Can Florida's Public Workforce Afford to 'Live Local'?
Introduction
The Live Local Act — passed in March 2023 — took effect at the end of July 2023. Sponsors and supporters of this bill touted that it would house “the backbone of our communities. The ones who build it up, the ones who protect it, the ones who serve it. The ones who deserve to have access to housing that is affordable.” This was done so that they can “save time and money for themselves, their families, and their futures.”[1], [2], [3], [4]
As the terms above are often used to describe public educators, law enforcement officers, firefighters, and EMTs/paramedics, one would expect Live Local’s established target, “workforce” housing, to be affordable for those groups. However, Florida Policy Institute’s (FPI’s) analysis of the 25 Metropolitan Statistical Areas (MSAs) across Florida shows a trend of housing unaffordability for many sole-earner public servants and their families.
Area Median Income and “Workforce” Housing, Explained
Workforce housing is most commonly intended for households at 80 percent to 120 percent[5] of the Area Median Income (AMI).[6] Because AMI is based on geography, the 80 percent floor for Florida’s 67 counties ranges between the following amounts:
- $36,560 - $68,800 for a 1-person household
- $41,760 - $76,320 for a 2-person household
- $46,960 - $85,920 for a 3-person household
- $52,160 - $95,440 for a 4-person household
This means that educators, police officers, firefighters, and paramedics must have a household income at or above the applicable income floor in order to afford the average unit created under Live Local.
Over a Third of Florida Households are Housing Cost-Burdened
Housing is considered “affordable” when a household is paying 30 percent or less of their income on housing costs (rent, mortgage, etc.). A household is defined as “cost-burdened” when it spends more than 30 percent of household income on housing costs and “severely cost-burdened” when housing costs surpass 50 percent of the household’s income. In Florida, nearly 2.9 million households are considered cost-burdened, and nearly 2.4 million of those households also fall into the severely cost-burdened category.[7] While only a little over a third of the state’s total households are cost-burdened, the less money a household brings in, the higher the chance it will fall into this category.[8] Additionally, Floridian renters are substantially more burdened when it comes to housing. Almost 1.5 million renters are cost-burdened, and nearly 760,000 of these are severely cost-burdened.[9] Renters who are cost-burdened account for over half of Florida’s total renters.
Although those households under 80 percent AMI are not targeted by Live Local, their need for affordable housing is substantial. Figure 1 shows the overall breakdown of cost-burdened households in Florida.
Breaking Findings Down By Profession[10]
Live Local and the Public Workforce
In order to assess the impacts of Live Local on the workforce population in Florida, FPI assessed the average salary for key professions — educators, law enforcement officers, firefighters, and paramedics/EMTs — and whether these public workers would be able to afford housing developed under this program. Salary data was obtained for MSAs and compared to the affordability guidelines for their corresponding counties. (See Methodology for more details). These professions were chosen specifically because they correspond to the types of workers referenced in discussions around Live Local: those workers who are “the backbone of our communities” and who “build [them] up, . . . who protect [them], . . . who serve [them].”[11]
Law Enforcement Officers
“Protect and Serve” is the oft-used slogan by many law enforcement agencies. These public employees make up part of the “workforce” targeted by Live Local workforce housing. However, housing affordability has often eluded Floridians in these positions, forcing them to relocate after time and resources were spent to train them.[12] While Florida has been increasing pay and bonuses to boost applicant rates,[13] the average police officer’s salary in most Florida counties still falls below 80 percent AMI if the worker is the sole breadwinner in a three- or four-person family. (See Table 1 and Figure 2.)
Only one MSA has a county where a law enforcement officer cannot afford the county’s 80 percent AMI floor on the average pay, meaning that law enforcement officers in one-person households can afford rent in the remaining 66 counties.
When considering law enforcement officers working as sole breadwinners in households with more than one person, however, workforce housing is far less affordable on the MSAs’ average salary (See Table 1).
While promotions and bonuses can increase compensation for law enforcement officers over the course of their careers, affordability can still be a challenge for those in larger households, such as single parents or people taking care of an infirm family member as a dependent. Housing affordability is also an important factor for law enforcement agencies in being able to attract or retain qualified candidates when they cannot afford to live where they work.
