Legislative Practicum for Senator Rene Garcia

Practicum and Policy Background

Senator Rene Garcia of Republican Party, State of Florida was selected for this Nursing Legislative Practicum because of the state of origin and his diverse views on healthcare reforms. Garcia works with healthcare committee and therefore understands that the State of Florida continues to experience budget shortfall as more Medicaid patients are included under the ongoing reforms. Therefore, the only viable option is to expand the managed care plan.

Volunteering roles focused on working on a regular service provided by Feeding South Florida to provide healthy foods to families living below the Federal Poverty Line. During the interaction with Susana Guasch, a councilperson in Medley, Florida, the Bill SB 294 sponsored by Garcia known as the Florida Kid Care Program appeared to be interesting for this study. Hence, more efforts focused on understanding the Bill. A volunteering chance provided insights about health laws, tort law reviews, policy formulation procedures and opportunities for the public to contribute.

The Florida Kidcare Program recognizes medically underserved and uninsured, specifically children described as “qualified alien” in Florida. Hence, Garcia wants the children to be referred as “lawfully residing children” under the new Act. The Senator wants to ensure that the amendment provides eligibility for “optional payments for medical assistance and related services for particular lawfully residing children” (Garcia, 2015). However, the amendment shall clarify that undocumented immigrants are excluded from eligibility for optional Medicaid payments or related services.

Garcia’s values are shaped by the ongoing reforms in the healthcare system and the plight of uninsured children (Cosman, 2005). The Senator has recognized that Florida needs to increase healthcare access and decrease cost as well. Consequently, he asserts that the only viable option is expanding managed care accessibility through Medicaid and other payment options. In this regard, “lawfully residing children” will gain access to healthcare services.

The US legal status under Medicaid started to change with “the Immigration Reform and Control Act amendments of 1986” (Rosenbaum, 2007). The State Children’s Health Insurance Program (SCHIP) covers Florida KidCare Program that was created in 1998 to offer medical insurance to uninsured children below the age of 19 years whose family income was above Medicaid limits, but below the Federal Poverty Level (FPL) (Garcia, 2015). Uninsured children may benefit from either SCHIP or Medicaid. The major challenge since 2004 for enrolled legal aliens is that they do not qualify for the Title XXI federal funds because they are not qualified aliens. The “not qualified alien status” among legal alien children leads to further healthcare disparity in the State of Florida and the nation as a whole (Parmet, 2013). Today, however, the proposed change strives to introduce a clause of ‘lawfully residing children’ so that unqualified aliens may qualify for Medicaid payments or related services.

The Bill proposed by Garcia targets qualified alien children. This group of US immigrants cannot meet their medical costs, and they are classified under the Federal Poverty Level. In this regard, they are powerless, marginalized and lack any influences in society and healthcare policymaking. Senator Garcia, as a representative of this group, must strive to promote policies that will benefit them and ensure they get Medicaid and related services eligibility.

One major challenge with providing insurance cover to illegal aliens or other forms of immigrants is medical cost. Hence, healthcare access for immigrants continues to raise social, ethical, legal, economic and cultural concerns for the healthcare sector in the US (Parmet, 2013). Consequently, policymakers, politicians and other healthcare stakeholders aim to change this state and ensure increased coverage and access to healthcare for persons in the US.

As access to healthcare increases under the Affordable Care Act, the cost of providing such services also increases. Improving quality of care, affordability and widespread accessibility have been major forces driving reforms in the sector. Lawmakers have also found opportunities to formulate policies that would transform their areas of interests by ensuring that resources are available to marginalized, legal aliens. It is expected that such reforms will continue to provide positive changes in the healthcare sector.

Based on Senator Rene Garcia Bill, all qualified alien children shall be referred to as lawfully residing children. According to Garcia, expanded managed care plan can solve the problem of rising costs and cater for legal alien children. This would ensure that such children are entitled to Medicaid and other related cover services under the Title XXI federal funds. The Bill, however, clarifies that undocumented immigrants will not be included under “eligibility for optional Medicaid payments or related services” (Garcia, 2015).

The Bill aims to expand managed care, provide Medicaid and related services to ‘lawfully residing children’ and ensure that they qualify for Title XXI federal funds. Individuals who feel that they should not cover medical costs for ‘illegal alien children’ may oppose this Bill. Besides, it may possibly exert more pressure on taxpayers and increase costs of healthcare for the State.

The Bill has been analyzed by Health Policy members and is currently under analysis at Appropriations Subcommittee on Health and Human Services (Post-Meeting). The bill is effective July 1, 2015 (Garcia, 2015).

Legislative Initiative Plan for Florida Kidcare Program

Understanding Effects of Proposed Changes

Action: The Bill is currently at Appropriations Subcommittee on Health and Human Services (Post-Meeting) for analysis and will be effective July 1, 2015. Rene Garcia must review all critical comments and evaluate raised concerns. He must explain effects of the proposed changes to all affected parties.

Responsible persons:Senator Rene Garcia and his team of experts on healthcare reforms, tort laws and financial appropriation will explain all noticeable and hidden effects of proposed changes.

Time: All intended explanations must be provided before the Bill comes effective on July 1, 2015. Thus, the team of expert led by the Senator will conduct their activities between May 1, 2015 and June 15, 2015.

Resources: Huge financial resources shall be required to create awareness about the Bill and inform affected ‘lawfully residing children’ in the State of Florida.

Communication: A team of experts shall collect their feedback, but the Senator will be responsible for all outside communication with the public, other lawmakers and other affected stakeholders.

Constitutional Issues

Action: Review all areas of the Federal Constitution and State laws currently affected by the Bill. For instance, the Federal funding for CHIP cannot extend beyond September 30, 2015. All legal definition of ‘lawfully residing children’, aliens, legal, illegal, qualified aliens, not qualified aliens among others must be reviewed.

