The mission of the Florida Department of Health (Department) is to protect, promote, and improve the health of all people in Florida through integrated state, county, and community efforts. The Department’s goal is to be the healthiest state in the nation. Our values are illustrated by the acronym ICARE:
- Innovation: We search for creative solutions and manage resources wisely.
- Collaboration: We use teamwork to achieve common goals and solve problems.
- Accountability: We perform with integrity and respect.
- Responsiveness: We achieve our mission by serving our customers and engaging our partners.
- Excellence: We promote quality outcomes through learning and continuous performance improvement.
Accomplishing our mission begins with fundamental plans of action. The Department’s State Health Improvement Plan (SHIP) establishes goals for the public health system, which includes: state and local government agencies, health care providers, employers, community groups, universities and schools, nonprofit organizations, and advocacy groups. The Department uses a collaborative planning process to foster shared ownership and responsibility for the plan's implementation, with the goal of efficient and targeted collective action to improve the health of Floridians.
The Department led a diverse group of stakeholders to build Florida's SHIP for 2017-2021. The partnership conducted a comprehensive state health assessment to identify the most important health issues. The SHIP Steering Committee recently set five-year priorities based on the health issues and strategic opportunities identified in the assessment. Workgroups identified goals, strategies, and measurable objectives around each priority issue.
Additional plans include the Agency Strategic Plan, which provides a unified vision and framework for action. This plan positions the Department to operate as a sustainable integrated public health system and provide Florida’s residents and visitors with quality public health services The Long-Range Program Plan provides the framework and justification for the agency budget. It is a goal-based plan with a five-year planning horizon and focuses on agency priorities in achieving the goals and objectives of the state.
In 2016, the Department received first-in-the-nation national accreditation as an integrated Department of Health through the Public Health Accreditation Board (PHAB). This seal of accreditation signifies that the unified Department, including the state health office and all 67 county health departments, has been rigorously examined and meets or exceeds national standards for public health performance management and continuous quality improvement. The Department is required to provide examples of quality improvement activities to demonstrate conformity with the PHAB standards and to maintain accreditation status. Seeking and maintaining accreditation status has stimulated quality and performance improvement opportunities within the Department; improved visibility, credibility and reputation among community partners and public health peers within the state and nationally; improved identification and use of evidence-based programs and metrics; and increased cross-department collaboration.
The Title V MCH and CYSHCN directors, along with MCH and CMS staff, utilize various methods to determine the importance, magnitude, value, and priority of competing factors that impact health services delivery. The five-year needs assessment and continual assessment during interim years provides valuable direction. Many of the Department’s priorities, policies, and services originate through legislative bills, statutory regulations, administrative rules, and directives from the State Surgeon General. Priorities for improving public health are addressed through a variety of plans that address collaboration with our partners as well as internal agency priorities. The Title V program receives input and advice from statewide partnerships, stakeholders, and other agencies and organizations.
Comprehensive community health assessment and health improvement planning are the foundations for improving and promoting healthier communities. County health departments use a common process for collecting, analyzing, and using data to educate and mobilize communities, develop priorities, gather resources, and plan and implement actions to improve public health.
At the state and local levels, three critical assessments provide the basis for action: community health status assessment, forces of change assessment, and local public health system assessment using the National Public Health Performance Standards Program. Assessment findings inform the selection of strategic community health priorities. Goals, strategies, and measurable objectives are used to develop a community health improvement plan that includes implementation strategies and action plans. Two important, tangible products of these efforts are state and community health status profile reports and state and community health improvement plans, resulting in state and local documents reflecting each area's needs and priorities.
The Department has identified the following seven performance measures listed below in equal priority to each other, all of which have impact on the MCH and CYSHCN population:
1. Childhood Vaccines – Increase vaccination to prevent disease and keep all children protected from health threats. High immunization levels lower disease incidence, lower health care costs, and protect travelers from vaccine-preventable diseases. Increasing access to and availability of vaccines help keep families and communities protected from emerging health threats and improve overall school attendance.
