HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 231 Services for Veterans and Their Families
SPONSOR(S): Zika and others
TIED BILLS: IDEN./SIM. BILLS: SB 260
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Local Administration & Veterans Affairs 17 Y, 0 N Renner Miller
Subcommittee
2) Health Care Appropriations Subcommittee 15 Y, 0 N Mielke Clark
3) State Affairs Committee 24 Y, 0 N Renner Williamson
SUMMARY ANALYSIS
Veterans throughout the United States face mental health and substance abuse issues. Depression,
posttraumatic stress disorder, and suicide affect numerous veterans returning from combat.
In 2014, the Legislature appropriated $150,000 to the Florida Department of Veterans Affairs (FDVA) to create
a pilot program expanding existing Florida 211 Network (information and referral network) services to veterans
in Hillsborough, Pasco, Pinellas, Polk, and Manatee Counties. Through the pilot project, veterans receive
information on available services, referrals to federal Veterans Affairs (VA)-funded and other community-based
services, and care coordination to verify that referrals lead to successful service connection.
The bill authorizes FDVA to establish the Florida Veterans’ Care Coordination Program (Program) to provide
veterans and their families dedicated behavioral health care referral services, primarily for mental health and
substance abuse. Through the Program, a veteran may call a separate veteran-dedicated support line to
receive assistance and support from a fellow veteran trained to respond to the calls for assistance.
If FDVA establishes the Program, FDVA may contract with a nonprofit entity with statewide phone capacity to
serve veterans and that is accredited by the Council on Accreditation and is fully accredited by the Alliance of
Information and Referral Services. The contracting entity must enter into agreements with Florida 211 Network
participants to provide services to veterans.
The bill specifies Program goals, services, and requirements. If the Program is established, FDVA must
compile data collected by the Florida 211 Network into a report for the Governor, President of the Senate, and
Speaker of the House of Representatives by December 15, 2022.
The bill has no fiscal impact on the FDVA for Fiscal Year 2021-2022 and an indeterminate negative fiscal
impact on the FDVA thereafter.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives .
STORAGE NAME: h0231e.SAC
DATE: 3/17/2021
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Present Situation
Veterans and Mental Health and Substance Abuse
Florida has the nation’s third-largest veteran population with roughly 1.5 million veterans.1 Veterans
face unique challenges and some struggle with mental health and substance abuse.
Posttraumatic stress disorder (PTSD) is a psychiatric disorder that can occur in people who have
experienced or witnessed a traumatic event, including war or combat.2 The National Center for PTSD,
within the United States Department of Veterans Affairs (VA), lists the percentage of veterans with
PTSD by service era:
Between 11 and 20 percent of veterans who served in Operations Enduring Freedom3 and Iraqi
Freedom4 were diagnosed with PTSD in a given year.
About 12 percent of veterans who served in the Persian Gulf War5 were diagnosed with PTSD
in a given year.
About 15 percent of veterans of the Vietnam War6 were diagnosed with PTSD at the time of the
most recent study in the late 1980s. However, the National Center for PTSD estimates that
about 30 percent of veterans of the Vietnam War have had PTSD in their lifetimes.7
A strong association exists between PTSD and substance abuse disorders (SUD) among veterans.
Statistics show:
More than two in 10 veterans with PTSD also have SUD.
Almost one in three veterans seeking treatment for SUD also have PTSD.
About one in 10 veterans returning from the wars in Iraq and Afghanistan have problems with
alcohol or other drugs.8
Suicide rates for veterans continue to be a cause of national concern. More than 6,000 veterans
committed suicide each year from 2008 to 2016. In 2016, the suicide rate was 1.5 times greater for
veterans than for non-veteran adults, after adjusting for age and gender. From 2005 to 2016, the
increase in the suicide rate among veterans in Veterans Hospital Administration (VHA) care was lower
than among veterans not in VHA care.9
1
Enterprise Florida, Florida Defense Factbook, January 2020, p. 1, https://www.enterpriseflorida.com/wp-content/uploads/Florida-
Defense-Factbook-2020.pdf (last visited Jan 29, 2021).
2
American Psychiatric Association, What is Posttraumatic Stress Disorder?, https://www.psychiatry.org/patients-families/ptsd/what-
is-ptsd (last visited Jan. 28, 2021).
3
October 7, 2001, ending on the date prescribed by presidential proclamation or by law. See s. 1.01(14)(h), F.S.
4
March 19, 2003, ending on the date prescribed by presidential proclamation or by law. See s. 1.01(14)(i), F.S.
5
August 2, 1990, to January 2, 1992. See s. 1.01(14)(g), F.S.
6
February 28, 1961, to May 7, 1975. See s. 1.01(14)(f), F.S.
7
National Center for PTSD, VA, How Common is PTSD in Veterans?,
https://www.ptsd.va.gov/understand/common/common_veterans.asp (last visited Jan. 27, 2021).
8
National Center for PTSD, VA, PTSD and Substance Abuse in Veterans,
https://www.ptsd.va.gov/understand/related/substance_abuse_vet.asp (last visited Jan. 27, 2021).
