work. Thanks so much for your help. It does make a difference. If you wish to speak to any item on the agenda or during the public comment portion of the meeting, please fill out a speaker card. Each person addressing the board shall have three minutes to complete his or her comments on each agenda item for which he or she has filled out a card. The chair has the discretion to determine or alter the time limits on any agenda item. The Board of County Commissioners requests that speakers appearing under the public comment section of the agenda. Limit their comments or presentations to matters relating to county business that are within the board's control, authority, and jurisdiction. Good morning. Welcome to the July 3rd special meeting for the Board of County Commissioners. We'll start with the Pledge of Allegiance. Commissioner Goodson, we have a quorum. I'll call the meeting to order. We have one item on the agenda today. Commissioners, we haven't been here for a little while, so let's just remember we're going to intro the item, then we'll do questions, cards, and then we'll have discussion and we'll vote. Just as a housekeeping issue, without objection from the board, we're going to have an executive session after this meeting upstairs in the county manager's office. We have some updates from the fire union. I don't anticipate that taking too long, so without objection, we're going to do that. Okay, very good. Jill, I think you're ready. Okay, good morning, Commissioners. This agenda item is at the request of the affected hospitals and requests approval of a rate resolution to impose non-advalorum special assessments against private, for-profit, and non-profit local hospitals for the state's Medicaid-managed care program. The providers listed on the assessment rule, which is attached to the agenda, are the only ones paying this assessment. This is not an assessment or a tax on any residential or business property in the county. Again, it's only those hospitals listed. And this federally approved program allows the state to access federal Medicaid funds for managed care expenditures, and that offsets the hospital's Medicaid shortfalls. And there are representatives here to answer any questions the board has. Okay. Are there questions for Jill? No questions for Jill. Just, I'll add something to that, just so we understand why we're having a special meeting today. There's language in the big, beautiful bill, as it's being called. And the president's going to apparently sign that tomorrow, so we need to do this today. So that's why we're here today, just as a point of clarification. Commissioner Delaney, for Jill, do you have a question? Thank you. Yeah. I have received a lot of feedback from the public when this meeting came public. And so people are concerned about, one, are their taxes going to go up? And I'm hearing you say that, you know, and I understand that it's not going to affect us locally in that way. But people are concerned about federal taxes. This isn't, just to put it on the record, this isn't an expansion of federal taxes. This is just giving our hospitals more access to money that's already there. That's my understanding of this program. Okay. Thank you. Any other questions for staff? No? Okay. We do have some cards. I think most of the cards are just for questions. Sandra Sullivan. So I would like to see additional transparency on why this has to be done before the big, beautiful bill. Like, what does that garner this process? Because they're talking about a lot of cutbacks to Medicaid. You know, 14 million illegals allegedly on Medicaid and not providing services to illegals. And, you know, having people work that should be working in order to receive Medicaid. So there's going to be huge shortfalls in Medicaid. So what does this do? I mean, this is counterintuitive. This doesn't make sense to put this in place. The language says, uh, to local hospitals in Brevard County annually provide millions of dollars of uncompensated care to patients who qualify for Medicaid. Uh, Medicaid covers only 60% of those costs. And so this helps them, this is the same, this helps them to use this money to match and get more money from the federal government. But what we're hearing is the federal government's cutting those federal money. So what's the real gain here? Like it doesn't, it doesn't add up. Um, and then there's a couple other things. So I look back on the 2021, uh, agenda and the documents and, you know, some of our players have changed. They signed, they signed legal agreements that they wanted to do this, but then I looked at the tax roll and that ordinance was never executed in, in terms of it was, they were never taxed. And so here we are days before the big, beautiful bill. And suddenly we're