2. Health Equity – Ensure Floridians in all communities have opportunities to achieve healthier outcomes. Florida has experienced lower morbidity and mortality rates across several diseases, but gaps continue to exist. All Floridians should be able to attain the highest level of health, regardless of gender, race, ethnicity, age, geographic location, or physical and developmental differences. Eliminating health gaps between different communities in Florida is a strategic priority for the Department.
3. Trauma Services – Develop a trauma system that ensures the highest quality service. Florida will have an integrated trauma system that drives performance through data reporting and competition with a goal of ensuring quality outcomes for severely injured patients.
4. HIV Infections – Reduce the incidence of HIV infections through a comprehensive program to prevent the transmission of HIV and provide care and treatment to those already infected. By reducing the incidence of HIV, more Floridians will live longer, healthier lives.
5. Infant Mortality – Reduce infant mortality to improve health outcomes for all infants. Infant mortality is a key measure of a population’s health. While the overall infant mortality rate has reached historic lows in recent years, these improvements have not been uniform across all groups, particularly among black infants. Reducing the black infant mortality rate will improve health outcomes for Florida’s children, families, and communities.
6. Inhaled Nicotine – Decrease inhaled nicotine use to provide a longer and healthier life. Cigarette smoking remains a major cause of cancer deaths in the United States. Florida has led the nation with innovative strategies to teach young people about the dangers of smoking and give current smokers the resources and support they need to quit.
7. Licensure Time – Decrease time to issue licenses to health care professionals so they may serve medical needs more quickly. By decreasing the licensure processing time, health care professionals will be able to get to work in a timelier manner.
The Department has also adopted the National Association of City and County Health Officials’ Protocol for Assessing Community Excellence in Environmental Health - PACE EH. For several years, the Bureau of Environmental Health has supported county health departments to work with their communities and address environmental health concerns. Collectively, county health departments who have implemented PACE EH in communities have become a national model, and provided evidence that communities can identify environment and urban planning issues as environmental health issues and address the social determinants of health. All projects are designed to open the lines of communication between the county health departments and affected communities.
Addressing the needs of children with special needs is the primary focus of our Office of Children’s Medical Services Managed Care Plan and Specialty Programs. Florida has over 1,000,000 children and youth with special health care needs and over 100,000 children with medical complexities.
In 2011, the Florida Legislature created Part IV of Chapter 409, Florida Statutes, directing the Agency for Health Care Administration (AHCA) to create the Statewide Medicaid Managed Care (SMMC) program. As a subset of the SMMC program, the SMMC Managed Medical Assistance program was fully implemented in 2014 with the components of Managed Medical Assistance and Long-Term Care. The SMMC program is designed to promote patient-centered care, personal responsibility, and active patient participation; provide fully integrated care with access to providers and services through a uniform statewide program; and implement innovations in reimbursement methodologies, plan quality, and plan accountability. The CMS Managed Care Plan (CMS Plan) is a specialty plan option for clinically eligible CYSHCN. The CMS Plan provides a broad range of medical, therapeutic, and supportive services for eligible children. The CMS Plan’s statewide provider network includes over 45,300 primary care providers, specialists, hospitals, university medical centers, and other health care providers. Over 67,000 of Florida’s CYSHCN are enrolled in the Children’s Medical Services Plan, receiving direct care services for their medical, behavioral, and developmental needs. Care coordination services increase the number of children who receive well-child visits, immunizations, flu vaccinations, follow up, and linkage to services. The CMS Plan will also begin tracking quality of life measures in 2019.
The CMS Plan implemented its new health care delivery system model on February 1, 2019. This new model was conceived with comprehensive stakeholder input at the family, provider, and community levels; as well as state and national experts. With the improved health plan model, CMS now has flexibility in payments to providers, increased and enhanced care coordination services, and the ability to offer families valuable “in lieu of” services and enhanced benefits for improved services and access.
CMS is strengthening its public health services and systems for all CYSHCN with the creation of Regional Networks for Access and Quality (RNAQs) and Statewide Networks for Access and Quality (SNAQs). The goal is to improve access and quality for CYSHCN regardless of health insurance or where they may live. The focus is to align our Title V priorities by addressing social determinants of health and emerging themes from community needs assessments in the development or strengthening of community systems approaches, including the integration of multisector service systems to maximize outcomes for CYSHCN.
