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Florida Near Bottom on Federal Grants


Since the Affordable Care Act was signed, most state governments have made the most of the federal grants flowing from Washington for health-system reform. Not Florida.

State agencies in Tallahassee have either not competed for grants or, on occasion, have won them but then given the money back.  The latest: a $2.3 million grant for a toll-free consumer health information line. A Florida agency won it, records show, then decided not to take the money.

Florida got the lowest amount of ACA grant funding per capita – behind all 50 states and the District of Columbia – in 2011, according to a report by the University of Michigan’s Center for Healthcare Research and Transformation.

Its follow-up report, not yet posted, showed Florida did only slightly better per capita last year. It came in 48th, said Josh Fangmeier, health policy analyst at the center.

His data include grants that federal  health agencies have given to community clinics, universities and local governments that applied without a state-agency sponsor.  That’s why Florida received about $40 million in health grants in 2011 and about $80 million last year.

While state agencies received the bulk of federal health grants in other states, it was the reverse in Florida. State agencies accounted for less than one-tenth of the total last year: $7.6 million. 

The grants Florida agencies received are mostly apolitical, for such things as training doctors and nurses and maternal-child health.

If a grant would advance the implementation of the ACA, community organizations apply for it directly. An example is the recent announcement that Florida health centers will receive $8.1 million to help uninsured Floridians sign up for coverage when online enrollment begins Oct. 1

Florida’s avoidance of health grants has not drawn much attention – nowhere near as much as this year’s legislative decision not to accept federal funds to expand Medicaid.  It is estimated that Florida would have gained $51 billion over a decade in federal funds, enough to cover about 1 million low-income uninsured people.

To some state officials, the refusal to seek or accept federal money is a badge of honor. In March, Florida House Speaker Will Weatherford told the American Conservative Union that states are being “coerced” into health reform “with the promise of free money.”

“They’re trying to buy us off, one by one,” said Weatherford, R-Wesley Chapel, referring to the Obama administration. “But I am not buying it. Florida will not buy it. And America should not buy it.”

To Laura Goodhue of Florida CHAIN, a health advocacy organization, this attitude inflicts considerable harm on the public. 

“You’re only hurting your own constituents,” Goodhue said. 

One of the most painful grants that Florida passed up, she said, was  a five-year, $35.7-million “Money Follows the Person” grant that was intended to help patients who have physical or mental disabilities move out of nursing homes to less-confining residential care.  The application had been filed before Gov. Rick Scott took office.

What was particularly irksome about the loss of that grant to advocates was that initially Scott had said the state would accept the money. But the Agency for Health Care Administration never asked the Legislature for spending authority for the grant.  

“There were just a number of opportunities that Florida certainly should have taken up, but we didn’t,” Goodhue said.

While a lot of Republican-dominated state governments have resisted Obamacare, none has been as averse to seeking and accepting grant money as Florida. The state’s behavior was so unusual that two years ago it was the subject of a New York Times article.

At that time, state leaders said they weren’t accepting money tied to the ACA because they believed the law would be thrown out. Gov. Rick Scott told the Times, “I don’t want to waste either federal money or state money on something that’s unconstitutional.”

Last year, the U.S. Supreme Court upheld most parts of the law.  But Florida is still turning money away, including the $2.3 million grant for a Consumer Assistance Program. The Department of Elder Affairs  won the grant in July 2012, issued a request for proposals, and after they were submitted, canceled the program in April.

The grant, as the federal Center for Consumer Information & Insurance Oversight described it, was for  $2,344,000 to be spent in 2012-13 to “assist clients with questions and to provide technical assistance about their health coverage.”

Florida’s Consumer Assistance Program (CAP) grant application shows that the Department of Elder Affairs wanted to hire five temporary program specialists to answer questions from the public about the new and changing health insurance marketplace.

The elderly would continue to be referred to volunteers in the SHINE program (Serving Health Insurance Needs of Elders), as now. SHINE is a 20-year-old federally funded program that provides trained volunteers to help people over 60 figure out Medicare and other programs for which they qualify.

Most of the CAP grant money was to be used to beef up the toll-free phone network that SHINE uses and conduct a marketing campaign for the free information service. Putting the acronyms of the existing and new programs together, it was to be the “SHINE CAP” program.

The Department of Elder Affairs posted a request for proposals on March 15. Marketing and advertising companies were jazzed at the prospect of competing for a $2 million grant.

Michelle Ubben, chief operating officer for Sachs Media Group in Tallahassee, said a team there worked hard on their proposal for a multimedia campaign.

“It was right within the sweet spot of what the company does,” she said. “We felt like it was an exciting piece of work and we were eager to go after it.”

They came up with an elaborate campaign around “wayfinding,” using colors and signs to help people find their way through a complex system.

“We were really excited about this being a signature project for next couple of years that could improve the lives of Floridians and help an agency of government do its job better and take advantage of a historic opportunity,” Ubben said.

They were disappointed when the department canceled the project shortly after the deadline for proposals. All the applicants were told was that the money wasn’t available after all.

The decision came right after two top officials there received an e-mail from the Florida House.  Eric Pridgeon, health and human services budget analyst there, sent the e-mail April 7 to  two officials at the Department of Elder Affairs, Legislative Affairs Director Adam Lovejoy and Chief Financial Officer Jon Manalo.

In it, he wrote: “Can you advise how you will implement this grant/procurement?  Will you be coming to the LBC for budget authority?  Please advise.” LBC is short for Legislative Budget Commission.

The commission, which has some members from the House and some from the Senate, reviews budget and personnel actions by executive agencies or the courts to make sure they don’t violate the intent of the Legislature.

“We did not have the legislative budget authority to move forward,” Elder Affairs spokeswoman Ashley Marshall said in an email. “Therefore, the grant was returned.” 

A request to interview those involved in the decision—Lovejoy, Manalo and presumably Secretary Charles Corley – was denied.

Similarly, Pridgeon did not respond to calls and emails. House spokesman Ryan Duffy said, “Our House staff raised the concern that Obamacare’s a law that’s going to impact Floridians of all ages and so there was concern that the award was given to an agency that deals with elder affairs.”

Tallahassee consumer health advocate Brian Lee of Families for Better Care says he can hardly believe the state turned down the money for something as useful as an information line.  Taking the money, he said, “seems to be a no-brainer.”

Health News Florida is a service of WUSF Public Media.  Contact Editor Carol Gentry at (desk) 813-974-8629 or (cell) 727-410-3266 or by e-mail at cgentry@wusf.org. For more health news, visit HealthNewsFlorida.org.

Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.After serving two years as a Peace Corps volunteer in Colombia, Gentry worked for a number of newspapers including The Wall Street Journal, St. Petersburg Times (now Tampa Bay Times), the Tampa Tribune and Orlando Sentinel. She was a Kaiser Foundation Media Fellow in 1994-95 and earned an Master's in Public Administration at Harvard’s Kennedy School of Government in 1996. She directed a journalism fellowship program at the Centers for Disease Control and Prevention for four years.Gentry created Health News Florida, an independent non-profit health journalism publication, in 2006, and served as editor until September, 2014, when she became a special correspondent. She and Health News Florida joined WUSF in 2012.
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