Educators[14]
Florida is home to the lowest average pay for teachers in the nation.[15] This, combined with skyrocketing housing costs, means that many teachers are struggling to afford housing. Even back in 2020, when rent and mortgage prices were lower than they are currently, 17 percent of teachers and 22 percent of education support professionals were having “moderate or serious problems” paying their rents or mortgages.[16]
Only five counties have 80 percent AMI floors that cannot accommodate the average educator living alone. The remaining MSAs and 62 counties’ average educators’ salaries hit the Live Local floor.
However, when looking at educators working as the sole breadwinner in a two-, three, or four-person household, the affordability drops immediately (See Table 2.):
While all counties provide pay enhancements that can impact educator salaries for the years the enhancements are granted, some of these areas would still remain unaffordable at the workforce AMI floors for over a decade for those teachers earning only the base pay.[17]
There were two bills[18] that were introduced in the 2024 Florida legislative session that are aimed at raising educator base pay. Neither bill passed; however, even if they had passed, there would still be 26 counties[19] that would have failed to meet the 80 percent floor on two-, three-, and/or four-person households where the sole breadwinner is an educator.
Firefighters
While programs like Hometown Heroes can help firefighters in good enough credit standing to purchase homes, for those who are renting, there are far less options for permanent affordability.[20]
The average firefighter salary does not attain the 80 percent AMI floors in 23 counties –- over a third of Florida counties. Unaffordability for the remaining household sizes skyrockets. If a firefighter is the sole breadwinner in a family of two or more, nearly the entire state would be unaffordable. (See Table 3.).
Paramedics[21]
Even before the COVID-19 pandemic, there was a recruitment and retention crisis among paramedics and EMTs.[22] In fact, recruitment and retention has been the leading issue for paramedics and EMTs for years.[23] While paramedics/EMTs in one-person households actually surpass firefighters in the ability to afford rent at the 80 percent AMI floor, affordability for these workers drops off at a much higher rate for larger households.
Even though paramedic salaries have increased in the past year, over a fifth of Florida’s counties are unaffordable at 80 percent floors for paramedics - a total of 14 counties. Like the law enforcement officer and firefighter salaries, a larger household size where the paramedic is the main breadwinner quickly becomes unaffordable (See Table 4.).
The Most Unaffordable Counties and Related MSAs
The regions below are those where workforce housing is the least affordable for law enforcement officers, educators, firefighers, and EMTs/paramedics:
- Monroe County [South Florida nonmetropolitan area]
- Unaffordable for all occupations at all household sizes.
- Brevard County [Palm Bay-Melbourne-Titusville]
- Affordable only for two of the four occupations in a one-person household
- Bay County [Panama City], Alachua County [Gainesville], Gilchrist County [Gainesville], Flagler County [Deltona-Daytona Beach-Ormond Beach], and Lake County [Orlando-Kissimmee-Sanford]
- Unaffordable for every occupation starting at a two-person household
Live Local Policy Considerations
As the above data shows, many in the public workforce cannot afford the “workforce housing” targeted by Live Local, despite serving in critical roles within communities. While Live Local does provide tax credits[24] and property tax exemptions[25] that can support housing development for AMIs under 80 percent, these types of tax breaks mean that local governments would not be collecting the foregone tax revenue that would have been used to support local public schools and emergency services.[26] It is also worth noting that the “Missing Middle” tax exemption piece of Live Local, which grants a 100 percent property tax exemption on units below 80 percent AMI and a 75 percent property tax exemption on units from 80 to 120 percent AMI, has resulted in a concentration of significantly more applications and approvals for new construction units at 120 percent AMI — comprising 96.3 percent — compared to those at lower income thresholds.[27] On the other hand, renovated units at 120 percent AMI make up only slightly over half of successful applications — 53 percent.[28]
Additionally, while the state’s private developer loan program, SAIL,[29] requires that 20 to 40 percent of units built are at AMIs lower than the “workforce” levels, the majority of units — between 60 and 80 percent — may still be unattainable for the public workers touted when the bill was in session. On top of this, the Florida Legislature attempted — unsuccessfully — to pass two bills[30] that would have removed the 40 percent requirement for developers using Low-Income Housing Tax Credits (LIHTC). Had it passed, only 20 percent of the units would have been required to be affordable.