jumping through hoops. Why what's the real, what's the real story here? Um, and, and the, the documentation from 2021, a few things, uh, prior to the imposition of an assessment, the County shall have a fully executed agreement with the state of Florida. I do not see that, um, in the documents attached. Um, it says that, um, um, adoption, uh, if there's no objection to the, the, the property owners of the assessments. And again, some of those owners have changed. Um, so, and previously you had executed agreements from the hospital. And again, you know, it seems like if you're doing this now, you should have, that in place. Um, here's one of the, this is Rockledge that doesn't have any tax for this. It's not been put into place. So you can't just say, well, we did this, uh, this ordinance in 2021. So we can do this now. Um, this was, uh, a declaration, uh, by, by James Richard Whitney, who says he's chief legal officer of Adelanto healthcare ventures. And, um, um, in my official capacity, I am testifying the affidavit that these, these, this represents the following hospitals. Um, and that they did an official ballot for voting, um, and all of this. But again, that was 21. That was four years ago. Don't you have to go through this process again? It just seems like this whole process is, is rushed. And then I'll say, you know, in terms of, you know, who benefits, you know, health first is 83% of, of these entities. And so, you know, the whole thing doesn't smell right. And I think the public deserves a little bit more explanation that just prior to the big, beautiful bill and a huge cutbacks at the federal level. And this is being on the, on the premise that this will help get, you know, reimbursements for, you know, for Medicaid, that's not paid the 40% that's, that they don't collect. None of this seems to make sense. Okay. And I just think we, we owe a little bit more explanation of what the, the, the real agenda here. There isn't a lot of trust. Say something about the timeliness of this. We had this on the July 8th agenda, just so that you understand. So we were happy. I think the County was happy to take it up on July 8th. Uh, but because the legislation moved a little bit faster than we anticipated, I mean, in June, we were planned to take this up and in July 8th, uh, meeting. And now that things have progressed quicker than that, um, where we have to have this meeting. So, um, could you help us out on maybe just clarifying from, um, do have some cards here. One of the providers, I mean, ultimately, I think we're doing what we can to help protect our healthcare providers. Yeah. Rachel Rexford, Adelanto Healthcare Ventures. We represent the hospitals. I can provide just a little clarity on why it has to be done now. It's because of the provider tax freeze provision that's in the big, beautiful bill. Um, so basically once the big, beautiful bill goes into effect, um, the rates right now that the County can assess the hospital at hospitals at will be frozen indefinitely. Um, and right now in Florida, um, statewide, we're at about 3.5%, um, in terms of, uh, the assessment, um, under federal law, we can go as high as 6%. So really Florida and the counties, across Florida are missing out on that. If the big, beautiful bill, um, passes and those, those, um, freezes go into effect, um, immediately. So that's a little more about why it has to be done. Now, if that's helpful, if there's anything else I can clarify, just let me know. Commissioner Altman? Yes. Maybe more of a comment. Um, having been up in Tallahassee for over 20 years, uh, this, this, uh, Medicaid, um, program is Florida has been a leader in the country and it's quite a, uh, uh, quite a complex set of us. It's nothing new. It's been debated publicly for many, many years. It's been a, uh, reported. It's a program that allows us to work with our hospitals through an assessment program to generate revenue to bring down federal matching funds. And without it, our hospitals would be in serious problems. And we already talked about, and we're having a meeting on, uh, AMS today. We have one hospital that's closed. It would be a, a huge, huge, uh, problem for the state of Florida. If we don't, if we don't adapt, so we don't get caught in this freeze, I was not aware that the big, beautiful bill that's freezing these rates. So obviously it doesn't cost, this will save our, our Brevard County taxpayers millions of dollars and it will, um, it will, um, bring them our hard earned federal funds to provide the most basic of service healthcare for our constituents. So I can think of nothing more important, saving taxpayer dollars, providing healthcare for our citizens. Just don't get more critical than that. This is really important. I have a question for you