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exclusions (to 12 months exclusion and 6 months look-back time), and mandates guaranteedissue (through a high-risk pool) and guaranteed renewability. Regarding individual insurancemarket reforms, Florida does not apply community rating, limits pre-existing conditionexclusions, and mandates guaranteed issue (through a high-risk pool) and guaranteedrenewability. Florida has a state-sponsored high-risk pool with 638 enrollees as of December2002. Florida has a state COBRA expansion program to 18 months for small firms. 273Incentives for Small GroupsThe Governor’s Task Force on Access to Affordable Health Insurance, created in 2003,recommended that Florida establish purchasing pools for small groups (2-25), and this wasimplemented by the Florida legislature in 2004. The Small Employers Access Program wasappropriated $250,000 and is authorized to solicit bids for standard and alternative benefitpackages, but one provision recommended by the task force was not in the final bill, which wasallowing the winning bidder in each geographic region the exclusive opportunity to providecoverage to small groups in that region. Not having this could weaken the market for potentialbidders. The Office of Insurance Regulation is talking to small group carriers about interest inthe program and implementation. Just as in Texas, some group carriers have expressedskepticism about purchasing pools and reluctance to participate. 274Florida’s Health Care and Insurance Reform Act of 1993 created 11 Community HealthPurchasing Alliances (CHPAs) and implemented other significant insurance reforms on thesmall group market. 275 The CHPAs developed from a pilot project funded by the Robert WoodJohnson foundation, and the program went statewide in 1993 with the legislation. Other reformswere adopted at the same time including guaranteed availability to small employers andmodified community rating, requiring carriers to pool their small groups for rating purposes, sothese made the CHPAs not as important. They had a costly infrastructure and carriers began todrop out by 1997, so they were repealed in 2003 and replaced with Health Care Alliances,which were also not embraced by insurers. 276Medicaid and SCHIP InitiativesIn Florida, 64.3 percent of Medicaid beneficiaries are enrolled in managed care. 277 Florida has afamily planning waiver that extends family planning services for up to two years for women whowere pregnant and on Medicaid and who would have lost these services 60 days postpartum. 278Florida has used Section 1931 to expand Medicaid coverage by increasing income disregards.After a beneficiary has been enrolled for 12 months or more, the state may disregard a family’sfirst $200 in monthly earnings and 50 percent of the remaining monthly earnings beforecalculating if families’ incomes are below the eligibility level to qualify for Medicaid. 279 Floridahas a full-cost buy-in program for parents to buy SCHIP insurance at full cost for children ages 5to 9 with family incomes over 200 percent FPL. 280Not counting waivers that are pending or have expired, Florida has three 1915(b) Freedom ofChoice Waivers (for managed care, children’s inpatient psychiatric services, and nonemergencytransportation). Florida has three current 1915(c) Home and Community-BasedServices Waivers, for disability services, brain and spinal injuries, and cystic fibrosis. The statehas three 1115 waivers: the family planning waiver, a waiver for a pharmacy program forMedicare recipients, and a cash and counseling program. 281Other Health Insurance Reforms/InitiativesFlorida Governor Jeb Bush recently proposed a fundamental restructuring of Florida’s Medicaidprogram to control growing costs. He and his staff outlined a program where the state wouldC-15