Potential Paths Forward
Live Local is set to end in 2033, meaning the state can either renew the bill at that date or return to funding affordable housing solely through the state’s existing affordable housing fund, The Sadowski Trust. This also means that there are several legislative cycles to implement amendments that would make Live Local more equitable and in-line with the spirit of its purpose. Some examples of potential paths are as follows:
- Codify language, lowering the AMI ranges or at least reserve a portion of the funding — separate from tax credits, property taxes, and FHFC discretion — for lower AMI levels.
- Designate a recurring portion of the future Live Local allocations to go to local governments through the Statewide Housing Initiatives Partnership (SHIP) program to specifically target lower AMIs or to construct housing affordable to house public workers.
- Apportion money to local governments to be used as housing vouchers and property insurance-related gap financing to compensate for the shortfalls.
The significant investment that Live Local makes in affordable housing is certainly needed and a step in the right direction. However, to truly address Florida’s housing crisis, there also needs to be an investment in housing solutions that include workers with incomes under the 80 percent threshold. These Floridians are hired by municipalities to build up, protect, and serve our communities, and they should be able to live in the communities they serve.
Notes
[1] Florida Senate Committee on Community Affairs, “Committee on Community Affairs Meeting” Feb. 8, 2023, 9:30 AM (1 hr., 8 secs.), https://www.flsenate.gov/media/VideoPlayer?EventID=1_zc8d1g0v-
202302080930&Redirect=true, “Dignity of work and value of family life.”
[2] Florida House of Representatives Ways and Means Committee, “Ways and Means Committee Meeting” Mar. 20, 2023, 2:30 PM (48 mins., 47 secs.), https://www.myfloridahouse.gov/VideoPlayer.aspx?eventID=8652, “Dignity of work and value of family life.”
[3] Florida House of Representatives, “House Session” Mar. 23, 2023, 12:00PM (1 hr., 21 mins., 2 secs.), https://www.flsenate.gov/media/VideoPlayer?EventID=1_zp1pj23y-202303231200&Redirect=true, “No matter their state in life and income . . . [t]he ones who deserve to live where they work.”
[4] Florida House of Representatives, “House Session” Mar. 24, 2023, 11:00AM (1 hr., 40 mins., 22 secs.), https://www.flsenate.gov/media/VideoPlayer?EventID=1_zp1pj23y-202303241100&Redirect=true, “The people who are the backbone of our communities. The ones who build it up, the ones who protect it, the ones who serve it. The ones who deserve to have access to housing that is affordable . . . [So that they can] save time & money for themselves, their families, and their futures.”
[5] There were two unsuccessful companion bills (HB 1307/SB 1552) introduced in the 2024 legislative session that would have raised the AMI for moderate-income persons to 140 percent AMI in some municipalities.
[6] Tiffany N. Ford and Jenny Schuetz, "Workforce Housing and Middle-Income Housing Subsidies: A Primer," The Brookings Institution, Oct. 29, 2019, https://www.brookings.edu/articles/workforce-housing-and-middle-income-
housing-subsidies-a-primer/.
[7] Florida Housing Data Clearinghouse, "All Households, Cost Burden by Income, 2022 Estimate (Summary)," University of Florida’s Shimberg Center for Housing Studies, http://flhousingdata.shimberg.ufl.edu/affordability/results?nid=1.
[8] Florida Housing Data Clearinghouse, "All Households, Cost Burden by Income, 2022 Estimate (Summary)," University of Florida’s Shimberg Center for Housing Studies, http://flhousingdata.shimberg.ufl.edu/affordability/results?nid=1.
[9] Florida Housing Data Clearinghouse, "Renter Households, Cost Burden by Income, 2022 Estimate (Summary)," University of Florida’s Shimberg Center for Housing Studies, http://flhousingdata.shimberg.ufl.edu/affordability/results?nid=1.
[10] Methodology: To make the data more streamlined and consistent, MSAs were used for average salaries. The counties themselves may have incentive pay or a baseline that is higher or lower than the MSA mean. It must be noted that three MSAs do not have average salaries available for paramedics/EMTs.
