Health, Children, and Aging

LEGISLATION THAT PASSED

Drug Pricing and Coverage – Like the federal Trump Rx plan, HB 697 originally aimed at lowering the price of drugs via the Most-Favored Nation policy, setting upper drug price limits based on similar international markets. A committee substitute whittled the bill down from 22 pages to five pages, keeping only some provisions relating to pharmacy benefit managers (PBMs). The bill makes it unlawful for a PBM to force a pharmacy to take a loss when dispensing a drug or to reimburse a nonaffiliated pharmacy less than an affiliated pharmacy. PBMs would be required to allow in-network pharmacies to submit consolidated appeals comprised of multiple adjudicated claims featuring identical drugs, day supplies, and dates of service. PBMs exclusively serving a Program of All-Inclusive Care for the Elderly (PACE) are exempt from the PBM law. A Senate bill (SB 1760) also contained a prohibition against a PBM from maintaining any ownership interest in an affiliated manufacturer. The Senate substituted HB 697 for SB 1760, so this provision was not in the final version of the bill. It passed both chambers.

AIDS Drug Assistance Program – Facing a $120 million shortfall in the Ryan White Part B Aids Drug Assistance Program (ADAP) due to federal funding cuts, a Department of Health (DOH) emergency rule reduced eligibility from 400% of the federal poverty level to 130% beginning March 1. It also limits the drugs covered by the program. As many 11,000 low-income Floridians would lose access to their medication. In the final week of session, the Senate adopted an amendment to HB 697 (see above) to extend the higher income limit until June and appropriate $31 million to fund it. The Senate described it as “critical stop-gap funding” while he Legislature works on a long-term solution. The amendment also included increased reporting requirements for DOH. The House and Senate both approved the bill, with the amendment, unanimously.

Child Care and Early Learning – SB 1690 creates the Florida Child Care Fund to expand access to early learning and child care by channeling donations, grants, and legislative appropriations through a Department of Education direct-support organization. It will fund care for children currently on waiting lists. Subject to an appropriation, the TEACH Scholarship Program administrator will establish and administer the Center for Early Childhood Professional Recognition to ensure statewide alignment of training, trainer approval, and competency-based assessments for early learning professionals. SB 1690 was approved by the House and Senate.

Alzheimer’s Disease Awareness Initiative – SB 578 would require the Department of Elder Affairs to contract for the development and implementation of the Alzheimer’s Disease Awareness Initiative. The program would assist Florida residents that are affected by Alzheimer’s disease and dementia related disorders with obtaining reputable national research. Other components include an informational website, use of the ADRD Resource Guide, health care provider education in partnership with the Department of Health, public event advertising, and a statewide mobile in-person outreach program that prioritizes underserved communities. Florida TaxWatch has long supported Alzheimer’s disease research as a worthwhile cause with a high return on investment for Florida. SB 578 unanimously passed the House and Senate. 

Temporary Certificates for Practice in Areas of Critical Need – HB 809 will expand this program by authorizing the Board of Medicine, the Board of Osteopathic Medicine, and the Board of Nursing to approve continued practice of out-of-state licensed health care practitioners that have an active primary care treatment relationship with at least one patient in an area that was identified as an area of critical concern when the certificate was issued but has subsequently lost such designation. HB 809 passed the House and Senate.

Preventing Child Drownings – Florida TaxWatch has released a series of reports showing that drowning remains a leading cause of death for children in the United States, with Florida consistently ranking among the highest states for child drowning fatalities. Learning to swim can reduce drowning risks by 88 percent. FTW research has helped to make legislative progress through programs like the Swimming Lesson Voucher Program. Our latest in a series of reports on the topic recommends expanding prevention efforts including requiring hospitals to show new parents drowning prevention videos, enhancing safety measures for vulnerable populations, and increasing access to swimming lessons. This year, a bi-partisan effort addressed this issue with several bills proposing a variety of measures .

• Swimming Lesson Voucher Program – HB 85 and SB 428 expand this program, which provides free swimming lessons, through a voucher system, to eligible low-income Florida residents with children age four or younger. The bills would expand eligibility for the program to children between 1 and 7.  
• Drowning Prevention Education – SB 606 and HB 503 require hospitals, birth centers, and childbirth educators to distribute educational materials on drowning prevention (produced by the Department of Health) to parents and caregivers as part of postpartum education. 
• Water Safety Requirements – SB 658 requires new water safety measures for certain landlords and vacation rental operators, mandating exit alarms or self-closing doors near water bodies and at least one pool safety feature.

SB 606 was combined with SB 428 and approved by both chambers.  SB 658 passed the Senate but was not taken up by the House.

LEGISLATION THAT DID NOT PASS

Florida’s New Frontier in Healthcare – HB 693, the Big Beautiful Healthcare Frontier Act was the main bill of the House’s healthcare package. The Senate companion was SB 1758. Both bills would codify requirements contained in the federal One Big Beautiful Bill Act for SNAP and Medicaid, including expanding the work requirement for SNAP. SB 1758 also proposed a work requirement for most able-bodied Medicaid recipients. The bills would direct the Department of Children and Families to lower its SNAP payment error rate by modifying its eligibility determination process, submitting an improvement plan to the Executive and Legislative branches, and establishing a quality assurance review process. Failure to lower Florida’s error rate from the current 15% to 6% could result in a federal penalty of $1 billion annually, beginning in 2028. (TaxWatch recently highlighted the fiscal impact federal changes to SNAP would have on Florida). Also, HB 693 would have made a number of healthcare changes, including elimination of the state’s Certificate of Need program (later amended out), authorization for EMTs, paramedics, physician assistants, and social workers to participate in interstate licensure compacts; authorization for eligible APRNs to practice autonomously in all specialties without an established physician protocol, requiring insurers to credit patient payments for out-of-network providers toward their deductibles. SB 1756 also had a good provision to seek federal approval for a home and community-based behavioral health services program designed to cover an expanded array of services to adults with serious mental illness who are high utilizers of services in institutional settings. Both chambers passed their own bill, but could not reach a final agreement.