Florida has 18 pediatric children’s hospitals statewide to serve the acute, chronic, and complex needs of children. To ensure CYSHCN receive the health care services they require, CMS partners with a network of primary care providers, federally qualified health centers, and pediatric specialists. CMS is implementing integrated behavioral health services in the primary care setting with telepsychiatric consultation. Pilot projects are being expanded and a formal evaluation will inform decision making and future planning.
To effectively plan for improving health, it is imperative to understand health is shaped by the social, economic, and environmental conditions in which we live, and the available and accessible community resources. It is necessary to address the conditions that produce our health rather than only treating medical conditions after they occur. This section discusses the principal characteristics important to understanding the health status and needs of not only Florida’s population but more specifically the MCH and CYSHCN population.
According to statewide population estimates conducted by the Florida Legislature, Office of Economic and Demographic Research, Florida has a total population of 20.8 million citizens, following only California and Texas as the third most populous state. Between 2010 and 2018, Florida’s population increased by 10.8 percent. The most recent demographic data as of April 1, 2018, shows 77.4 percent of Florida’s population is white,16.9 percent black, and 5.7 percent other races, mixed race, or unknown. Of the total population by ethnicity, 25.6 percent are Hispanic and 74.4 percent non-Hispanic. More than half of the state’s population (51.6 percent) is between the ages of 25-64 and 28.6 percent are between the ages of 0-24. Florida’s population 65 and older comprise 20.1 percent of the state’s population compared to just 15.2 percent in this age group nationally in July 1, 2016. A greater percentage of health care resources are expended on the elderly population in Florida compared to other states.
The Office of Minority Health and Health Equity, led by the Senior Health Equity Officer, serves as the Department’s coordinating office for consultative services and training in the areas of cultural and linguistic competency, partnership building, program development and implementation, and other related comprehensive efforts to address the health needs of minority and underrepresented populations. The Office promotes the integration of culturally and linguistically appropriate services within health-related programs across the state to ensure the needs of the state’s racial and ethnic minority communities are addressed, as well as the needs of people who are lesbian, bisexual, gay, transgendered (LGBT).
The Department established a Health Equity Program Council to focus on the issue of health equity. The council is comprised of county health department officers and leaders in the state health office. The council guides county health department and state health office efforts by monitoring emerging research and expanding and implementing evidence-based practices statewide.
The first project of the Health Equity Program Council was Florida’s Healthy Babies Initiative, the Department’s direct response to focus on the black-white infant mortality gap. During phase one of the initiative, the Department invested $1.5 million in Title V funding. Funding was provided to the county health departments to conduct an enhanced data analysis on infant mortality, including an environmental scan of existing pertinent programs, and to host a community action-planning meeting to examine disparities in infant deaths, the role of social determinants of health, and to propose local action. Phase IV began in July 2018 with the selection of six evidenced-based projects for county health departments to select one or more from. The workplan templates are attached as Supporting Document 2.
Another overarching initiative within the Department is Healthiest Weight Florida, a public-private collaboration bringing together state agencies, nonprofit organizations, businesses, and entire communities to help children and adults make consistent, informed choices about healthy eating and active living. The initiative works closely with partners to leverage existing resources to maximize reach and impact. These partners include the business community; hospitals; non-governmental organizations; nonprofit agencies; other federal, state, or local government agencies; and volunteer coalitions.
Encouraging physical activity and healthier food choices has a positive impact on birth outcomes and child health. Women who are healthier before and during pregnancy lessen the risk of maternal and infant morbidity and mortality.
Several factors determine what people eat, but access to healthy food and beverages has a major influence. Finding healthy food is not always convenient. Studies have found that people buy food that is readily available. Today, it is often the case that communities with the highest rates of obesity are also places where residents have few opportunities to conveniently purchase nutritious, affordable food.
Following the Centers for Disease Control and Prevention (CDC) declaration of a national opioid epidemic, Florida’s Governor signed Executive Order 17-146 on May 3, 2017 directing the Surgeon General to declare a statewide public health emergency. Signing the emergency order allowed the state to immediately draw down more than $27 million in federal grant funding from the United States Department of Health and Human Services (HHS) Opioid State Targeted Response Grant, which was awarded to Florida in April 2017 to provide prevention, treatment, and recovery support services to address this epidemic. The State Surgeon General issued a standing order for Naloxone, an emergency treatment for opioid overdose, ensuring first responders have immediate access to this lifesaving drug to respond to opioid overdoses.
