Tensions erupt in House over DeSantis-backed Hope Florida program's $10M windfall
Rep. Alex Andrade, who chairs the House Health Care Budget Subcommittee, didn't like the answers.
'I'm more stunned, than anything else, by the responses, the demeanor, the flippancy (toward) the serious questions we have,' Andrade, R-Pensacola, told reporters after the hearing. 'This is an endemic problem in state agencies right now and it's something that we've got to work on.'
Shevaun Harris, the secretary of the Agency for Health Care Administration, had struggled to answer questions on a series of issues related to Hope Florida, a program spearheaded by First Lady Casey DeSantis that tries to connect Floridians receiving welfare and Medicaid with other services to help move them off government assistance.
Andrade and other members of the panel expressed alarm over $10 million that went to the Hope Florida Foundation as part of a settlement between AHCA and Centene, a large provider of services under Florida's Medicaid managed care plans.
Under state law, money from settlements must be reported by state agencies to the Legislature, but this wasn't.
As Harris explained, the overall settlement was $67 million, with $57 million going to AHCA. It had to do with overpayments related to pharmacy benefit managers, she said, but the other $10 million was a donation from Centene to the Hope Florida Foundation, so the money never came to AHCA and was therefore was not state funds reportable to the Legislature.
The settlement was reached in October; Harris didn't take the helm at AHCA until February. 'The settlement agreement had a lot of attorneys involved, taking great care to make sure everything was done appropriately,' she said.
But Andrade, an attorney, maintains the funds are taxpayer money and the settlement violates state law: 'The reference to that $10 million not being taxpayer dollars I find offensive,' Andrade said at one point in the hearing.
He noted the settlement was for repaying overpayments from the state's Medicaid program. 'At what point did it suddenly become not taxpayer money?' asked Andrade, a state representative since 2018.
Andrade also raised concerns about Hope Florida getting preferential treatment in the state's Medicaid Managed Care contracts. Specifically, health care insurers must cooperate with Hope Florida as part of the contract.
Another gripe from the committee was the alleged lack of transparency surrounding Hope Florida.
'I still don't get a clear response over who is responsible for Hope Florida,' said Rep. Marie Woodson, D-Hollywood. 'We need to have some names.'
Harris explained that the Hope Florida program uses state employees at many different agencies to help connect those in need with services throughout state government and with nonprofits, including churches, who can provide food, clothing and shelter for those in crisis.
That means there is no executive director of the Hope Florida program, she added.
But the Hope Florida Foundation, which is a nonprofit, is a separate entity. She said that group has a board and later in the hearing said its chairman is Josh Hay, CEO of Indelible Solutions, a Tallahassee-based management consulting firm.
As a nonprofit, the Hope Florida Foundation is required to file tax forms with the IRS that are required to be made available upon request by members of the public, but reporters from the Miami Herald/Tampa Bay Times Tallahassee Bureau have said they were turned away after making such a request at the Department of Children and Families headquarters in the capital.
The heightened scrutiny of Hope Florida comes as Casey DeSantis is said to be considering a run for governor in 2026 to replace her husband, Gov. Ron DeSantis, who is term-limited. DeSantis has pushed lawmakers to codify Hope Florida, which was started by Casey DeSantis in 2021, into law.
At one point in the hearing, Harris said the Hope Florida program was simply trying to help those in need and implied lawmakers weren't sharing that goal.
'I'm not sure why we're here," Harris said. "And I understand there are questions being asked and we're doing our best to be transparent to answer but it does feel like we're not aligned in this overall goal of helping families.
'It's kind of sad, genuinely," she added. "This is the goal of helping individuals get back on their feet. I don't know what's wrong with that.'
'I'm going to take umbrage at that claim,' Andrade replied. 'We're a separate government body tasked with oversight and direction of state agencies and we discover that state agencies are redirecting money secretly, at the eleventh hour, in a legal settlement without giving us any notice? And the accusation is that we don't care about helping Florida families? I take personal issue at that insinuation, Secretary.'