though. Um, I assume that every county in the state of Florida will have to do what we're doing now. Um, about 25, 26 jurisdictions. Yeah. Only the counties that have a local provider participation fund. Um, some of the counties can't do it because they only have like one hospital. So under federal law, um, they don't qualify to have an LPPF. Um, but yes, all the jurisdictions. And so far we just have Brevard today and Leon left. And so we've done all of them and all the votes have been successful and unanimous. And, you know, I would say that if any member of the public and Sandra included, obviously we'll include you. Um, if they want to, if they want to get more information about this program, I will offer myself and my office as a resource. We can provide you a lot of history and a lot of data. And it's, it's a, it's a pretty complex, like I said, Florida's probably led the nations. It's a good, good people like yourself. So this is really important. Okay. Any other questions? Okay. Um, thank you, Rachel. We, we appreciate that. I do have three other cards. Um, I think they're going to wave in support if we don't have other questions. Um, Cortez-Wetley, right? Sir, you wave in support. Okay. Thank you very much. Terry Ford, sir. Health first. Wave in support. Okay. And then we have Stephen Lord for circles of care today. Also wave in support. Okay. Very good. All right. Commissioners. I think we're done with the questions. Any other, and cards, any other discussion on the item before we vote? Is there a motion on the item? Okay. We have a motion by Commissioner Goodson. We have a second by Commissioner Altman. Clerk will call the roll. Commissioner Delaney. Yes. Vice Chair Goodson. Yes. Commissioner Atkinson. Yes. Commissioner Altman. Yes. Chairman Feltner. Yes. We'll show that pass as five zero. Thank you very much, commissioners. We do have one public comment card before we head upstairs. Sandra Sullivan. Good morning. Sandra Sullivan, South Patrick Shores. So, um, previously I came here and expressed concern because in 2021 we had a 20, uh, 33% assessment for fire and, um, it didn't really pan out because the cost of growth was so high. Um, there wasn't enough money to really address what the intent of that was, which was close the gap on the wages for the, for fire. Um, so here we are, you know, with even more growth and we're doing a 37% increase. And as the magistrates report indicated, um, county's words that we're competing growth money with paying wages. So a couple of statements in there that suggest the county doesn't have enough money to address both. Um, so I just want to, um, mention that the idea brought forth by, um, gentlemen, firefighter Daco, um, is absolutely brilliant. And that is a, um, half cent or one cent sales tax. Um, and if you think about it, we have 24 new hotels coming online. We are a tourist county. We do the, you know, they do, they go to the hospitals, they go to the port, they go to, they, they go to the, the beaches. Um, they do all these calls that are tourism related. And so the sales tax makes a lot of sense. And so you're going to be this fiscal crisis, what would even the, the, what you're talking about, um, as a contract right now, not going to fix the problem. It's a bandaid, but you're still bleeding. Okay. So the, the solution I'm going to make a suggestion to you, because you got two crises hitting the county. You got, you got the federal government just came down. Brevard still has the highest number of deaths of manatees every year. The lagoon is, you know, problematic. So now you can't put in any more septic systems and you need to expand your sewer systems. And you just got cut by funding by DeSantis on some of those projects. My suggestion to you is not to wait to 2026 to pay the costs, costs to do in business, to do two referendums, one for an infrastructure surtax with a half cent for transportation and a half cent to address the sewage plants over in, in the air capacity and the pipes need to go to them and the old pipes and as well as stormwater. So that's one cent. And you do a second one, either a half cent or full cent for the fire for, for fire and EMS. We're space, we need a good hazmat. We, we, we could deal with, with having a FEMA team because FEMA is being cut. You know, there's a lot of things we can do here to do this right. And it's, it's not a lot of expense. I talked to Tim Bobanek and I think this would be, I think you need to do this and you can't afford to wait another year. And this is the right way to do it. Okay. Thank you. That's the last of the cards. So it is nine 17. Let's just say we're going to start at nine 30. Can we do that? Make that nice and, and round number. Anything else before we go up there? All right. Thank you everyone.