In 2014, neonatal abstinence syndrome (NAS) became a reportable condition in Florida. MCH epidemiologists worked with Department staff, the CDC, state academic partners, and clinical experts on validating hospital inpatient discharge records as a means of passive NAS surveillance. This work serves as a guide to help state health agencies across the nation make informed decisions on how to conduct NAS surveillance. Additionally, the data is being used to initiate quality improvement initiatives at the local level.
Florida shares borders with the reservations of two tribal governments, the Seminole Tribe and the Miccosukee Tribe. These governments have their own public safety and emergency services for reservation residents, but a substantial portion of their tribal citizens live outside the reservation boundaries. The Department established the American Indian Health Advisory Committee to provide guidance on issues impacting American Indian populations in Florida. The committee consists of representatives from tribes and stakeholders serving American Indian communities and staff from the Office of Minority Health and Health Equity.
Florida is also home to many non-governmental tribal communities, whose members may be spread out geographically but who gather frequently to maintain their community's identity, culture, language, traditional knowledge, and traditional ways. These groups do not have government status either as a preference, or because their structure is not suited to political governance, or because they cannot provide documentation that they maintained a tribal government during the years that it was illegal to do so. A subset of this category would be American Indian Christian Churches, which bring members and descendants of various American Indian nations together around a shared faith practice that incorporates inter-tribal practices in their worship. Another subset of this category would be American Indian associations that organize cultural gatherings that are open to visitors. Yet another subset are American Indian associations concerned with activism in favor of American Indian causes.
Per the 2010 Census, individuals in Florida identifying as only Native American comprise a total of 71,458. In addition, Native Americans experienced a 33.5 percent increase in identification as Native Americans (alone) over the 10-year (2000-2010) period. This is a greater increase than white or black (alone) over the same period.
Florida is a temporary home to well over 100 million tourists and visitors each year, which presents challenges to the state’s public health system. In 2018, Florida welcomed 124.7 million tourists, a 5.3 percent increase over 2017, the highest number in any year. Migrant farm workers and unauthorized immigrants also have a significant impact on the state’s public health services and resources. Florida was home to 775,000 unauthorized immigrants in 2016. California and Texas are the only states with greater numbers of unauthorized immigrants. If citizenship questions are added to the 2020 census, Florida could see a reduction in total census numbers, and a possible reduction in federal funding such as Title V, education, and transportation funds, as well as a possible reduction in our total number of congressional representatives.
The racial, ethnic, and cultural diversity of Florida’s population creates unique challenges as well as increased opportunities. This diversity makes Florida a more interesting place to live, work, and play. As the racial and ethnic make-up of the country, our state, our workplaces, and schools become increasingly varied, it is important that we recognize and value these differences. People from diverse cultures contribute language skills, new ways of thinking, new knowledge, and different experiences. Diversity helps us recognize and respect the customs, behaviors, and traditions of others, allowing for bridges of trust, respect, and understanding to be built across cultures.
The Title V program, along with private and public health providers, contributes to meeting the challenges that come with the state’s diverse group of residents, immigrants, tourists, and visitors. The Department supports the culturally diverse MCH population by tailoring services provided through the Title V program to meet the needs of different cultures. Educational materials are developed in English, Spanish, and Haitian Creole. The Department contracts with Language Line Services to provide telephonic interpretation services in over 180 languages, allowing a client to communicate with a health care provider through a conference or three-way calling system. Language Line Services also provides written translation services in over 100 languages and translates documents such as health-related educational materials into multiple languages.