Gray Rohrer is a reporter with the USA TODAY Network-Florida Capital Bureau. He can be reached at grohrer@gannett.com. Follow him on X: @GrayRohrer.
This article originally appeared on Tallahassee Democrat: Hope Florida under fire for lack of oversight, $10M settlement
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Miami Herald
2 hours ago
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Health groups aim to counter growing ‘national scandal' of elder homelessness
At age 82, Roberta Rabinovitz realized she had no place to go. A widow, she had lost both her daughters to cancer, after living with one and then the other, nursing them until their deaths. Then she moved in with her brother in Florida, until he also died. And so last fall, while recovering from lung cancer, Rabinovitz ended up at her grandson's home in Burrillville, Rhode Island, where she slept on the couch and struggled to navigate the steep staircase to the shower. That wasn't sustainable, and with apartment rents out of reach, Rabinovitz joined the growing population of older Americans unsure of where to lay their heads at night. But Rabinovitz was fortunate. She found a place to live, through what might seem an unlikely source — a health care nonprofit, the PACE Organization of Rhode Island. Around the country, arranging for housing is a relatively new and growing challenge for such PACE groups, which are funded through Medicaid and Medicare. PACE stands for a Program of All-Inclusive Care for the Elderly, and the organizations aim to keep frail, older people in their homes. But a patient can't stay at home if they don't have one. As housing costs rise, organizations responsible for people's medical care are realizing that to ensure their clients have a place to live, they must venture outside their lanes. Even hospitals — in Denver, New Orleans, New York City and elsewhere — have started investing in housing, recognizing that health isn't possible without it. And among older adults, the need is especially growing. In the U.S., 1 in 5 people who were homeless in 2024 were 55 or older, with the total older homeless population up 6% from the previous year. Dennis Culhane, a University of Pennsylvania professor who specializes in homelessness and housing policy, calculated that the number of men older than 60 living in shelters roughly tripled from 2000 to 2020. 'It's a national scandal, really, that the richest country in the world would have destitute elderly and disabled people,' Culhane said. Over decades of research, Culhane has documented the plight of people born between 1955 and 1965 who came of age during recessions and never got an economic foothold. Many in this group endured intermittent homelessness throughout their lives, and now their troubles are compounded by aging. But other homeless older adults are new to the experience. Many teeter on the edge of poverty, said Sandy Markwood, CEO of USAging, a national association representing what are known as area agencies on aging. A single incident can tip them into homelessness — the death of a spouse, job loss, a rent increase, an injury or illness. If cognitive decline starts, an older person may forget to pay their mortgage. Even those with paid-off houses often can't afford rising property taxes and upkeep. 'No one imagines anybody living on the street at 75 or 80,' Markwood said. 'But they are.' President Donald Trump's recent budget law, which makes substantial federal cuts to Medicaid, the public insurance program for those with low incomes or disabilities, will make matters worse for older people with limited incomes, said Yolanda Stevens, program and policy analyst with the National Alliance to End Homelessness. If people lose their health coverage or their local hospital closes, it will be harder for them to maintain their health and pay the rent. 'It's a perfect storm,' Stevens said. 'It's an unfortunate, devastating storm for our older Americans.' Adding to the challenges, the Labor Department recently halted a job training program intended to keep low-income older people in the workforce. 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The Hill
2 hours ago
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Pesticides test MAHA-MAGA alliance
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'It's obvious that there are tensions within this newfound coalition between MAHA and MAGA, and there are some big issues there,' said Mary Holland, CEO of Children's Health Defense, a group that was founded by Health and Human Services Secretary Robert F. Kennedy Jr., considered the MAHA flagbearer. Conservatives have traditionally sided with big business, supporting fewer regulations on potentially toxic substances. Kennedy and his disciples, meanwhile, espouse stricter environmental protections, while also bucking mainstream science on vaccine safety. The disparities on chemicals and pesticides within their coalition put Republicans in the middle: Do they side with big business or health concerns? On many issues, business interests appear to be winning. 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I think that this is a case of the Democratic Party looking to blame Republicans for it,' Lyons said. While the pesticide issues have generated some sparks between MAHA and MAGA, the administration has taken a number of other actions to also reduce restrictions on the chemical industry more broadly. Trump himself exempted from environmental standards more than 100 polluters, including chemical manufacturers, oil refineries, coal plants and medical device sterilizers. The EPA, meanwhile, has put chemical industry alumni in leading roles and has said it wants to loosen restrictions on emissions of various cancer-linked chemicals. Asked about Trump's move to exempt polluters from Clean Air Act rules, Holland said 'there's clearly tensions' within the GOP coalition. 'Those factions, if you will, more protective of corporate and more challenging to corporate, are both striving to get the president's ear, and I don't think they've come to a complete, sort of settlement agreement,' she said.