[11] Florida House of Representatives, “House Session” Mar. 24, 2023, 11:00AM (1 hr., 40 mins., 22 secs.), https://www.flsenate.gov/media/VideoPlayer?EventID=1_zp1pj23y-202303241100&Redirect=true, “The people who are the backbone of our communities. The ones who build it up, the ones who protect it, the ones who serve it. The ones who deserve to have access to housing that is affordable . . . [So that they can] save time & money for themselves, their families, and their futures.”
[12] Kimberly Kuizon, "Proposed workforce housing for Sarasota County Sheriff's Office employees," Fox 13 Tampa Bay, Apr. 29, 2024, https://www.fox13news.com/news/proposed-workforce-housing-for-sarasota-county-sheriffs-
office-employees.
[13] Executive Office of the Governor of Florida, "Governor Ron DeSantis Awards 4,000th Law Enforcement Recruit Bonus" Jan. 30, 2024, https://www.flgov.com/2024/01/30/governor-ron-desantis-awards-4000th-law-enforcement-recruit-bonus/#:~:text=Each%20of%20the%204%2C000%20law,%2C%E2%80%9D%20said%20Governor%20Ron%20DeSantis.
[14] Methodology Note: The educator salaries utilized here are broken into the grade levels taught by the school educators. Because there were varied salaries, the average salary was calculated by finding the mean of the educators’ average salaries and then choosing the mean that was closest to the averaged amount. This was done over picking a grade level because not every level was listed for every MSA.
[15] Norin Dollard, PhD, "Florida FY 2024-25 Budget Summary: Education," Florida Policy Institute, Aug. 22, 2024, https://www.floridapolicy.org/posts/florida-fy-2024-25-budget-summary-education.
[16] Tim Walker, "Educators Struggle to Find Affordable Housing," NEA Today, Apr. 1, 2024, https://www.nea.org/
nea-today/all-news-articles/teachers-struggle-find-affordable-housing.
[17] The following counties have an unchanging base pay for over a decade’s time: Hamilton, Hillsborough, and Washington (11 years); Okaloosa (13 years); Citrus, Lafayette, Liberty (15 years); Broward and St. Lucie (16 years); Brevard, Lake, Seminole, and Volusia (20 years); and Wakulla (22 years).
[19] Alachua, Brevard, Broward, Duval, Escambia, Hernando, Hillsborough, Lake, Lee, Leon, Manatee, Miami-Dade, Monroe, Nassau, Okaloosa, Orange, Osceola, Palm Bay, Pasco, Pinellas, Santa Rosa, Sarasota, Seminole, St. Johns, St. Lucie, and Walton.
[20] Florida Housing Finance Corporation, "Hometown Heroes Program," https://www.floridahousing.org/
live-local-act/hometown-heroes-program.
[21] Methodology Note: There are three counties that do not list average salaries for paramedic/EMTs.
[22] Greg Friese, "Pay Paramedics a Thriving Wage to End the Retention Crisis," EMS1, Sept. 17, 2024, https://www.ems1.com/recruitment-and-retention/articles/pay-paramedics-a-thriving-wage-to-end-the-
retention-crisis-68xRW8ONK5rmnMvM/.
[23] EMS1, "Digital Edition: What Paramedics Want in 2024," Aug. 8, 2024, https://www.ems1.com/ems-trend-report/
digital-edition-what-paramedics-want-in-2024.
[24] Florida Housing Finance Corporation, "Live Local Program Tax Credit," https://www.floridahousing.org/live-
local-act/live-local-program-tax-credit.
[25] Florida Housing Finance Corporation, "Multifamily Middle Market Certification Newly Constructed Multifamily Project Ad Valorem Tax Exemption," https://www.floridahousing.org/live-local-act/multifamily-middle-market-
certification.
[26] The Law Offices of Stephen K. Hatchey, P.A., "Ad Valorem vs Non Ad Valorem: What to Know," https://floridarealestatelawyer.org/ad-valorem-vs-non-ad-valorem/#:~:text=Ad%20Valorem%20taxes%2C%20a%20Latin,benefit%20the%20community%20at%20large.