9
Office of Mental Health and Suicide Prevention, VA, VA National Suicide Data Report 2005-2016,
https://www.mentalhealth.va.gov/docs/data-sheets/OMHSP_National_Suicide_Data_Report_2005-2016_508.pdf (last visited Jan. 28,
2021).
STORAGE NAME: h0231e.SAC PAGE: 2
DATE: 3/17/2021
Federal Veterans Crisis Line
The VA Veterans Crisis Line connects veterans and current service members in crisis and their families
and friends with information from qualified responders through a confidential toll-free hotline, online
chat, and text messaging service.10
Since being launched in 2007, the Veterans Crisis Line has answered more than 4.4 million calls and
initiated the dispatch of emergency services to callers in crisis more than 138,000 times. In 2009, an
anonymous online chat service was added. In 2011, a text-messaging service was also added to
provide another way for veterans to connect with confidential, round-the-clock support.11
Florida 211 Network
A 211 network is a telephone-based service offered by nonprofit and public agencies throughout the
United States that provides free and confidential information and referral services 24 hours a day,
seven days a week. The network helps callers identify and connect with health and human service
programs that can meet a variety of needs, including food, housing, employment, health care, and
crisis counseling.12
The Florida Alliance of Information and Referral Services (FLAIRS) is the 211 collaborative
organization for the state and is responsible for designing, studying, and implementing the Florida 211
Network.13 The Florida 211 Network14 operates as the single point of coordination for information and
referral of health and human services.15 These services are available statewide through any cell phone
provider as well as through landlines in all 67 counties by dialing 2-1-1.16 There are 13 Florida 211
Network certified providers serving the areas shown below. 17
10
VA Veterans Crisis Line, What to Expect, https://www.veteranscrisisline.net/about/what-to-expect (last visited Jan. 28, 2021).
11
VA Veterans Crisis Line, What It Is, https://www.veteranscrisisline.net/about/what-is-vcl (last visited Jan. 29, 2021).
12
Florida 2-1-1 Association, http://www.my211florida.org/ (last visited Jan. 29, 2021).
13
S. 408.918(3), F.S.
14
S. 408.918, F.S.
15
S. 408.918(1), F.S.
16
Supra note 10.
17
Florida Alliance of Information and Referral Services, Map of 2-1-1 Centers, http://www.flairs.org/wp-
content/uploads/sites/13/2019/09/FL-211-providers-and-coverage-areas-061819.pdf (last visited Jan. 29, 2021).
STORAGE NAME: h0231e.SAC PAGE: 3
DATE: 3/17/2021
To participate in the Florida 211 Network, a 211 provider must be fully accredited by the National
Alliance of Information and Referral Services or have received approval to operate, pending
accreditation from its affiliate, FLAIRS.18
Council on Accreditation
The Council on Accreditation (COA) is an international accrediting entity that accredits private and
public organizations and programs providing human services.19 The COA specifically accredits entities
providing child welfare, behavioral health, and community-based social services.20
Crisis Center of Tampa Bay Pilot Project
In 2014, the Florida Legislature appropriated $150,000 to create a pilot program expanding existing 211
services to veterans in Hillsborough, Pasco, Pinellas, Polk, and Manatee Counties.21 The Crisis Center
of Tampa Bay (CCTB), through the pilot program, expanded its services to veterans and launched the
Florida Veterans Support Line (1-844-MYFLVET) in November 2014.22 The expanded service is
veteran-specific and peer-based. By calling the Florida Veterans Support Line, veterans in the Tampa
Bay region are able to speak with a fellow veteran, called a Peer-to-Peer Coordinator, and are offered:
Comprehensive information and referral to VA-funded services and other community-based
services;
Assistance and support provided by a peer who has experienced the transition from military
back to civilian life; and
Care coordination services, including system navigation, advocacy, and ongoing support.23
Since the CCTB implemented the pilot program in 2014, veteran and veteran family participation has
steadily increased:
Fiscal Year (FY) 2014-2015,24 the Florida Veterans Support Line served 1,135 veterans.25
FY 2015-2016, the Florida Veterans Support Line served 1,315 veterans.26
FY 2016-2017, the Florida Veterans Support Line served 7,343 veterans.27
FY 2017-2018, the Florida Veterans Support Line served 28,962 veterans.28
FY 2018-2019, the Florida Veterans Support Line served 17,699 veterans.29
FY 2019-2020, the Florida Veterans Support Line served 25,800 veterans.30
October through December 2020, the Florida Veterans Support Line served 6,890 veterans.31
Expansion of the Florida Veterans Support Line
18
S. 408.918(2), F.S. The full accreditation process requires a remote database review, consultation component, on-site review, and
demonstration of a call handling component, as well as payment of a membership fee. See
https://www.airs.org/i4a/pages/index.cfm?pageid=3286 (last visited Jan. 29, 2021).
19
Council on Accreditation, http://coanet.org/home/ (last visited Jan. 29, 2021).
