For years, many have advocated for critical healthcare reforms in Florida. Over the past decade, Florida has witnessed healthcare-related budget battles, funding cuts, and fraud, and at the same time, the number of uninsured Floridians continues to surge. The passing of national healthcare legislation under the Obama administration may bring immediate benefits to Florida in the form of billions of dollars in federal funding and changes in health insurance coverage, healthcare delivery, and healthcare technology. Some argue that Florida’s economic future relies in part on these promised benefits. Benefits, affecting Florida residents, providers, and insurers, include:

• Closing the Medicare Part D “doughnut hole” by the year 2020;
• Funding existing Community Health Centers and the construction of new centers;
• Insurance coverage for young adults seeking to remain on their parents policy until age 26;
• Affordable insurance coverage for uninsured Florida residents with pre-existing medical conditions;
• Insurance plan protections such as bans on dropping sick people, elimination of lifetime caps, streamlined appeal processes for denied claims, and prohibitions against excluding children based on a pre-existing condition;
• Creation of pilot projects based on the patient-centered medical home concept;
• Incentive payments for the implementation and use of electronic health records;
• Affordable insurance plans through state-run insurance exchanges;
• Extended Medicaid coverage for adults and children; and
• Compulsory insurance mandates requiring individuals to buy health insurance or pay a fine.
 
Despite congressional passage of these reforms, the issue remains controversial in Florida, as the State is seeking judicial repeal of federal laws imposing insurance mandates and extended Medicaid coverage. While the reforms promise increases in coverage, it is argued that the state will be debilitated by the costs.
 
To help Florida expand its Medicaid coverage, the federal government will likely be providing about $700 million in additional Florida Medicaid funding. Combined with recent Florida budget legislation providing about $270 million to be spent on hospitals, nursing homes, and caner research, efforts to improve Florida’s startling healthcare statistics seem hopeful.
 
Additional healthcare funding, of course, paves the way for increases in healthcare fraud. In an effort to combat rampant Medicaid fraud in South Florida, the federal government has granted the Florida Medicaid Fraud Control Unit (“MFCU”) the authority to conduct routine claims review, such as claims screening, billing practice pattern analysis or verification of services rendered. Previously, the Florida Agency for Health Care Administration (“AHCA”) was the only state Medicaid agency allowed to use Medicaid matching funds to detect and investigate fraud, and MFCU relied on referrals from AHCA.
 
Reforms in health insurance coverage, healthcare delivery, and healthcare technology are designed to promote the widespread delivery of efficient healthcare services throughout this state. Naturally, Florida healthcare providers must stay abreast of the changes in provider reimbursement and related incentives designed to promote this goal. Moreover, those who expeditiously implement delivery and technology reforms will reap the greatest benefits.