House Speaker Daniel Perez on Tuesday rolled out a far-reaching proposal to cut Medicaid and a low-cost state children’s health insurance program while tightening work requirements for people who rely on the state’s food-assistance program.
Contained in two separate bills — HB 693 and HB 697 — dubbed “Florida’s New Frontier in Healthcare” by Perez, the package would change Florida statutes as necessary to implement the “One Big Beautiful Bill” passed by Congress at the urging of President Donald Trump.
HB 693 would require people on food assistance who are not disabled and who don’t have young children to show they are working through age 64. Florida law now requires people to show they are working through age 59.
The bill would keep certain immigrants, including refugees, asylees, parolees, and abused spouses and children, from enrolling in Medicaid or the federal Supplemental Nutrition Assistance Program (SNAP).
The House had not prepared or released a legislative analysis or estimated fiscal impact for either bill.
Florida has since 2018 limited Medicaid retroactive eligibility for adults to just one month. It was a cost-saving change championed by former Gov. Rick Scott, who had to convince the federal government to waive its rules so it could be implemented.
The One Big Beautiful Bill, though, allows states to pare back Medicaid eligibility for pregnant women and children from three months to two. Perez’s proposal would change state law to allow it to happen. And it wouldn’t require additional federal approval.
“President Trump’s bold leadership through the One Big Beautiful Bill set the standard for real, results-driven healthcare reform, and Florida is proud to lead the way in implementing that vision at the state level,” Perez said in a prepared statement.
“We are taking decisive action to cut red tape, grow our healthcare workforce, expand patient choice, and protect taxpayer dollars while ensuring families can access high-quality care when they need it most. In partnership with the President’s leadership, Florida is delivering real results.”
“New” frontier sounds familiarWhile Perez touts the “new frontier,” some of the proposals in the bill are familiar.
Sponsored by Miami Republican Rep. Mike Redondo, HB 693 would repeal the requirement that nursing homes, hospice services, and intermediate care facilities for individuals with developmental disabilities secure certificates of need (CON) before building new facilities or adding services.
CONs are a regulatory tool long controversial with critics who argue they limit competition and access, while proponents contend they help control costs by preventing an over-proliferation of services.
GET THE MORNING HEADLINES.SUBSCRIBE The Florida Legislature in 2019 eliminated CON requirements for general hospitals, specialty hospitals, and tertiary services but maintained the requirement for nursing homes. At the time, the nursing home industry argued to retain CONs for nursing homes.
The Florida Health Care Association, the state’s largest nursing home lobby, said it was still reviewing the legislation. Senior Director of Strategy and Communications Kristen Knapp said the association will take a formal position when its board meets in January.
Redondo’s bill aims to expand access to health care by expanding the type of services the health care workforce can provide.
Specifically, HB 693 authorizes all advanced practice registered nurses to work independently of medical doctors. While some advanced nurses can do that today, it’s authorized on a limited basis and only for the provision of primary care.
To me, that's the most problematic provision of the bill.
– Jacksonville health care attorney and lobbyist Christopher Nuland, on autonomous practice for advanced nurses
“To me, that’s the most problematic provision of the bill,” said Jacksonville health care attorney and lobbyist Christopher Nuland, whose clients include the Florida Chapter of the American College of Physicians Services; the Florida Chapter, American College of Surgeons; and the Florida Neurosurgical Society, among others.
The bills were filed Tuesday. They have not been referred to committee. But they are guaranteed to attract plenty of attention when the House starts to debate them.
Some of the more controversial provisions, Nuland predicted, will attract lobbyists who have an interest in Medicaid, SNAP, and the children’s health insurance program, as well as those who lobby for organized medicine.
“The question is, can the bills sustain different attacks on different parts?” Nuland asked.
The second bill, HB 697, takes aim at prescription drug costs.
The bill would establish a “most favored nation” pricing model for prescription drugs in Florida, requiring drug manufacturers selling here to report international drug pricing data as a licensure requirement. The Agency for Health Care Administration would identify, publish, and routinely update the lowest international price paid for each drug among countries with comparable economic standards and market-based health systems.
To guarantee reduced costs for consumers, the bill would require commercial insurers, Medicaid health plans, and pharmacies to pay no more than the established benchmark price and insurers to use resulting savings to reduce premiums and patient cost-sharing.
“This bill is about restoring fairness, competition, and transparency to a system that has become deeply tilted against patients,” bill sponsor Rep. Jennifer Kincart Jonsson said in a prepared release.
“Following President Trump’s leadership on drug pricing reform, Florida is standing up for families at the pharmacy counter by demanding market-based pricing, cracking down on abusive PBM [pharmacy benefit manager] practices, and ensuring patients can rely on stable access to the medications they need.”
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