The last Legislature also challenged continuation of Medicaid cost-based reimbursement (CBR) for county health departments, with the end result being a one year reprieve pending a comprehensive review of the Florida Department of Health and its programs. The cost-based formula for health departments had allowed incorporation of much of the infrastructure cost of serving uninsured and undocumented clients into a county health department’s CBR rate. The Legislature also mandated a number of funding cuts in health departments in areas providing direct services for the uninsured.
The new Legislature has signaled that it intends to eliminate CBR for county health departments. The immediate impact in The New River Community Health Center service area would be a further reduction of current limited services, and the elimination of primary care.
The Legislature cannot reduce FQHC PPS reimbursement, and neither has it signaled any intent to make any changes. Since no FQHC is located in The New River Community Health Center service area , the impact on primary care access as a result of the county health department CBR elimination would be drastic.
The Florida State Children’s Health Insurance Program (SCHIP) may also be dramatically affected. In previous Legislatures there have been a number of cut costing actions taken, such as capping the number of children eligible for the non-Medicaid portions of Kid Care. There may be further reductions in eligibility as a result of the pressures on the state budget, or by changes in Medicaid that have been signaled.
Florida’s physicians are firmly opposed to any cuts in Medicare reimbursement which may occur as part of federal deficit reduction. The major course of action that has been expressed is opting out of Medicare. While the impact on The New River Community Health Center service area providers may not be as great, since there are no specialists who rely on Medicare funding, specialty access for residents in facilities and physician practices outside The New River Community Health Center service area could be severely compromised.
A major unknown has recently occurred in neighboring Bradford County. The former Critical Access Hospital affiliated with the University of Florida, Shands Starke, was sold to Health Management Associates. The new administration has indicated that it is considering reverting back to the hospital’s former 49 bed capacity, and to initiate a number of new services, including surgery, pulmonary care, and orthopedics. It also intends to expand the number of specialty services, such as cardiology, and increase outpatient services in Starke. These services will be available to New River CHC clients through an MOU (Attachment 7).
A primary economic change in The New River Community Health Center service area has been a dramatic halt to residential development over the past four years. A planned golf community was scraped in 2008. Numerous housing starts have been...