[27] Florida Housing Finance Corporation, “MMM Applicant Units Report: Applications Meeting New Construction-Certified,” Ap. 2024, pg. 5, https://www.floridahousing.org/docs/default-source/programs/live-local-act/multifamily-middle-market-certification/mmm-applicant-units-report.pdf?sfvrsn=71a4f17b_1.
[28] Florida Housing Finance Corporation, “MMM Applicant Units Report: Applications Meeting New Construction-Certified,” Ap. 2024, pg. 5, https://www.floridahousing.org/docs/default-source/programs/live-local-act/multifamily-middle-market-certification/mmm-applicant-units-report.pdf?sfvrsn=71a4f17b_1.
[29] Florida Housing Finance Corporation, “The State Apartment Incentive Loan Program,” https://www.floridahousing.org/programs/developers-multifamily-programs/state-apartment-incentive-loan.
Re-employment Assistance (RA)
Department of Children and Families (DCF) Multi-Program Policies
Supplemental Nutrition Assistance Program (SNAP)
Medicaid
Child Nutrition Programs
Temporary Assistance for Needy Families (TANF)
Re-employment Assistance (RA)
American Rescue Plan Act Changes. The American Rescue Plan Act of 2021 extended PEUC and PUA benefits through the week ending September 6, 2021. It also increased the maximum duration of PEUC benefits ($300 a week) to 53 weeks and the maximum duration of PUA to 79 weeks. Although PEUC and PUA did not end until September 6, 2021, Florida withdrew from the Federal Pandemic Unemployment Compensation Program (FPUC) effective June 26, 2021. FPUC provided persons who were out of work due to COVID-19 with an additional $300 a week in unemployment insurance.
Reemployment Assistance weeks reverted to 12 effective January 1, 2022. DEO determines the maximum number of weeks available to RA claimants based on a statutory formula that looks at the average unemployment rate for the most recent third calendar year quarter (i.e., July, August, and September). Based on the downturn in unemployment, the maximum number of weeks for RA reverted to 12 effective January 1, 2022.
RA work-search and work registration requirements reinstated on May 30, 2021. Persons filing an application for RA benefits beginning March 15, 2020, are not required to complete work registration in Employ Florida through May 29, 2021. In addition, work search requirements for individuals requesting benefits for the weeks beginning March 15, 2020, were also reinstated on May 30, 2021.
RA biweekly reporting requirements reinstated. Although previously waived, biweekly reporting was reinstated effective May 10, 2020. DEO’s guide to claiming weeks is here.
Mobile app deployed. DEO has deployed a mobile app for RA applications.
DEO announces extended benefits. DEO announced implementation of Extended Benefits (EB).
Resources and guidance. For a list of resources and guidance from the United States Department of Labor on unemployment insurance and COVID-19, go here.
For DEO’s “Reemployment Assistance Frequently Asked Questions and Additional Resources,” updated 12/30/2020, go here.
For DEO’s latest claims data, go here.
Department of Children and Families (DCF) Multi-Program Policies
DCF opens offices. DCF has reopened its brick-and-mortar storefronts, which were previously closed due to coronavirus.
DCF adds call center numbers. DCF has added a call center number for Monday through Friday, from 7 a.m. to 6 p.m. Call center numbers now include 850-300-4323, 866-762-2237, or TTY 1-800-955-8771.
Certification periods extended by 6 months only through August 2020. Certification periods for cash, food and medical assistance were extended by 6 months for individuals and families scheduled to recertify in April through August 2020. FNS’ approval of the SNAP extension for August is here. However, effective September 1, 2020, SNAP, TANF and Medicaid recertifications have been reinstated, although DCF says that no one will lose Medicaid due to recertification.
DCF allows phone interviews. Phone interviews are now being used for TANF cash and SNAP food assistance.
Mandatory work requirements suspended only through May 2021. Under a directive from Governor DeSantis to waive work requirements for safety net programs, DCF waived work requirements for individuals participating in the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) through May 2021. To do this, DCF explains that it partnered with the Department of Economic Opportunity to apply “good cause” statewide for TANF and SNAP recipients who would otherwise be subject to participation in mandatory work requirements as a condition of receiving those benefits. Through May 2021, persons who were sanctioned in the past due to work requirements will be able to reapply and participate in SNAP or TANF again.
