House & Senate Bill FAQs
Read NICA’s FAQs about the bill. These include answers to questions sent to NICA through the form on this page.
Overview Questions
What bills are being discussed?
The bills being discussed are Senate Bill (SB) 1668 and House Bill (HB) 1291, filed in the Florida Senate and House of Representatives. NICA suggested these bills to make sure the program has enough funding and runs better. However, these changes won’t happen unless the Florida Legislature passes these bills and they become law.
What is the main goal of these bills?
The main goal is to keep NICA financially strong so it can continue serving families for the long term. The bills set specific guidelines for when and how NICA’s funding would increase from new state funds, insurer assessments, and doctor and hospital assessment to remain financially sound.
The bills also do some other things to make the program better overall, like putting some board-approved benefits that NICA already provides into state law and strengthening the law about families applying to NICA first.
Why is this legislation only happening now?
NICA’s Executive Director has actually been working on this for years, but filing a bill can be a long and complicated process. Since NICA is at risk of dropping below an 85% actuarial soundness threshold sometime during 2027 or 2028, it would help if the Legislature acted now to protect the program for current and future families.
Specific Questions About the Bills
Will I have to get Medicaid instead of the insurance I have now?
No. The bills do not require parents to sign the participant up for Medicaid instead of other health coverage.
The proposed bills just make the current arrangement with Medicaid permanent so that families can continue to use Medicaid providers if they choose. While health coverage is required, you remain in control of which type of health coverage you select for your child.
Will NICA cut our services if the plan isn't actuarially sound?
The bill does not have any wording about or requirements to cut services. It only covers how the Office of Insurance Regulation is able to use the ways already in law to raise more funding. The bottom line is that after the 2021 law changes and the Medicaid lawsuit, NICA spends almost twice as much each year as it collects in assessments from doctors and hospitals. This means the program is at risk of not being actuarially sound, which would suspend the program for new families (though the program would continue with current families).
The bill will help us avoid this scenario by creating a clear plan for how and when NICA’s funding would increase to remain financially sound.
The benefit of this approach is that these mechanisms are not one-time—they are implemented as often as needed to ensure the program’s long-term financial health. This provides families with the assurance that the program will be adequately funded for the participant’s lifetime.
Why is it important for the plan to be actuarially sound?
Being actuarially sound generally means that the program has enough assets (cash and investments) to cover all future expenses for current participants—their entire lives. But right now, the program does not have enough assets to cover 100% of future expenses—just about 96%. Under current law, NICA is considered actuarially sound until it drops below 85%—and at that point, the program would be suspended and no new participants could be accepted (though the program would continue with current families).
Without new law to create a clear way to increase our funding, we might drop below the 85% threshold sometime during 2027 or 2028—that’s not far in the future. So the bills are designed to raise funding to ensure that the program maintains actuarial soundness and can continue to serve families long-term.
What would a suspended program mean for Florida families with children who suffered a birth injury?
NICA would keep operating for families already in it. But new families would not be able to enter NICA unless the Legislature took action.
I don’t see that doctors and hospitals have to pay more to fund NICA?
The bill does talk about doctors and hospitals paying more—because of the bill wording, this might be hard to see. But the bills require as part of the fund-raising process for the Office of Insurance Regulation to have doctors and hospitals pay more if necessary for actuarial soundness, along with assessments on some insurers.
Why are doctors and hospitals the last source of new funding for NICA?
To increase the bill’s chance of passing, the bill keeps the current order of funding sources that’s already in law but just hasn’t been used so far. But doctors and hospitals are still on this list of funding sources and would have increased assessments if needed for actuarial soundness.
Does "return to actuarial soundness" imply budget cuts or just tracking market fluctuations?
This refers to market fluctuations, not budget cuts. It means temporary changes in investment markets—like if there was a big drop in the stock market, but it was not going to last long. It’s about tracking normal ups and downs in NICA’s investments, not about cutting family services or benefits.
