Effort afoot to regain rejected millions for home visits

By Margie Menzel

THE CAPITAL, TALLAHASSEE, August 22, 2012.......Advocates say the opposition of Florida leaders to the federal health care overhaul threatens to end home visitation programs for 500 at-risk families and lead to 80 employees losing their jobs statewide.

That's because the federal funding would have come to Florida as part of the Patient Protection and Affordable Care Act – often called "Obamacare" by opponents – which opened the door to more money for home visits for young, at-risk parents.

Earlier this month, the Florida Department of Health notified the U.S. Department of Health and Human Services that the state was rejecting $4.9 million for such programs as Healthy Start, Healthy Families and the Nurse-Family Partnership, which combat child abuse, substance abuse, infant mortality and unemployment via in-home parent education.

"Having this money tied to the Affordable Care Act didn't help," said Carol Brady, executive director of Northeast Florida Healthy Start, one of the affected programs.

The Republican-dominated Legislature had turned down the original $3.4 million home visiting grant last year. It also came from HHS as a result of the federal health care law, which Florida was fighting in court at the time.

Then the Legislature learned that Florida had to accept the home-visiting grant in order to apply for a completely separate education grant, the federal Race to the Top program, which would have provided up to $100 million to the state. That competitive grant program had a provision that required that applying states have the home visiting program, so lawmakers bit the bullet and took the money.

But Florida – after winning a $700 million Race to the Top grant in 2009 – failed to win last year's big education award. So the 2012 Legislature withdrew from the home visit program. 

Meanwhile, the home visiting services had started in Escambia, Duval, Alachua and Pinellas, Putnam and Bradford counties. Brady said more than $4 million has already been invested in the targeted counties via last year's grant award.

"This investment will be wasted if the five sites are forced to close," Brady wrote earlier this month to David Willis, head of the federal program. "Services will be halted for 500 of the state's most vulnerable families…We beseech you to work with the communities that will be directly and adversely affected."

But after accepting and then rejecting last year's grant, Florida was ineligible for the second round of funding this year, valued at $4.9 million.

Brady said there's still some hope for the five programs, in that federal guidelines allow for a non-profit to receive the money. Advocates are trying to make that happen.

"But we're probably looking at six months to a year before the money can come back into the state," she said. "That's really the tragedy of the whole thing…Because the state originally accepted the money and then changed their minds later, in year two, we basically have five programs that are left high and dry."

Legislative leaders, though, say they don't want to be dependent on publicly-funded programs.

"It's a principled position that we have to take," said Ryan Duffy, spokesman for the Florida House Majority Office.

Duffy was speaking for House budget chief Rep. Denise Grimsley, R-Sebring. He described her as believing that "there comes a point in time when we have to stop being so reliant on the federal government."

Grimsley, he said, believes that faith-based groups, not government, should support at-risk families.

And when the home visiting programs came up last year, state Sen. Joe Negron, R-Stuart, and chair of the Senate committee that deals with the health budget, said medical settings are preferable to providing advice in people's homes.

Supporters of the home-visiting programs, though, consider them highly cost-effective. 

According to the Center for Prevention and Early Intervention Policy at Florida State University, home visiting slashes costs by reducing premature births, preventing child mistreatment, promoting home health and safety and lowering reliance on welfare.

The center found that Healthy Families, which uses volunteers to prevent child abuse and neglect, costs $1,625 a year per child, whereas caring for an abused child in state custody costs $68,797 for the same period.

"The children served by these programs are at the greatest risk to go into foster care," said Senate Democratic Leader and gubernatorial candidate Nan Rich. "But over 98 percent of children are not abused after they receive these services." 

Home visiting yields as much as $5.70 for every dollar spent on prevention, according to the center.

Jane Johnson, health and human services policy coordinator for the governor's office, agreed that the home visiting services prevent children from going into foster care. However, she said, the non-profits would benefit from making a better case for their successful outcomes to the Legislature.

"Our administration is committed to breaking the cycle of poverty," she said. "We would like to help families in poverty break the cycle."

Brady said unless an alternative funding route is found, the money will be sent back to the feds and distributed to other states. 

House GOP spokesman Duffy pointed out that state taxpayers would have been on the hook for $340,000 in administrative costs had the programs continued.

Whether federal or state government funding, he said, "it still comes from the pockets of Floridians."

The Legislature cut $10 million from Healthy Families in 2010 and $5.4 million from Healthy Start in 2011.