Work requirements were reinstated effective June 1, 2021.
Supplemental Nutrition Assistance Program (SNAP)
Emergency allotments (EA) ended. DCF automatically supplemented SNAP allotments of current recipients up to the maximum for a household’s size for July 2021. However, EA was discontinued beginning August 1, 2021.
The SNAP benefits increase by 15 percent ended in October 2021. Floridians who participate in SNAP to put food on the table will receive a temporary 15 percent supplement to SNAP under COVID relief passed by Congress and extended by the American Rescue Plan Act through September 2021.
FNS permanently increases SNAP through revamp of the Thrifty Food Plan. Effective October 2021, FNS has mandated a permanent increase to SNAP through a revamp of the Thrifty Food Plan. DCF says that the increase amounts to about 6% for Floridians.
Time limits suspended. SNAP time limits are suspended during the COVID-19 public health emergency. No one in Florida should be barred from SNAP due to time limits, even if they exhausted their time limit in the past.
Florida granted waiver to allow families to purchase groceries online. DCF has been granted a federal waiver to permit the State of Florida to launch a pilot project statewide effective April 21, 2020, that allows families to purchase groceries online with their Electronic Benefit Transfer (EBT) card instead of going into stores.
- At present, participating retailers are Walmart, Amazon, Aldi, BJ’s Wholesale Club, and Publix. DCF cautions, however, that EBT cards cannot be used for delivery fees.
- For more information, see DCF’s questions and answers about online purchasing with SNAP.
Medicaid
No Medicaid terminations from March 2020 through the end of the federal public health emergency. The national public health emergency has existed since January 27, 2020 and has been renewed by the Secretary of the U.S. Department of Health & Human Services in 90-day increments since that time. The most recent renewal is effective January 16, 2022.
On March 31, 2020, AHCA alerted providers and DCF posted on the ACCESS website that:
- No Medicaid recipient will lose Medicaid eligibility during the COVID-19 public health emergency (unless the individual is no longer a state resident or request voluntary termination); under the newly enacted Families First Coronavirus Response Act, a state is prohibited from ending coverage for recipients enrolled as of March 18th for the duration of the public health emergency if the state opts to obtain an enhanced federal Medicaid match.
- AHCA is working to notify recipients who may have received a termination notice in the month of March that their benefits will be reinstated.
- An FAQ released by federal CMS provides some examples of Medicaid eligibility groups protected under these "no termination" requirements including: former foster care youth aging out when they turn 26; youth aging out of children's eligibility when they turn 19; individuals who become ineligible for SSI; individuals no longer qualifying for Qualified Medicare Benefits (QMB). In a May 5, 2020 update, CMS states that this “no termination” requirement also applies to medically needy individuals determined eligible during the public health emergency even if they do not continue to meet their monthly share of cost in subsequent months. This protection extends through the last day of the month the public health emergency ends.
- On October 28, 2020, federal CMS issued a new interim final rule weakening the continuous coverage, “no termination” requirement. In states like Florida that have opted to cover full benefits for lawfully residing children in the first 5 years after entry into the United States, once they turn 18, states are now required to limit their coverage to emergency services. In addition, states are now permitted to reduce optional benefits such as dental coverage or increase cost-sharing such as requiring nursing home residents to contribute more to their costs of care. But in Florida this type of change would require the Legislature to amend state Medicaid law.
Redetermination/recertification times are reinstated. As of October 1, 2020 AHCA's website is alerting recipients that the Department of Children and Families is now mailing letters for case reviews to check if a household is still eligible for Medicaid and/or Medically Needy. AHCA is urging people receiving these letters to take steps now to re-apply. But note, Medicaid coverage will not end during the COVID-19 Public Health Emergency. In January 2021 DCF conducted one-year “automated renewals” for people whose sole income is social security and SSI and are enrolled in an SSI-related Medicaid program (e.g., MEDS/AD, Medically Needy and Medicare Savings Programs). People getting VA income were not included in the automated renewal.
