Florida’s most vulnerable residents — at-risk children, families living at or below the poverty level, the frail elderly and mentally and physically disabled — enter 2014 in as much peril as they were a year ago. One Editorial Board goal this year is to advocate for improved services to help less fortunate Floridians lead safer, healthier lives.
With Gov. Rick Scott and the Republican-led Legislature refusing to create a state Medicaid exchange under the generous terms offered by the federal Affordable Care Act, almost 1 million residents will fall into an uninsured healthcare gap in 2014. They won’t qualify for coverage under current state Medicaid eligibility guidelines, nor for the tax credits available under ACA to help them pay for private insurance in new healthcare markets.
Florida Republicans have joined at least 20 other GOP-led states in opting not to expand their Medicaid programs, even though the federal government will foot the entire healthcare bill for those enrolled in the expansion for 2014, 2015 and 2016 and pay no less than 90 percent of the costs after that.
This refusal, based on ideology not economics, will only drive up costs at public clinics and hospitals, with Jackson Health System being a major victim. Some 470,000 uninsured Miami-Dade residents, one of every three in the county, annually seek care at Jackson’s emergency room or other facilities, costing the hospital millions of dollars.
For the sake of nearly 1 million uninsured Floridians and the state’s public hospitals’ bottom lines, Mr. Scott and GOP lawmakers should reverse their refusal to expand the state’s Medicaid program this year.
Dozens of children under the purview of the Department of Children & Families died from abuse or neglect in 2013. When it came to neglect, the agency was often a major culprit. Children were left in abusive homes, only to end up dead and in the headlines. DCF workers often failed to follow up on initial abuse investigations or simply accepted a caregiver’s promise to do better. After DCF Secretary David Wilkins resigned under pressure, Gov. Scott appointed Esther Jacobo, from the Miami DCF district, interim secretary. Ms. Jacobo hired Casey Family Programs to review 40 abuse cases and recommend improvements. Among them, assigning two people to an investigation, making the investigations and follow-up monitoring seamless so a child doesn’t fall through the cracks.
It’s a start, but unless Gov. Scott and the Legislature increase funding for more investigators, case workers and training, the “new and improved” DCF will keep failing Florida’s vulnerable children.
Nothing much has changed in how the Agency for Health Care Administration regulates its nearly 3,000 licensed assisted living facilities since The Herald’s Carol Marbin Miller chronicled the deplorable conditions at many ALFs, uncovering more than 70 deaths and a host of injured residents over a 10-year period in the Neglected to Death series. Some homes avoid being licensed at all via generous loopholes in state law. AHCA has fined just seven of the 93 unlicensed operators it has identified since 2012.
The ALF industry has a lot of clout in the Legislature, where an ALF-reform bill passed in the Senate in 2013, but failed to gain traction in the House. Democratic state Sen. Eleanor Sobel of Hollywood and her allies will try again this session, but it’s the House leadership that needs to buck the powerful home-care industry and adopt measures that shut unlicensed homes and crack down hard on licensed ones that fail regular state inspections.
Also, the job of overseeing volunteer ALF and nursing-home inspectors at the Department of Elder Affairs has been in flux, with high turnover and the current search for a new ombudsman raising questions about the entire search process. It’s a crucial job that needs a strong, qualified occupant — soon.