The process will also involve public participation to get their feedback.

Responsible persons: Senator Sherrod Brown (D-Ohio) will lead these reviews to understand constitutional issues and seek for federal funding. These reviews will require a team of constitutional lawyers and experts to assist with the interpretation and identification of any legal challenges to the proposed Bill.

Time: All reviews and feedback should be collected before September 30, 2015. The team therefore will conduct the review between May 1, 2015 and August 30, 2015.

Resources: Financial resources will be required to conduct the reviews. In addition, some materials for the activity may be purchased from vendors.

Communication: Senator Sherrod Brown will coordinate communication affairs between team members. Any external communication will be channeled to Senator Garcia.

Fiscal Impact Statement

Action: This is the most critical part of the Bill. It affects several stakeholders. Explain how the Bill and expanded insurance covers will affect the private sector financially, including benefits and drawbacks. Explain cost implications for Agency for Health Care Administration, Department of Children and Families, and Florida Healthy Kids Corporation. The potential impacts on Title XXI federal funds must also be identified and possible approval bottlenecks.

Responsible persons: A team of experts working with Senator Garcia will perform impact analysis on different stakeholders.

Time: All impact analyses must be conducted before June 30, 2015. The team therefore will conduct the review between May 1, 2015 and June 30, 2015.

Resources: Financial resources will be required to support the analysis processes.

Communication: Senator Garcia will communicate impact assessment outcomes to all interested stakeholders.

Nursing’s Role/Implications in this Process

Nurse students learn about policymaking, changes and advocacy. Nurse leadership is vital for advocacy. Hence, effective leadership is required to influence policies and policymakers (Institute of Medicine, 2010). The most basic element of advocacy is to create rapport with various stakeholders to support the Bill. Different methods can help in advocacy initiatives and nurse advocacy is increasingly becoming imperative for patients (Sanford, 2012). A collaborative strategy, for instance, can help the advocate to work with various stakeholders in promoting the Bill at Appropriation committee.

Policymakers require factual evidence to support an initiative. In this regard, all facts gathered from the Legislative Initiative Plan must be applied to demonstrate the relevance of the Bill, how it will affect ‘lawfully residing children’, the private sector and the government and its agencies.

The nurse advocate will have to review all elements related to the Florida Kidcare Program. In addition, the nurse must understand how the current Medicaid is designed for ‘not qualified aliens’. Further, the nurse should also comprehend how expanding the managed care plan would reduce costs and increase accessibility where ‘lawfully residing children’ are concerned.

The nurse advocate would ensure that weaknesses of the current program are identified, and explain the importance of the Bill to overcome healthcare disparities. Potential impacts must also be explained. It is imperative to recognize that the aim of advocacy is to influence policymakers to make changes to the current one in order to accommodate new provisions. Sharing of information for informed decision-making would enhance positive outcomes.

It is indicated that the Bill would become effective from July 1, 2015. This implies that the uninsured and medically underserved immigrant children will have access to healthcare through Medicaid and other related services. It is expected the Bill would manage rising costs of care, compensation for the private sector will be provided, but potential administration costs remain indeterminate and can simply be absorbed by currently available resource. Finally, the Florida Healthy Kids Corporation will not experience any additional financial impacts because of the Bill.

Nurse advocate should support the Bill by identifying important decision-makers to push its agenda. In addition, it would also be important to identify how various stakeholders influence policymaking and passages of Bills. Nurse advocate must establish the extent of engagement required for the Bill to pass. It will also be imperative for the nurse to understand how lawmakers implement and enforce health public policies. Unquestionable factual materials to enhance persuasion should accompany any claims made to support the Bill. It would also help to have direct access to the most influential individuals during policymaking and advocacy processes. Other options such as litigation and disruption may also be applied to enhance outcomes of advocacy if lawmakers remain uncommitted to change.

Summary of the Nursing Practicum

The Nursing Practicum Legislative Report covered the Bill, Florida Kidcare Program in the State of Florida. The Florida Kidcare Program is sponsored by Senator Rene Garcia to expand the managed care plan. This Bill was evaluated during the volunteering period. The first section provides background information about the Bill and Senator Rene Garcia.

The Bill aims to provide insurance cover to ‘lawfully residing children’ in the State of Florida. Currently, such children are regarded as “qualified alien” and they, therefore, do not qualify for the Title XXI federal funds” (Garcia, 2015). The Bill, however, clarifies that undocumented immigrants will not be included under “eligibility for optional Medicaid payments or related services” (Garcia, 2015).

The second section of the Nursing Practicum report covered the Legislative Initiative Action Plan. The action plan explained major areas of the Florida Kidcare Program by describing actions, required resources, time, individual responsible, and communication.

The third section covers nursing implications for cases related to patient advocacy in healthcare policy formulation and implementation. It highlights that nurse advocates must understand proposed changes and work collaboratively with various stakeholders to realize the intended goals.


Cosman, M. P. (2005). Illegal Aliens and American Medicine. Journal of the American Physicians and Surgeons, 10(1), 6-10.

Garcia, R. 2015 SB 294: Florida Kidcare Program. Web.

Institute of Medicine. (2010). The Future of Nursing: Leading Change, Advancing Health. Web.

Parmet, W. E. (2013). Holes in the Safety Net — Legal Immigrants’ Access to Health Insurance. New England Journal of Medicine, 369, 596-598.

Rosenbaum, S. (2007). Medicaid and Documentation of Legal Status: Implications for Public Health Practice and Policy. Public Health Reports, 122(2), 264–267.

Sanford, K. D. (2012). Overview and Summary: Nurse Advocates: Past, Present, and Future. OJIN: The Online Journal of Issues in Nursing, 17(1).

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