Extended application time. Effective with applications filed in February 2020, the time for submitting documentation required to process an application is extended for 120 days from the date of the application and eligibility will still be effective the first day of the month the application was received. Effective July 1, 2021, this policy has been rescinded. Medicaid applications submitted on or after July 1, 2021 may be denied on the 30th day after application or the day after verification information is due. Applications filed prior to July 1, will be allowed 120 days to provide requested verification to establish Medicaid eligibility.
Exclusion of additional unemployment payments in determining eligibility. The $600/week of additional unemployment insurance payments under the CARES Act will not be counted as income in determining Medicaid eligibility. (However, these payments will be counted as income in determining marketplace subsidy calculations.)
Coverage of Medicaid services during the state of emergency
- Coverage of all medically necessary services to COVID-19 testing and treatment.
- Waiver of limits on services that must be exceeded to maintain the health and safety of recipients diagnosed with COVID-19 or when necessary to maintain a recipient safely in their home
- Waiver of prior authorization requirements for hospital, physician, advanced practice registered nursing, physician assistant, home health services and durable medical equipment and supplies. As of June 19, 2020, AHCA reinstated prior authorization requirements for all of these services.
- Waiver of copayments for all services
- Waiver of limits on early prescription refills, except for controlled substances
- Coverage of a 90-day supply of maintenance prescriptions when available at the pharmacy
- Reimbursement of out-of-state providers providing medically necessary services to Florida Medicaid beneficiaries. As of July 1, 2021, the availability of provider “provisional enrollment” for in-state and out-of-state providers will end.
- 120 day extension of time to request fair hearings. As of July 1, 2021, the extended timeframe ends and the standard timeframes available to recipients to submit an appeal or request a hearing will be reinstated.
- Delay of fair hearings only in those instances when the recipient is continuing to receive services pending the outcome of the hearing
COVID-19 Vaccines for Medicaid Enrollees. In an executive order published March 16, 2021 Governor DeSantis revised the vaccine distribution plan, which applies to the general public including Medicaid enrollees, to lower the age requirement to 40 effective March 29, 2021 and then effective April 5, 2021 all Floridians are eligible to receive any COVID-19 vaccination approved by the Food and Drug Administration.
Medicaid enrollees eligible to receive the vaccine may visit myvaccine.fl.gov to find a location distributing the vaccine and to schedule an appointment.
On March 12, 2021, AHCA published instructions for Medicaid enrollees on how to obtain Medicaid transportation once they have scheduled an appointment for a vaccine. AHCA states: "Florida Medicaid will take you to get the COVID-19 vaccine at no cost. All you need to do is set up a time to get your vaccine. Next, let your Medicaid plan know you need a ride and they will take care of the rest. If you are not enrolled in a plan, call the Medicaid Helpline at 1-877-254-1055 to find out the name and phone number for a transportation service."
The state has also recently launched a new email system to help bring COVID-19 vaccines to homebound seniors. Seniors will be able to sign up to have the vaccine come to them by emailing a request to HomeboundVaccine@em.myflorida.com.
AHCA has posted Medicaid Alerts and FAQs providing more detail on Medicaid service changes in response to COVID-19. They address a wide range of topics including, but not limited to: telemedicine guidance for medical, behavioral health, and early intervention services providers; long-term care provider network flexibilities allowing more types of providers to deliver specified long term care services; and continuity of care for adult day care center enrollees during the time these centers are closed.
AHCA is loosening coverage restrictions for behavioral health services. Effective May 5, 2020, all prior authorization requirements for mental health or substance use disorder treatment are waived and service limitations (frequency and duration) are lifted. For behavioral analysis services, current authorizations will be extended through an "administrative approval process" which does not require providers to reassess beneficiaries currently getting services. Effective July 1, 2021 service limits will be reinstated for behavioral health services and effective July 15, 2021 Medicaid prior authorization requirements will be reinstated for behavioral health services.
Per a May 29, 2020 provider alert, during the state of emergency AHCA will be reimbursing providers for telemedicine well-child visits provided to children older than 24 months through age 20. Providers are directed to actively work to schedule follow-up in-person visits to administer immunizations and other physical components of the exam which cannot be accomplished through telemedicine.