CBS News
4 hours ago
- CBS News
Native Americans want to avoid past Medicaid enrollment snafus as work requirements loom
Jonnell Wieder earned too much money at her job to keep her Medicaid coverage when the COVID-19 public health emergency ended in 2023 and states resumed checking whether people were eligible for the program. But she was reassured by the knowledge that Medicaid would provide postpartum coverage for her and her daughter, Oakleigh McDonald, who was born in July of that year. Wieder is a member of the Confederated Salish and Kootenai Tribes in Montana and can access some health services for free through her tribe's health clinics. But funding is limited, so, like a lot of Native American people, she relied on Medicaid for herself and Oakleigh. Months before Oakleigh's first birthday, the date when Wieder's postpartum coverage would come to an end, Wieder completed and returned paperwork to enroll her daughter in Healthy Montana Kids, the state's version of the Children's Health Insurance Program. But her paperwork, caught up in the lengthy delays and processing times for applications, did not go through. "As soon as she turned 1, they cut her off completely," Wieder said. It took six months for Wieder to get Oakleigh covered again through Healthy Montana Kids. Before health workers in her tribe stepped in to help her resubmit her application, Wieder repeatedly called the state's health department. She said she would dial the call center when she arrived at her job in the morning and go about her work while waiting on hold, only for the call to be dropped by the end of the day. "Never did I talk to anybody," she said. Wieder and Oakleigh's experience is an example of the chaos for eligible Medicaid beneficiaries caused by the process known as the "unwinding," which led to millions of people in the U.S. losing coverage due to paperwork or other procedural issues. Now, tribal health leaders fear their communities will experience more health coverage disruptions when new federal Medicaid work and eligibility requirements are implemented by the start of 2027. The tax-and-spending law that President Trump signed this summer exempts Native Americans from the new requirement that some people work or do another qualifying activity a minimum number of hours each month to be eligible for Medicaid, as well as from more frequent eligibility checks. But as Wieder and her daughter's experience shows, they are not exempt from getting caught up in procedural disenrollments that could reemerge as states implement the new rules. "We also know from the unwinding that that just doesn't always play out necessarily correctly in practice," said Joan Alker, who leads Georgetown University's Center for Children and Families. "There's a lot to worry about." The new law is projected to increase the number of people who are uninsured by 10 million. The lessons of the unwinding suggest that "deep trouble" lies ahead for Native Americans who rely on Medicaid, according to Alker. Mr. Trump's new law changes Medicaid rules to require some recipients ages 19 to 64 to log 80 hours of work or other qualifying activities per month. It also requires states to recheck those recipients' eligibility every six months, instead of annually. Both of these changes will be effective by the end of next year. The Congressional Budget Office estimated in July that the law would reduce federal Medicaid spending by more than $900 billion over a decade. In addition, more than 4 million people enrolled in health plans through the Affordable Care Act marketplace are projected to become uninsured if Congress allows pandemic-era enhanced premium tax credits to expire at the end of the year. Wieder said she was lucky that the tribe covered costs and her daughter's care wasn't interrupted in the six months she didn't have health insurance. Citizens of federally recognized tribes in the U.S. can access some free health services through the Indian Health Service, the federal agency responsible for providing health care to Native Americans and Alaska Natives. But free care is limited because Congress has historically failed to fully fund the Indian Health Service. Tribal health systems rely heavily on Medicaid to fill that gap. Native Americans are enrolled in Medicaid at higher rates than the White population and have higher rates of chronic illnesses, die more from preventable diseases, and have less access to care. Medicaid is the largest third-party payer to the Indian Health Service and other tribal health facilities and organizations. Accounting for about two-thirds of the outside revenue the Indian Health Service collects, it helps tribal health organizations