. As attorneys advocating for seniors' Medicare rights, Florida Legal Services have seen this firsthand. Even with their concerted advocacy, a consumer spent a full 20 months working through the Humana appeals process before the plan's denial of her medication was overturned. That experience illustrates the urgency of resolving unanswered plan questions now. Medicare provides funding for and the Florida Dept. of Elder Affairs administers the SHINE (Serving Health Insurance Needs of Elders) program, which offers free assistance to Medicare consumers and their families and caregivers.  Visit www.floridashine.org. Also, see CMS' on-line PDP selection guide at www.medicare.gov/my-medicare-tools.asp Sources:  Tampa Tribune, Kaiser Family Foundation, CMS, AARP, Medicare Rights Center    (Submitted by Greg Mellowe, Florida CHAIN)   A Time for Action on Mental Health Reform   The stars are in alignment to reform mental health in Florida.  Those of us concerned about mental health must mobilize now to take advantage of this moment.   The Florida Supreme Court has just issued a new report entitled “Transforming Florida’s Mental Health System”.  Judge Steven Leifman of Miami-Dade County led the effort to create it.  Most importantly, the report was the result of a collective effort by key members of Florida’s judicial and executive branches, with representation from the  legislative branch as well.    The report’s full title is “Constructing a Comprehensive and Competent Criminal Justice/Mental Health/Substance Abuse Treatment System: Strategies for Planning, Leadership, Financing, and Service Development”.  And it means just that.   The key message of the report is this: terrible human suffering takes place in Florida and we waste huge amounts of money because we do not have the level of community prevention and service programs promised when the state “deinstitutionalized” mental illness.    We closed acute care mental hospitals. However, the community care to follow the consumer did not come as called for.  Instead, our criminal justice system became the largest residential caretaker of mentally ill patients. We also know there is a similar inappropriate and avoidable impact on our hospitals and the health care system as a whole.  In both cases, our leadership has created the most expensive and least effective alternative to care for our mentally ill.  This newly issued report is an excellent road map for correcting the system for the benefit of everyone.  Even the manner of financing the change is proposed.   There is always the chance a report of this excellence will end up on a shelf.  That cannot happen.  This new report is so good and is endorsed by so many good people; if nothing results from it, it seems likely that nothing will ever be done.   Every person and organization that cares about health care in general and mental health in particular must organize and mobilize so this report becomes a living document leading to the necessary reforms.  Local communities and leadership must be educated.  This includes government leaders, community leaders and business leaders.  Our legislative delegations must know that their constituents will no longer tolerate a wasteful and ineffective approach to mental health.   Regional and local mental health leadership from all organizations must partner to organize this educational effort.  To this end, Mental Health America of Greater Tampa Bay, Inc. has hosted a Tampa Bay Region Brainstorming Council made up of important community mental health organizations that can take on the task for Tampa Bay.      Implementation of this report will mean savings and improvements for everyone in our local communities.  This is not only an effort to help a victimized minority of sad souls.  Reforming mental health is essential for all of society.  It is a reform that everyone will demand when the continued consequences are well-known.   It is up to us to make those consequences well-known.  If you want to help, please contact Florida MHA Public Policy Counsel Chairman, Rick Wagner, at 813.695.5490. To read a copy of the full report, please visit http://www.floridasupremecourt.org/pub_info/documents/11-14-2007_Mental_Health_Report.pdf.   (Submitted by Richard B. Wagner, MSWN, MURP, President,Mental Health America of Greater Tampa Bay, Inc. and Chair of the MHA Florida Public Policy Council; and Scott F. Barnett, J.D., LL.M., Executive Director, Mental Health America of Greater Tampa Bay, Inc.) 4th Town Hall Meeting Brings Together Diverse Interests to Spark Advocacy    On November 1, Hispanic Health Initiatives, with the assistance of Florida CHAIN, hosted a Town Hall meeting in Osceola County to spark interest and involvement in local health care advocacy. Consumers can impact health care service delivery through their advocacy as much as they can through their individual health choices, but may not consider influencing policy as part of the process of taking control of their own health care. The meeting, the fourth in a series conducted across Central Florida, follows similar gatherings convened in Orange, Seminole and Volusia Counties.   Zella Reid, DCF Community Partnership Specialist for Central Florida   The meeting was attended by a wide-ranging group of stakeholdersaffected in very different ways by critical health care policy decisions pending at the state and federal levels. They included local residents, local and neighborhood civic organizations, advocates, health plan representatives, the Florida Department of Children and Families, Osceola County government, State Senator Gary Siplin’s office and State Representative Darren Soto.    Greg Mellowe, FL CHAIN, & Josephine Mercado, Hispanic Health Initiatives The meeting provided an opportunity for constructive dialogue, in spite of and in fact as a result of the diversity of perspectives present. Consumers in need of health care services, advocates seeking to promote access to care, decision-makers concerned about how to fund services needed by their constituents, and even health plan representatives balancing the needs of their members with the imperative to control costs all agreed that education about and engagement in the decision-making process are critical. Among the topics presented were Medicaid Reform, KidCare and funding services through an increase in the Tobacco Tax.   More specifically, consensus seemed to emerge around the following issues: The potential expansion of Medicaid Reform, particularly into Central Florida, is of serious concern to the community, especially given the findings included in the State’s first evaluation. There are too many unanswered questions. Some of the problems that have cropped up in the Medicaid Reform experiment have long been identified as challenges associated with Medicaid managed care initiatives generally, if not with Medicaid itself, such as access to specialists. We must work to address these problems, regardless of how Medicaid Reform plays out. We have a responsibility to make certain that we utilize all available KidCare slots to provide coverage for the maximum number of uninsured children. Barriers to enrollment and misinformation remain, but partner organizations are connected to more of the community than ever, and so we are in a better position than ever to overcome those barriers. We have a responsibility to educate the public and our Congressional representatives regarding the urgent need to re-authorize and expand SCHIP, the federal program that funds KidCare. Ten years into the KidCare program, hundreds of thousands of Florida kids remain uninsured. The meeting served to illustrate well the sometimes surprising truth that consumers advocating for more or better health care services are likely to find more allies than they might expect. (submitted by Greg Mellowe, Florida CHAIN)   REAL STORIES FROM FLORIDA HEALTH CARE CONSUMERS    With Obstacle after Obstacle, Mother of Developmentally Disabled Children Says Look Elsewhere for Medicaid Reform Model   Kendra Garcia knows what it’s like to receive Medicaid services for her three developmentally disabled children in an effective, courteous and time sensitive manner. “When I lived in North Carolina, there was one phone number, one office and one person I called. She knew me, I knew her and as problems arose she helped me solve them,” she says about the caseworker assigned to her.   But one of her three children suffers from severe allergies and Florida, where Kendra has some family and is originally from, seemed to be a good choice to live and find the best care for her children.   Instead, soon after her arrival two years ago, she found herself in a different sort of hurricane than the ones associated with the weather: Florida’s Medicaid Reform. Within a period of 6 months, her children were switched in and out of plans without her knowledge–she would find out about the changes through the therapists informing her the plan she thought was in effect was in fact not.   In a number of instances this caused her youngest child, suffering from autism, to have to go without therapy for over 30 days while the insurance coverage was being sorted out.   Now, two of her children are with CMS and one is with Pediatric Associates because the latter offers Applied Behavioral Analysis services the former does not.   As she juggles which services are covered by which plan, she also has to contend with the complex method of prescription drug approvals inherent to Florida’s Medicaid program. “We had to fight for months for CMS to approve the allergy medicines that we had already determined worked for my son because they wanted to switch to a generic brand,” she recalls.   At a recent forum organized by the Agency for Health Care Administration to get provider and consumer feedback on Reform, Kendra also expressed frustration at how difficult it is to navigate Florida’s Medicaid Bureaucracy. She also complained that she found out about the meeting on a very short notice through her child’s therapist. “I did everything possible to attend because I didn’t want AHCA to think that everyone is happy with Reform just because they couldn’t make the meeting,“ she said.   Told that Florida Medicaid Reform is being touted as a model for the rest of the country, Kendra expressed outrage, saying, “There are going to be a lot of very upset people in the whole country if that is true. They should look at North Carolina instead as a model for providing Medicaid services.” (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 (Submitted by Greg Mellowe, 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