Medicaid Oversight – SB 1760 would have established a Joint Legislative Committee on Medicaid Oversight to ensure the state Medicaid program is operating in accordance with the Legislature’s intent and to promote transparency and efficiency in government spending. The legislation would have also created additional reporting requirements for Medicaid managed care plans. It is estimated that the bill’s revisions to the Achieved Savings Rebate (ASR) would have resulted in Medicaid managed care plans having to return approximately $128.3 million more in profit to the state in 2024. While this bill did not pass, it also contained some reforms to Pharmacy Benefit Managers that passed in another bill (see HB 697 above).

Nursing Education – Florida has an extreme nursing shortage, needing 60,000 additional nurses over the next decade. Add the fact that Florida has the lowest passage rate in the nation for the NCLEX – the exam nursing grads must pass before they get their license – and we have a real problem. HB 121 aims to improve nursing programs by strengthening approval and probation standards, shortening accreditation timelines, and expanding enforcement authority for the Board of Nursing. It also requires free remediation or tuition reimbursement when programs fail to prepare students for their exams. More nurses passing licensure exams means more nurses are able to enter the workforce immediately upon graduation. While the goal of improving nursing education in Florida is laudable and this bill may contribute to that, it should be noted that a nearly identical bill was vetoed by the Governor last year for being overly bureaucratic and hindering “the state’s ability to recruit and retain nursing programs and directors.” HB 121 was approved by the full House during its first floor session in Week 1. The Senate’s nursing education bill (SB 254) died in its last committee.

Health Care Provider Scope of Practice – In an effort to address health care workforce shortages, increase access to care, and reduce costs, Florida TaxWatch research has generally supported the past expansion of scope of service for medical providers such as Advanced Practice Registered Nurses and Physician Assistants. Allowing healthcare professionals to practice at the top of their education and training is a great way to leverage the existing workforce, provided that patient safety and quality of care remain paramount. This session, several bills dealing with scope of practice were considered.

• Certified Registered Nurse Anesthetists (CRNAs) – HB 375 would have authorized autonomous CRNAs to perform CRNA-specific acts without an established supervisory physician protocol. However, the bill allowed facilities to require an autonomous CRNA to operate under an established protocol approved by the medical staff or the governing board.
  
• Advanced Practice Registered Nurses (APRN) – HB 301 would have permitted certified psychiatric mental health APRNs to provide mental health services under autonomous practice, as defined by board rule. Currently, APRNs are only authorized to practice autonomously in primary care practice.
  
• Dental Therapist – HB 363 would have created “dental therapist” as a licensed profession, authorizing dental therapists to perform services including placements of temporary crowns and certain tooth extractions under a supervising dentist.
  
• Other – HB 693‘s many provisions included authorizing autonomous practice for all advanced practice registered nurse specialties and eliminating the cap on the number of physicians assistants a physician can supervise. Another provision authorized dentists to delegate additional tasks to dental hygienists, including dental hygiene diagnosis and treatment and administering fluoride. All three of these provisions would align Florida with favored federal criteria for Rural Health Transformation grants. 

The House passed all these bills, but they were not considered by the Senate.

Child Welfare – SB 560, HB 395, and HB 763 each require the Department of Children and Families and community-based care lead agencies to coordinate and publish meeting minutes from quarterly meetings with organizations that empower children in state care. While HB 395 only had this provision, the final versions of the other bills each had a distinct feature. HB 763 would add a specific weekly cash allowance for children in out-of-home care starting at age six. SB 560 required a study to make recommendations for agency and legislative actions to ensure affordable and available liability insurance for community-based care lead agencies and their subcontractors. Even though HB 395 and SB 560 both passed their respective chambers unanimously and HB 763 advanced through committees, the Legislature could not settle on a final bill.

Social Work Licensure Interstate Compact – HB 13 would have established the Compact, enabling licensed social workers to practice across state lines in all participating states, whether in person or through telehealth. There is a shortage of qualified professionals, and this compact could help increase Floridians’ access to quality care and social work services, no matter where they are. Florida TaxWatch research supported last year’s licensure compact bill to help address the escalating physician shortage. HB 13 passed the full House. The Big Beautiful Healthcare Frontier Act (HB 693, see above) also contained the Social Work Interstate Compact. However, the Senate did not buy in.

Child Welfare – SB 7018 transitions the “Step into Success” pilot into a permanent statewide program to provide former foster youth with expanded workforce education and internship opportunities. The Office of Continuing Care is tasked with recruiting mentors, establishing regional cohorts, and developing mandatory trauma-informed training for all participating organizations. The bill also requires the Florida Institute for Child Welfare to implement a program to identify and catalogue the best practices of community-based care lead agencies across the state. Florida TaxWatch encourages formalizing successful pilot programs that provide community-based care services to vulnerable populations. SB 7018 passed the full Senate, but the House did not take it up. However, a Senate Health Care budget conforming bill (SB 2518) also includes the expansion of Step into Success. This will be a conference issue.

Coordinated Access Model Pilot Program – HB 783 establishes a new pilot program in Clay, Dual, and St. Johns counties to help with coordinating access for behavioral health care using a single point of entry. It will use a single, electronic referral platform to coordinate behavioral health services among multiple providers and standardized screening, referral tools, and warm handoffs for service coordination. Florida TaxWatch encourages pilot programs aimed at providing community-based care services to vulnerable populations. HB 783 was passed by the full House. The Senate did not advance its companion (SB 1618) and did not take up the House bill.