Coverage of home and community-based waiver services (HCBS) - In response to the public emergency, Florida obtained approval from the federal government to make changes in HCBS waiver programs, including the Long Term Care and Developmental Disabilities programs. The changes are effective retroactively from January 27, 2020 to January 26, 2021. Details can be found here. They include, but are not limited to:
- permitting virtual evaluations, assessments and care planning meetings in lieu of face to face meetings and use of electronic signatures;
- lifting service limits in order to address health and welfare issues of enrollees;
- adjusting service prior authorization requirements;
- temporarily expanding the settings where services can be provided;
- allowing payments for support services provided to enrollees in hospital or short- term institutional settings; and
- prohibiting visitors in certain residential settings to minimize the spread of infection.
Note on COVID-19 testing, treatment, and vaccines for the uninsured. Florida has not opted to receive 100 percent federal Medicaid funding for COVID-19 testing of people without health insurance. Under the 2021 American Rescue Plan Act this option has been expanded to cover COVID-19 treatment and vaccines for the uninsured as well. Since the state has not taken up this option Floridians must look to an uneven patchwork of free testing, treatment, and vaccine resources scattered around the state. AHCA advises that uninsured people may receive free testing from their county health department or a federally qualified health center and that “many communities provide testing for free for individuals who do not have insurance. Please [click here] to find a test site in your area. Uninsured individuals should ask before the test whether testing is free of charge." There are no state agency instructions on where uninsured people can receive free treatment. However, more information on possible sources for free treatment is available here.
Residency proof no longer required at some vaccine sites, “paving the way for migrants.” - On April 29, 2021 Surgeon General Rivkees issued a new public health advisory specifying that COVID-19 vaccines are available to “a Florida resident” or someone “who is present in Florida for the purpose of providing goods or services for the benefits of residents and visitors of the State of Florida.” This new policy applies to all state-run and federally supported vaccination sites. It rescinds an advisory issued in January that had restricted vaccinations to people who could show proof of Florida residency
2021 unemployment compensation claimants can access free or reduced cost health insurance through the ACA marketplace. The Affordable Care Act (ACA) Marketplace was re-opened in February 2021 to give people who need health insurance a new “special enrollment" opportunity to get covered. The 2021 American Rescue Plan eliminated or vastly reduced premiums for many people with low or moderate incomes.
Starting July 1, 2021, people who received or have been approved for unemployment compensation for any week beginning in 2021 can access free or reduced cost comprehensive health insurance plans through the ACA marketplace. This benefit is available regardless of someone's current income. To get this benefit, people must enroll in the marketplace no later than August 15, 2021. For help with enrollment, contact Covering Florida at 877-813-9115.
Child Nutrition Programs
School children in distance learning still eligible for free or reduced cost meals. Students in distance learning for 2020-21 can still receive school meals through the National School Lunch Program if they are eligible. The student or parent/guardian may pick up meals at the school but should contact their school for more information.
For a list of current child nutrition program waivers for Florida from USDA, go here.
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
Congress allows increased fruit and vegetable benefits. At present, WIC provides $9 for children and $11 for women monthly for fruits and vegetables. The American Rescue Plan Act makes funding available for a four-month increase in the benefit of up to $35 monthly, if a state chooses to do so.
DOH attains waiver allowing remote issuance: Department of Health (DOH) obtained a waiver of the requirement that participants pick up their EBT cards in person at recertification or during nutritional education appointments.
WIC participants allowed to substitute certain food. Under a waiver from USDA, WIC participants in Florida are allowed to substitute milk of any available fat content and whole wheat or whole grain bread in package sizes up to 24 oz. when 16 oz. packages are unavailable.
USDA waived physical presence requirements: Although the scope and logistics are unclear at this time, USDA has given DOH permission to waive the requirement that persons be physically present at each certification or recertification determination in order to determine eligibility under the program through May 31, 2020.
USDA extends certification periods through May 31, 2020, for some participants.
For a list of current WIC waivers for Florida from USDA, go here.
Temporary Assistance for Needy Families (TANF)
HHS provides guidance. HHS has issued guidance on the flexibilities in TANF to respond to COVID-19.