I also heard some speakers at the committee meetings said that the bill won't raise assessments on physicians and hospitals. Is this right?
The bill keeps the process already in law to raise assessments on doctors and hospitals if the plan needs more funding. It just gives a clear “trigger” for this to start taking place and puts in deadlines for action. For example, lines 834-838 in HB 1291 authorize the Office of Insurance Regulation to increase assessments on doctors and hospitals proportionally.
Are these reports just what NICA has been doing or does it imply showing budget cuts as well? (lines 839-843, HB 1291, filed version)
These are reports NICA is already doing. NICA already creates projections showing where the program will be financially in the future. These reports help the Office of Insurance Regulation understand projected future costs (such as due to program growth and inflation) and would also show potential revenue increases and their impact after the Office of Insurance Regulation increased funding. Examples of these reports are already available in NICA’s board materials and in its September 2024 legislative report. This is about financial planning and projections, not about showing budget cuts.
What does the Office of Insurance Regulation do, and what does NICA do, under the bill? How do these tasks fit together to keep NICA in good financial shape?
Here’s how the process would work:
First, the Office of Insurance Regulation (OIR) does a report at least every 2 years to see if NICA has enough cash flow (money coming in to pay the bills right now) and whether it is actuarially sound (will have enough money over the long term).
Then, if the report shows NICA needs more cash flow or is not actuarially sound, funding increases happen in this order:
- First, the $50 million contribution would be required
- If additional funding is still needed, insurer assessments would increase
- If the shortfall remains after those steps, physician and hospital assessments would increase
Then, if new funding is given to NICA, NICA needs to report on how well that new funding is helping it.
NICA also lets the Office of Insurance Regulation know if, between when the Office of Insurance Regulation does its reports on NICA, NICA thinks the plan is not actuarially sound. The Office of Insurance Regulation can then look at NICA’s information and do its own review. This is another check to make sure the plan is staying in good financial shape.
This creates a clear, step-by-step process to keep NICA financially strong so it can continue serving families for the long term.
What benefits will go in law under this bill?
The bill puts some benefits into law that NICA already provides. These are benefits like:
- Covering the costs to establish legal guardianships
- Providing mental health counseling for family members
- Paying for all health insurance costs (premiums, copays, deductibles, and other expenses)
Will my day-to-day experience with NICA change?
No. For example:
- Families can still be paid to care for their loved ones
- Families will work with case managers and handle requests and reimbursements the same way
- NICA will pay for health coverage that families choose for the participant—the participant can be on their own plan or a family plan, a plan from a family member’s employer, a plan through an insurance agent, or a plan obtained another way. You can choose the plan that has the most providers you want.
Will applying to NICA change?
No. Applying for NICA is still part of the process for a family with a child who has suffered a neurological birth injury prior to pursuing court action. The bill just strengthens the existing requirement that families of birth-injured children should apply to NICA first.
Does the bill change who NICA serves?
No. The program will continue to serve the same families it always has. One thing you might notice is that the program now uses the term “participant” instead of “child” because many people in the program are now adults, as participants are living longer lives.
Does the bill have anything to do with Medicare? I saw that mentioned in the bill title (beginning part after the “relating to” phrase).
No, that is an error. We will be letting staff know about it. It doesn’t affect what the bill does.
What happens to current participants and families if the program were suspended to new families?
A new family would not be able to petition the Division of Administrative Hearings to enter the program. The current statutory requirements for NICA for participants who had already entered the program would still apply. The statute does not specify any changes to the program for current participants in that situation.
Supporting the Legislation
If I can't attend a Legislative committee meeting in person, can I send a letter to be read on my behalf?
Communicating with legislators is important and can make a real difference. The best way to share your thoughts is to email directly the Legislators on the committees who will vote on the bill. This way your message is more likely to get to them. If you would like more information on how to contact legislators or need help with this process, please contact Melissa.