A significant funding shortfall threatens the Florida Birth-Related Neurological Injury Compensation Association (NICA), a program designed to support children with neurological injuries stemming from birth-related complications. With projected claims amounting to $1.7 billion and assets totaling only $1.5 billion, lawmakers are grappling with how to ensure the program remains solvent while addressing the needs of affected families.
The proposed solution, Senate Bill 1668, aims to stabilize NICA’s finances but has raised concerns about potential restrictions on payments to parents and guardians. During a Senate Banking and Insurance Committee meeting on January 28, 2024, Laura Youmans, director of legislative and government affairs for the Florida Justice Association, criticized the bill for tightening benefits rather than addressing the funding mechanisms. “The solution should be to more fully address the funding mechanisms, not to reduce or condition benefits to families,” she stated.
Established in 1988, the NICA program was created in response to soaring medical malpractice premiums that were driving obstetricians and gynecologists out of Florida. Families who opt into NICA relinquish their right to sue healthcare providers, limiting the liability for these professionals. This arrangement is intended to provide stability for both the families receiving support and the medical community.
Renee Oliver, a board member of NICA whose son is enrolled in the program, emphasized the urgency of the reform. “Families are always vigilant because one missed alarm, one clogged tube, one seizure, one breathing emergency — those things are life-threatening,” she remarked. Oliver underscored that families are not seeking extravagant benefits, only the fundamental necessities for their children’s survival and dignity.
The Senate committee approved the bill with a 9-1 vote, with Sen. Jonathan Martin of Fort Myers as the sole dissenting voice. Martin did not elaborate on his decision during the meeting. The bill’s sponsor, Sen. Colleen Burton, expressed the challenge of sustaining quality care while maintaining program affordability. “The challenge that we face is how do we sustain that care at the level that gives them the highest quality of life,” she noted.
A companion measure, House Bill 1291, moved forward in the House Insurance and Banking Subcommittee on January 29, 2024. Lawmakers have sought to reform NICA following investigative reports by the Miami Herald and ProPublica in 2021, which unveiled significant issues, including failures to inform families of all available benefits.
The latest annual report from NICA reveals alarming financial projections. Although the program reported $38 million in assessments from hospitals and physicians in 2025, it incurred claims totaling $143.1 million. Investment income provided a temporary buffer, allowing NICA to end the year with a surplus of $27.2 million, following a prior deficit of $63.7 million.
The proposed legislation includes provisions to ensure some benefits, such as dental coverage, while also introducing restrictions. For example, families may lose coverage if a parent is working remotely to care for their child, a stipulation Youmans described as an “impossible choice.” Additionally, the bill mandates that families maintain comprehensive major medical coverage for their children.
To bolster the program’s finances, the Office of Insurance Regulation could access up to $50 million from a trust fund for insurance regulation enforcement, an increase from the current $20 million. If NICA’s assets drop below 90% of projected costs, the Office can impose assessments of up to 0.25% on casualty insurance policies to reinforce the program. Notably, the bill does not propose increasing the existing assessments on hospitals and physicians, which have remained unchanged since NICA’s inception.
Currently, hospitals are assessed $50 per live birth annually, while non-participating physicians are charged $250 per year. Participating physicians contribute $5,000 annually. Rep. Adam Anderson, who sponsors the House bill, stated that the proposed changes would not diminish benefits and are crucial for ensuring NICA’s long-term viability. “The bill establishes explicit, repeatable mechanisms and thresholds to automatically activate these remedies as needed,” he explained, aiming to maintain the program’s solvency without requiring further legislative intervention.
As discussions continue, the fate of NICA and the families it serves remains uncertain. Lawmakers face the dual challenge of addressing immediate financial concerns while ensuring that the needs of children with severe medical conditions are met. The ongoing debate reflects a broader struggle within the healthcare system to balance fiscal responsibility with the imperative to provide essential care to the most vulnerable.