The health of the economy plays a major role in the health status of the state’s MCH population. The economy in Florida has been recovering since the economic downturn suffered during the most recent nationwide recession. The average annual wage in Florida currently stands at 88.5 percent of the national average. Florida’s economy is heavily reliant upon the service-related industry, where minimum wage jobs with little or no benefits are more the norm than the exception. A lack of well-paying jobs makes it difficult for many individuals and families to meet their basic needs. Those households most disproportionately affected are female-headed households, blacks, Hispanics, people living with a disability, and unskilled recent immigrants. According to the latest final numbers from the U.S. Bureau of Labor Statistics, Florida’s unemployment rate was 3.4 percent in April 2019, this in below the national employment rate of 3.6 percent. Florida had a four-year adjusted cohort graduation rate for public high schools of 80.7 percent. In comparison, the corresponding national rate was 84.1 percent during the 2015-16 school year. Florida’s standard diploma is a rigorous credential for which standards and testing requirements have periodically increased. Because states have different criteria for awarding a standard diploma, comparing rates among states is problematic.
Florida’s total area is 58,560 square miles. Driving from Pensacola in the western panhandle of Florida to Key West at the southernmost point is nearly an 800-mile journey. The 1,200 miles of coastline become a target during hurricane season, and 2,276 miles of tidal shoreline are subject to concerns regarding water quality and fish and wildlife habitat degradation.
With the threat of tropical depressions and hurricanes looming every summer, the Department takes emergency preparedness seriously for all sorts of possible threats or disasters. Florida’s Public Health Preparedness effort is an excellent model of public-private cooperation. Funding made available post-9/11 facilitated conversations beyond just emergencies that enhanced the integration of services and systems among state, federal, local, and private entities. Well organized public-private partnerships benefit from the strengths and competencies of both systems.
When hurricanes approach, the Department operates and staffs Special Needs Shelters (SpNS) to allow people with special or complicated medical needs, their family members, and aides to safely shelter from the storms, with nurses on hand to assist with their needs. Hurricane Michael, the strongest hurricane to hit Florida since Hurricane Andrew in 1992, produced devastating winds and storm surge. Thirteen SpNS were opened serving 297 clients, 155 caregivers and 65 staff members. This category five storm was directly responsible for 16 deaths and approximately $25 billion in damage to the United States. Florida’s panhandle is still recovering from the impacts of the storm.
At-risk or vulnerable populations include those groups whose needs may not be fully integrated into planning for disaster response. These populations include persons with physical, cognitive, or developmental disabilities. Included in this group are persons with limited English proficiency, the geographically or culturally isolated, medically or chemically dependent, homeless, frail elderly, children, and pregnant women. Meeting the needs of vulnerable populations during or following a disaster is a key component of public health and medical preparedness planning. CMS collaborates with the county health departments in planning for disasters, staffing the special needs shelters around the state, and assisting in recovery efforts.
The basic statutory authority for MCH is section 383.011, F.S, Administration of Maternal and Child Health Programs. The statute authorizes the Department to administer and provide MCH programs, including prenatal care programs, the WIC program, and the Child Care Food Program. This statute also designates the Department to be the agency that receives the federal MCH and Preventive Health Services Block Grant funds.
Section 383.216, F.S., authorizes prenatal and infant coalitions for the purpose of establishing partnerships among the private sector, the public sector, state government, local government, community alliances, and MCH providers and advocates, for coordinated community-based prenatal and infant health care. Chapter 64F-2, Florida Administrative Code, establishes rules governing coalition responsibilities and operations. Chapter 64F-3, FAC, establishes rules governing Healthy Start care coordination and services.
Section 383.014, F.S, authorizes screening and identification of all pregnant women entering prenatal care and all infants born in Florida, for conditions associated with poor pregnancy outcomes and increased risk of infant mortality and morbidity. This statute also governs screening for metabolic disorders and other hereditary and congenital disorders. Chapter 64C-7, FAC, establishes rules governing prenatal and infant screening for risk factors associated with poor outcomes, and rules related to metabolic, hereditary, and congenital disorders.
The basic statutory authority for CYSHCN and their families is Chapter 391, F.S., known as the Children's Medical Services Act. Section 391.016, F.S., establishes the Children’s Medical Services Program, and defines two primary functions: provide to children and youth with special health care needs a family-centered, comprehensive, and coordinated statewide managed system of care that links community-based health care with multidisciplinary, regional, and tertiary pediatric specialty care; and provide essential preventive, evaluative, and early intervention services for children at-risk for or having special health care needs, to prevent or reduce long-term disabilities.
To Top
Narrative Search