pay their staff, maintain or expand services, and build infrastructure. Tribal leaders say protecting Medicaid for Indian Country is a responsibility Congress and the federal government must fulfill as part of their trust and treaty obligations to tribes. The Trump administration prevented states from disenrolling most Medicaid recipients for the duration of the public health emergency starting in 2020. After those eligibility checks resumed in 2023, nearly 27 million people nationwide were disenrolled from Medicaid during the unwinding, according to an analysis by the Government Accountability Office published in June. The majority of disenrollments — about 70% — occurred for procedural reasons, according to the federal Centers for Medicare & Medicaid Services. CMS did not require state agencies to collect race and ethnicity data for their reporting during the unwinding, making it difficult to determine how many Native American and Alaska Native enrollees lost coverage. The lack of data to show how the unwinding affected the population makes it difficult to identify disparities and create policies to address them, said Latoya Hill, senior policy manager with KFF's Racial Equity and Health Policy program. KFF is a health information nonprofit that includes KFF Health News. The National Council of Urban Indian Health, which advocates on public health issues for Native Americans living in urban parts of the nation, analyzed the Census Bureau's 2022 American Community Survey and KFF data in an effort to understand how disenrollment affected tribes. The council estimated more than 850,000 Native Americans had lost coverage as of May 2024. About 2.7 million Native Americans and Alaska Natives were enrolled in Medicaid in 2022, according to the council. The National Indian Health Board, a nonprofit that represents and advocates for federally recognized tribes, has been working with federal Medicaid officials to ensure that state agencies are prepared to implement the exemptions. "We learned a lot of lessons about state capacity during the unwinding," said Winn Davis, congressional relations director for the National Indian Health Board. Nevada health officials say they plan to apply lessons learned during the unwinding and launch a public education campaign on the Medicaid changes in the new federal law. "A lot of this will depend on anticipated federal guidance regarding the implementation of those new rules," said Stacie Weeks, director of the Nevada Health Authority. Staff at the Fallon Tribal Health Center in Nevada have become authorized representatives for some of their patients. This means that tribal citizens' Medicaid paperwork is sent to the health center, allowing staff to notify individuals and help them fill it out. Davis said the unwinding process showed that Native American enrollees are uniquely vulnerable to procedural disenrollment. The new law's exemption of Native Americans from work requirements and more frequent eligibility checks is the "bare minimum" to ensure unnecessary disenrollments are avoided as part of trust and treaty obligations, Davis said. The GAO said the process of determining whether individuals are eligible for Medicaid is "complex" and "vulnerable to error" in a 2024 report on the unwinding. "The resumption of Medicaid eligibility redeterminations on such a large scale further compounded this complexity," the report said. It highlighted weaknesses across state systems. By April 2024, federal Medicaid officials had found nearly all states were out of compliance with redetermination requirements, according to the GAO. Eligible people lost their coverage, the accountability office said, highlighting the need to improve federal oversight. In Texas, for example, federal Medicaid officials found that 100,000 eligible people had been disenrolled due to, for example, the state system's failure to process their completed renewal forms or miscalculation of the length of women's postpartum coverage. Some states were not conducting ex parte renewals, in which a person's Medicaid coverage is automatically renewed based on existing information available to the state. That reduces the chance that paperwork is sent to the wrong address, because the recipient doesn't need to complete or return renewal forms. But poorly conducted ex parte renewals can lead to procedural disenrollments, too. More than 100,000 people in Nevada were disenrolled by September 2023 through the ex parte process. The state had been conducting the ex parte renewals at the household level, rather than by individual beneficiary, resulting in the disenrollment of still-eligible children because their parents were no longer