A significant funding shortfall threatens the Florida Birth-Related Neurological Injury Compensation Association (NICA), a program designed to assist children with neurological injuries from birth. The program is projected to face claims totaling $1.7 billion, while only having $1.5 billion in assets. This discrepancy has prompted lawmakers to propose a bill aimed at addressing the funding crisis, yet concerns arise regarding potential limitations on payments to families.
The proposed legislation, known as SB 1668, is under scrutiny for potentially restricting benefits for parents and guardians without increasing assessments on hospitals and physicians, which are crucial for financing the program. Laura Youmans, director of legislative and government affairs for the Florida Justice Association (FJA), expressed her apprehension during a Senate Banking and Insurance Committee meeting on January 28, 2024. Youmans stated, “Instead of addressing assessments, the bill tightens benefits and restricts payments to families.”
The FJA has not formally opposed the bill but advocates for higher assessments on healthcare providers, which have remained unchanged since NICA’s inception in 1988. This stagnation fails to reflect healthcare inflation and the increased longevity of children benefiting from the program, escalating operational costs.
NICA was established to mitigate the impact of soaring medical malpractice premiums that were driving obstetricians out of Florida. Families that enroll in the program relinquish their right to sue hospitals or physicians, thereby limiting the liability of healthcare providers. Renee Oliver, a NICA board member with a son in the program, emphasized the necessity of the bill to ensure the program’s viability. “Families are always vigilant because one missed alarm, one clogged tube, one seizure, one breathing emergency — those things are life threatening,” Oliver remarked. She added that families are merely seeking essential resources to ensure their children’s survival and dignity.
The Senate committee advanced SB 1668 with a vote of 9-1, with Senator Jonathan Martin of Fort Myers as the sole dissenting voice. Martin’s rationale for voting against the bill remains unexplained.
Senator Colleen Burton, the bill’s sponsor, highlighted the challenge of sustaining quality care while ensuring the program’s financial health. “The challenge that we face is how do we sustain that care at the level that gives them the highest quality of life while continuing to be able to pay for the program?” she said.
On January 29, 2024, a similar proposal, HB 1291, successfully passed through the House Insurance and Banking Subcommittee. Legislative efforts to reform NICA have been ongoing, especially following a 2021 investigative series by the Miami Herald and ProPublica that exposed various inadequacies within the program, including failures to inform families about all available benefits.
The latest annual report from NICA reveals that while the program serves 245 participants, it is currently facing a financial imbalance. In 2025, NICA collected $38 million in assessments from hospitals and physicians, while claims reached $143.1 million. Despite a favorable investment income of $140 million, NICA’s financial position fluctuated, witnessing a net positive of $27.2 million after a previous year marked by a deficit of $63.7 million.
While the proposed bill guarantees certain benefits for families, such as dental coverage, it also imposes restrictions. Specifically, the program would cease payments if a parent is working from home while caring for their child, a condition criticized by Youmans as an “impossible choice.” Furthermore, the bill mandates that families maintain comprehensive medical coverage for their children.
In a bid to bolster the program’s sustainability, the legislation allows the Office of Insurance Regulation to access $50 million from a trust fund for insurance regulation enforcement if NICA’s assets drop below 90% of projected costs. Should this measure prove insufficient, the Office of Insurance Regulation can impose assessments of up to 0.25% on casualty insurance policies to support the program. Notably, there are no proposed increases to the existing assessments on hospitals and physicians, which currently stand at $50 per live birth and $250 for non-participating physicians, while participating physicians pay $5,000.
Rep. Adam Anderson, the sponsor of the House bill, maintains that the legislation will not reduce benefits and is essential for ensuring NICA’s long-term viability. “The bill establishes explicit, repeatable mechanisms and thresholds to automatically activate these remedies as needed, ensuring that the program remains solvent indefinitely without requiring any legislative action,” he stated.
As discussions continue, the future of NICA and its ability to deliver necessary care to families of children with neurological injuries hangs in the balance, underscoring the critical nature of both legislative action and funding reform.
