Pensacola Rep. Alex Andrade is putting Florida’s Medicaid managed care plans on notice — reduce infant mortality or face real financial consequences.
- Andrade is following through on a commitment he made in October to use his chairmanship of the House Health Care Budget Subcommittee to address the state’s infant mortality crisis. Read House Health Care Plan.
Backstory
In Escambia County alone, the infant mortality rate for Black babies stands at over 13 per thousand births. The ratio between Black and white infant mortality is three to one.
- “The racial disparity alone is jarring, right? When I realized just how significant the racial disparity on this alone was, my jaw dropped,” said Andrade in a (We Don’t) Color on the Dog podcast.
The state lawmaker did his homework. “I did a deep dive on this stuff and realized that 25% of infant mortality deaths are due to unsafe sleeping conditions,” Andrade said. “And something like 45% are due to issues that are potentially preventable in the first trimester—such as preterm births, hypertension, getting pregnant immediately after giving birth, not having any type of care in that first trimester, not taking prenatal vitamins.”
Money Tied to Reducing Infant Mortality
A provision in the House health care spending plan proposed by the House Health Care Budget Subcommittee would continue withholding 2% of each managed care plan’s capitation payments, a practice in place since October, but would dramatically rewrite how plans earn that money back.
- Competing for dollars: only two of the eight statewide plans could unlock the full 2%. One slot goes to the plan recording the largest infant mortality rate reduction. The other goes to the plan reporting the greatest reduction by raw numbers. If one plan leads in both categories, it stands alone at the top.
Plans showing year-over-year improvement would recoup half the withheld funds. Plans that backslide? They forfeit the entire withholding and get suspended from auto-assignment for four months.
Why this matters: That auto-assignment piece is where the real teeth are. When Medicaid beneficiaries don’t choose a plan within 60 days of enrollment, they’re automatically assigned one. It’s a guaranteed stream of new enrollees. Losing that pipeline for four months could significantly depress a plan’s enrollment and revenue. During the 2019 managed care transition, one region alone had nearly 113,000 recipients eligible for auto-assignment — roughly a quarter of the regional pool.
Andrade and his committee have changed the reimbursement structure to inject competition into a system where all plans currently qualify for full withholding based on broader quality metrics.
Whether the Senate shares that ambition remains unclear. Senate Budget Chief Ed Hooper confirmed the upper chamber won’t release its spending plan until next week.
Community Effort
Inweekly has reported on Pensacola’s infant mortality for years. In 2024, we reported that over the past decade, Escambia County has averaged one infant dying every 12 days before the baby reaches its first birthday. The racial split is nearly even: White 39%, Black 49%, Other 12%.
- The Escambia Children’s Trust had allocated nearly half of its $10 million budget to after-school programs and another $1 million to helping kids in the juvenile justice system, but nothing to pilot programs to reduce infant mortality and the low birth rate. The Trust ignored my plea to do something.
Miller Returns: In September 2025, Quint Studer brought Jill Miller, President and CEO of Bethesda Inc. and the bi3 Fund, to Pensacola to speak at the 2025 Civic Leader Summit. Miller had previously visited Pensacola to speak at CivicCon, but she had little impact, even though she helped Hamilton County, Ohio, go from one of the highest infant mortality rates in the country to the lowest in its history.
- Studer and I joined forces to bring attention to Miller’s success. Read How Cincinnati Transformed Its Greatest Challenge Into Its Greatest Success.
Studer helped form a Maternal Health Task Force. State Rep. Michelle Salzman told the PNJ about the 16-member task force which includes Miller, Studer and representatives from the Florida Agency for Health Care Administration, Florida Department of Health, Florida Department of Children and Families, Northwest Florida Health Network, Ascension Sacred Heart, Baptist Hospital, HCA West Florida, Santa Rosa Medical Center, Community Health Northwest Florida, Health Start and Florida Blue. They met on Friday, Oct. 24 and plan to reconvene in December.
- The public has seen nothing from the task force. However, Lindsey Cannon, executive director of the Children’s Trust, this week announced the Trust would budget $3.5 million for ages 0-5. She mentioned the task force at the Trust board meeting but gave no details.
Big Price Tag
I reviewed Miller’s efforts in Ohio and estimated it would take $5 million over three to five years to improve infant mortality in Escambia County. Read Looking for $5 million to End Infant Mortality.
The Covenant Health and Community Services Foundation, Children’s Trust and the Medicaid providers could do this. I have little faith in Healthy EscaRosa doing anything other than creating an awareness campaign and another dashboard. Read Outtakes—Will Our Health Ever Improve?