eligible. Ninety-three percent of disenrollments in the state were for procedural reasons — the highest in the nation, according to KFF. Another issue the federal agency identified was that some state agencies were not giving enrollees the opportunity to submit their renewal paperwork through all means available, including mail, phone, online, and in person. State agencies also identified challenges they faced during the unwinding, including an unprecedented volume of eligibility redeterminations, insufficient staffing and training, and a lack of response from enrollees who may not have been aware of the unwinding. Native Americans and Alaska Natives have unique challenges in maintaining their coverage. Communities in rural parts of the nation experience issues with receiving and sending mail. Some Native Americans on reservations may not have street addresses. Others may not have permanent housing or change addresses frequently. In Alaska, mail service is often disrupted by severe weather. Another issue is the lack of reliable internet service on remote reservations. Tribal health leaders and patient benefit coordinators said some tribal citizens did not receive their redetermination paperwork or struggled to fill it out and send it back to their state Medicaid agency. Although the unwinding is over, many challenges persist. Tribal health workers in Montana, Oklahoma, and South Dakota said some eligible patients who lost Medicaid during the unwinding had still not been reenrolled as of this spring. "Even today, we're still in the trenches of getting individuals that had been disenrolled back onto Medicaid," said Rachel Arthur, executive director of the Indian Family Health Clinic in Great Falls, Montana, in May. Arthur said staff at the clinic realized early in the unwinding that their patients were not receiving their redetermination notices in the mail. The clinic is identifying people who fell off Medicaid during the unwinding and helping them fill out applications. Marlena Farnes, who was a patient benefit coordinator at the Indian Family Health Clinic during the Medicaid unwinding, said she tried for months to help an older patient with a chronic health condition get back on Medicaid. He had completed and returned his paperwork but still received a notice that his coverage had lapsed. After many calls to the state Medicaid office, Farnes said, state officials told her the patient's application had been lost. Another patient went to the emergency room multiple times while uninsured, Arthur said. "I felt like if our patients weren't helped with follow-up, and that advocacy piece, their applications were not being seen," Farnes said. She is now the behavioral health director at the clinic. Montana was one of five states where more than 50% of enrollees lost coverage during the unwinding, according to the GAO. The other states are Idaho, Oklahoma, Texas, and Utah. About 68% of Montanans who lost coverage were disenrolled for procedural reasons. In Oklahoma, eligibility redeterminations remain challenging to process, said Yvonne Myers, a Medicaid and Affordable Care Act consultant for Citizen Potawatomi Nation Health Services. That's causing more frequent coverage lapses, she said. Myers said she thinks Republican claims of "waste, fraud, and abuse" are overstated. "I challenge some of them to try to go through an eligibility process," Myers said. "The way they're going about it is making it for more hoops to jump through, which ultimately will cause people to fall off." The unwinding showed that state systems can struggle to respond quickly to changes in Medicaid, leading to preventable erroneous disenrollments. Individuals were often in the dark about their applications and struggled to reach state offices for answers. Tribal leaders and health experts are raising concerns that those issues will continue and worsen as states implement the requirements of the new law. Georgia, the only state with an active Medicaid work requirement program, has shown that the changes can be difficult for individuals to navigate and costly for a state to implement. More than 100,000 people have applied for Georgia's Pathways program, but only about 8,600 were enrolled as of the end of July. Alker, of Georgetown, said Congress took the wrong lesson from the unwinding in adding more restrictions and red tape. "It will make unwinding pale in comparison in terms of the number of folks that are going to lose coverage," Alker said. This article was published with the support of the Journalism & Women Symposium (JAWS) Health Journalism Fellowship, assisted by grants from The Commonwealth Fund. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
