The Florida Agency for Health Care Administration (AHCA) has announced its application for the Florida Health Care Workforce Sustainability Section 1115 Demonstration, an ambitious initiative to address critical workforce shortages in Medicaid. Florida is the first state to seek federal approval for a standalone 1115 demonstration program focused exclusively on testing health care workforce innovations on a large scale. Over five years, the initiative aims to address immediate and long-term workforce challenges in medically underserved areas.

Florida is committing nearly $1.4 billion, which, when paired with federal funding, will generate an average of $617 million annually over five years to build, strengthen, and sustain the state’s health care workforce. The program includes immediate solutions, such as loan repayment programs, alongside long-term strategies like expanding training opportunities in community-based settings.

Goals of the Section 1115 Demonstration

This Section 1115 demonstration focuses on improving Medicaid access and care quality through workforce development. The key objectives include:

1. Enhancing the capacity and effectiveness of Florida's health care workforce to meet the evolving needs of the state's diverse population by implementing targeted training and recruitment programs.
2. Improving health care access and quality across Florida by strategically addressing workforce shortages and retention challenges through innovative workforce development initiatives supported by federal funding.
3. Developing a resilient framework for community-based health care workforce initiatives aimed at resolving pediatric home care nursing concerns highlighted by the Department of Justice (DOJ), particularly for children enrolled in Medicaid with complex medical conditions.

Florida Medicaid has faced federal scrutiny and legal challenges over inadequate in-home nursing care for children with medical complexities. The DOJ has mandated transitioning these children from institutional care to home and community-based settings while ensuring full staffing of authorized in-home nursing hours. The waiver prioritizes recruitment and retention of pediatric-focused nurses and caregivers to meet these requirements, ensuring children receive the necessary care in their homes.

Key Workforce Programs

The waiver outlines several new initiatives to strengthen the health care workforce, including:

1. Training, Education, and Clinicals in Health (TEACH): Expands clinical training opportunities in underserved areas by supporting federally qualified health centers, community mental health centers, certified community behavioral health clinics, and rural health clinics to strengthen the workforce pipeline.
2. Florida Reimbursement Assistance for Medical Education (FRAME): Offers loan repayment incentives for registered nurses (RNs) and licensed practical nurses (LPNs) serving Medicaid recipients in rural or underserved areas. Participants can receive up to $45,000 over four years and are required to contribute 25 hours annually of voluntary primary care services in a free clinic or through another volunteer program operated by the state.
3. Dental Student Loan Repayment Program: Addresses dental workforce shortages by providing loan repayment assistance to Florida-licensed dentists and dental hygienists practicing in underserved areas.
4. Florida Funding Initiative for the Recruitment, Sustainment, and Training of Nursing (FIRST): Supports public teaching hospitals with funding to offset the costs of advanced nursing education and patient care complexities, helping grow the nursing workforce.

Click here to access Section 1115 demonstration documents for more information.

Immediate and Long-Term Impacts

The initiative promises substantial short- and long-term benefits for Florida’s health care workforce.

In the short term, loan repayment programs will benefit more than 3,000 health care professionals, including doctors, nurses, dentists, physician assistants, and mental health practitioners, who commit to serving Medicaid recipients in underserved areas for up to five years. Programs like FRAME will alleviate financial barriers for eligible participants, enhancing retention and stability.

Long-term impacts include expanded community-based training opportunities at 844 facilities, such as federally qualified health centers and behavioral health clinics, to address workforce shortages where they are most critical. Additionally, funding for nursing education will support 13 facilities, creating a robust pipeline of qualified nurses to sustain Medicaid services.

Gaps in the Waiver: A Call to Expand Support for Home Health Settings

While the demonstration marks a significant advancement, it largely overlooks the critical needs of home- and community-based services (HCBS) by excluding essential professionals beyond nursing. The program overlooks critical roles such as physical therapists, occupational therapists, speech-language pathologists, and direct care workers — key contributors to comprehensive Medicaid care delivery.

To build a truly sustainable Medicaid workforce, providers are encouraged to participate in the public comment process and advocate for:

• Expanding loan repayment programs to include HCBS professionals.
• Tailoring recruitment and retention initiatives specifically to home health care settings, which face unique challenges compared to hospitals and clinics.

Public Input Requested: How to Participate

AHCA is seeking feedback during the 45-day comment period, open from December 11, 2024, through January 24, 2025. Stakeholders, providers, and the public are encouraged to participate by attending public hearings or submitting written comments. Your voice is essential in shaping the future of Florida Medicaid. Participate during this critical comment period to help create a sustainable and inclusive health care workforce.

Public Hearings

Wednesday, January 8, 2025
1:30-3:30 PM
Agency for Health Care Administration
2727 Mahan Drive
Building 3, Conference Room A
Tallahassee, FL 32308

Friday, January 10, 2025
10:00 AM-12:00 PM
Orlando Hurston Complex
400 West Robinson Street
North Tower N109, Conference Room 1
Orlando, FL 32801

Submit Comments

Comments may be emailed to FLMedicaidWaivers@ahca.myflorida.com or mailed to:

Workforce Sustainability Section 1115 Demonstration
Agency for Health Care Administration
2727 Mahan Drive, MS #20
Tallahassee, FL 32308