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Events

Agency for Health Care Administration (AHCA) Medicaid Reform Workshops

Nov 8   9:00 am-noon (for Health Care Providers)

Nov 8   1:00-4:00 pm (for Medicaid beneficiaries)  

Hilton Ft. Lauderdale Airport, 1870 Griffin Rd, Dania Beach

The intent of this meeting will be to gather feedback from Medicaid beneficiaries related to various aspects of the Medicaid Reform Pilot. The specific topics of discussion will be Health Plans’ Customer Service, the Agency’s Outreach efforts and Health Plans’ benefit packages. All are invited.

Features international experts. $35 includes continental breakfast. RSVP or more information: 305/854-2568

Supported Employment and Benefits Management Training  

for Individuals with Disabilities, their Family Members and Support Coordinators. For information, contact 850/386-2022 or diamondw@wilres.com.

Health Foundation of South Florida Concern Awards Gala Luncheon

Dec 6  Conrad Hotel, Miami

This event will honor recipients of the Foundation’s annual Concern Awards. Email sgantman@hfsf.org or call 305/374-9199.

Notices

FLORIDA AUDIO CONFERENCES AND WEBCASTS

STATEWIDE NOTICES  

NATIONAL EVENTS & NOTICES

CONFERENCES AND EVENTS 

Sponsored by the Intercultural Cancer Council and Baylor College of Medicine. Presentations can address: Basic, clinical, and behavioral research, Community-based program research and evaluation, Community-based participatory research, Health services research, Health policy research, Papers addressing the disproportionate impact of cancer on racial, ethnic and medically underserved populations.