20
Council on Accreditation, About COA, http://coanet.org/about/whats-new/about-coa/ (last visited Jan. 29, 2021).
21 Specific appropriation 595 of HB 5001, 2014-2015 General Appropriations Act.
22
CCTB, Overview of Current Funding (on file with Local Administration & Veterans Affairs Subcommittee).
23
CCTB, Florida Veterans Support Line, What we offer, https://www.myflvet.com/about-1 (last visited Jan. 29, 2021).
24 The CCTB pilot program operates with an October-September fiscal year. Its first operating year began on October 28, 2014.
25 CCTB, Florida Veterans Support Line 1-844-MYFLVET: Fiscal Year 2015 Report (on file with Local Administration & Veterans
Affairs Subcommittee).
26
CCTB, Overview of the 1-844-MYFLVET Support Line (on file with Local Administration & Veterans Affairs Subcommittee.)
27
CCTB, 1-844-MYFLVET: Demographic Data FY 2016 and FY 2017 (on file with Local Administration & Veterans Affairs
Subcommittee).
28
CCTB, Overview of the 1-844-MYFLVET Support Line (on file with Local Administration & Veterans Affairs Subcommittee).
29
CCTB, Florida Veterans Support Line, Statewide Data, Fiscal Year 2019, Fiscal Year 2020, Fiscal Year 2021-Q1 (on file with
Local Administration & Veterans Affairs Subcommittee).
30
Id.
31
Id. The totals for the most recent fiscal year reflect the first quarter of FY 2020-2021, October through December 2020.
STORAGE NAME: h0231e.SAC PAGE: 4
DATE: 3/17/2021
In 2017, $400,000 was provided to the Florida Department of Veterans’ Affairs (FDVA) in conjunction
with the CCTB to fund local call centers statewide to connect veterans with resources and services.
This funding was not used to expand the Peer-to-Peer Coordination component from the pilot project.32
In 2018, the VA provided partial funding for a statewide expansion of the Peer-to-Peer Coordination
component in the amount of $1,102,502 for September 2018 through September 2021. Additionally, the
Department of Children and Families (DCF) provided $538,000 for operations from February 1, 2019,
through June 30, 2019.33 DCF activated a second-year option beginning July 1, 2019, and expiring
June 30, 2020, for $1,000,000.34 Subsequently, DCF provided funding for FY 2020-2021 for
$1,070,000. Pending additional funding allocations, there is the possibility for three more years of
funding through September 2024.35
Effect of the Bill
The bill authorizes FDVA to establish the Florida Veterans’ Care Coordination Program (Program) as a
statewide program to provide veterans and their families dedicated behavioral health care referral
services, primarily for mental health and substance abuse. The Program must be modeled after the
pilot program established in 2014 by the CCTB and FDVA in Hillsborough, Pasco, Pinellas, Polk, and
Manatee Counties.
If FDVA establishes the Program, it may contract with a nonprofit entity with statewide phone capacity
to serve veterans that is accredited by COA and fully accredited by the National Alliance of Information
and Referral Services. The nonprofit entity selected must enter into agreements with Florida 211
Network participants to provide services to veterans.
The goals of the Program include preventing suicide by veterans, increasing the use by veterans of
programs and services provided by the VA, and increasing the number of veterans who use other
available community-based programs and services. Program services include:
Telephonic peer support, crisis intervention, and information on referral resources;
Treatment coordination, including coordination of follow-up care;
Assessment of suicide risk as part of an immediate needs assessment, including safety
planning and support; and
Resource coordination, including data analysis, to facilitate acceptance, enrollment, and
attendance of veterans and their families in programs and services provided by the VA and
other available community-based programs and services.
The bill requires Program teams to:
Track the number of requests from veterans or family members;
Follow up with callers to determine if they have pursued referrals and whether additional help is
needed;
Implement communication strategies to educate veterans and their families about programs and
services provided by the VA and other community-based programs and services; and
Document all calls and capture necessary data to improve outreach to veterans and their
families and report such data to the contracted entity.
Florida 211 Network participants must establish and maintain a database of services available locally.
Both FDVA and its contractor must work with managing entities to educate service providers about the
Florida Veterans Support Line and the Program.
32
CCTB, Overview of the 1-844-MYFLVET Support Line (on file with Local Administration & Veterans Affairs Subcommittee).
33
Id.
34
Email from Sunny Hall, Vice President of Client Services, CCTB, RE: funding (Dec. 10, 2019) (on file with Local Administration
& Veterans Affairs Subcommittee).
35
CCTB, 1-844-MYFLVET Current Funding. (On file with Local Administration & Veterans Affairs Subcommittee).
STORAGE NAME: h0231e.SAC PAGE: 5
DATE: 3/17/2021
Florida 211 Network participants must provide all collected data to the FDVA. By December 15, 2022,
FDVA must submit a report to the Governor, President of the Senate, and Speaker of the House of
Representatives that must include:
The nature, number, and outcome of each call rec