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 Un- and Underinsured: From Practical Local and Regional Solutions to State and National Health Reform

Dec 9-12   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.

Making Race, Making Health: Historical Approaches to Race, Medicine, and Public Health

Submission deadline: Jan 1

Nov 13-15, 2008   Austin, TX

Paper topics are not limited to national field or geographic area and proposals that explore a particular topic within a diasporic, imperial, or transnational framework are welcome. Conference intends to generate a dynamic conversation among scholars around the following themes: the interconnectedness between medical knowledge, medical practice, and processes of racialization; race, difference, and power within public health discourse and policy; inequality, activism, and health; and diagnostic and therapeutic regimes as sites of contestation.

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.

AUDIO AND WEB EVENTS    

 
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

Community-Campus Partnerships for Health (CCPH) Annual Award
Nominations deadline: Feb 12
The CCPH Annual Award recognizes exemplary partnerships between communities and higher educational institutions that build on each other's strengths to improve higher education, civic engagement, and the overall health of communities.

Planning Grant for Oral Health Promotion across the Life Span (R21)
Closing date for applications: May 7, 2010, Multiple deadlines
This funding opportunity announcement (FOA) is intended to encourage and support meritorious oral health promotion research directed at improving oral health and preventing diseases and/or their sequelae across the lifespan.

Healthy Kids Grant Program
Deadline: Jan 15
The General Mills Foundation, in partnership with the American Dietetic Association Foundation and the President's Council on Physical Fitness, is accepting applications for the Champions for Healthy Kids grant program. This national program will award fifty grants of $10,000 each to  community-based groups across the United States that develop  creative ways to help youth adopt a balanced diet and physically  active lifestyle. 

Continuing listings, in order of submission deadlines 

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.

Echoing Green Fellowships for Social Entrepreneurs

Application deadline: Dec 3
The Echoing Green Fellowship Program helps passionate social entrepreneurs worldwide develop new solutions to some of society’s most difficult problems. Through the program, Echoing Green offers individuals, and partnerships of no more than two individuals, seed funding to launch new organizations that turn their innovative ideas for social change into action. Projects must be the original idea of the applicants, and should not be the extension or expansion of another individual's or organization's mission or idea. Applicants must make a full-time commitment to the development of the project and must agree to lead the project for a minimum of two consecutive years.

2008 Barbara Jordan Health Policy Scholars Program

Application deadline: Dec 14

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.

Research on Social Work Practice and Concepts in Health (R03)

Closing date for applications: May 7, 2009, Multiple deadlines

This funding opportunity announcement (FOA) issued by the Office of Behavioral and Social Sciences Research solicits Small Research Grant (R03) applications from organizations/institutions that propose to develop empirical research on social work practice, concepts, and theory as these relate to the NIH public health goal of improving health outcomes for persons with medical and behavioral disorders and conditions.

Structural Interventions, Alcohol Use, and Risk of HIV/AIDS (R21)
Multiple deadlines
This Funding Opportunity Announcement (FOA) issued by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institutes of Health, solicits Exploratory/Developmental Research Grant (R21) applications from institutions/ organizations that propose to investigate the effectiveness of structural interventions that reduce the risk of HIV/AIDS transmission by changing the environment of alcohol use.

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. 

Health Insurance, Health Care Costs

Health Disparities

This current issue demonstrates an increase in the number of uninsured for a second year in a row.  The rate increase was most notable in the African American and Hispanic American populations. There was also an increase in the number of uninsured children under 18 years of age. (Aug 2007, U.S. Census Bureau)

Issue Brief: Racial and Ethnic Health Disparities 

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)

Assumed Equity: Early Observations from the First Hospital Disparities Collaborative

This article describes early findings from the planning phase of Expecting Success, a hospital-based collaborative project focused on reducing disparities in health care. (Sept/Oct 2007, Journal for Health Care Quality)

We're the Ones We've Been Waiting For: The State of AIDS in Black America ... and What We're Doing about It

assesses the impact of AIDS on the African-American community. The report offers statistical data on HIV and AIDS prevalence in the U.S., describes the current state of AIDS mobilization, and issues a call to action. (09/07, Black AIDS Institute)

Racial and Ethnic Disparities in Access to and Quality of Health Care

This report identifies the causes behind racial and ethnic disparities in health care access and quality. One of the key findings shows that Spanish-speaking Hispanics are most likely to lack access to health care when compared to other ethnic groups. (Synthesis Project at the Robert Wood Johnson Foundation)

Race, Stress, and Social Support: Addressing the Crisis in Black Infant Mortality

This background paper examines the impact of stress and stress mediators on pregnancy outcomes for African American women. The report also examines social support and other relational experiences and makes recommendations for related changes in public policy and maternal and child health practices. (09/07, Joint Center for Political and Economic Studies)