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IN THIS ISSUE:

CRIMINAL JUSTICE

Florida Professional Guardianship Information: 2025

Coercive Compassion: Theorizing Assisted Outpatient Treatment


EDUCATION

College Business Models for Scaling Purposeful Dual Enrollment

Hot Test Days, Lower Math Scores: How Heat Affects Student Achievement


GOVERNMENT OPERATIONS

Florida Department of Environmental Protection: 2025 Disposition of State Lands and Facilities Annual Report

Theory and Evidence for a Tax-Day Deduction

Early Educators and Public School Teachers: A Comparison of Labor Market Outcomes


HEALTH AND
HUMAN SERVICES

The Unintended Consequences of The Affordable Care Act’s Medical Loss Ratio Requirement

Sleep Problems, Decision-Making, and Suicide Attempts During Adolescence: A Longitudinal Birth Cohort Study

Health System Affiliation and Care for Dual-Eligible and Non–Dual-Eligible Medicare Beneficiaries



October 31, 2025

CRIMINAL JUSTICE

The Florida Guardianship Data Transparency System (FLGDT) database and public facing website officially launched in 2024. As of June 2025, 338 users had access to FLGDT. OPPAGA found FLGDT to be operational, but underlying data was incomplete. Clerks implemented approaches proposed by the Florida Clerks of Court Operations Corporation to capture missing data elements, but the absence of a unique identifier that links individual guardians to their cases continues to inhibit accurate reporting of guardianship data. Due to the lack of a unique identifier, OPPAGA used a subset of cases to generate professional guardian caseload statistics. OPPAGA received data extracted from the FLGDT database—which included 6,478 active professional guardianship cases—and identified the specific professional guardian in 56% of the cases. Analysis of these cases indicated that most guardians are appointed to 10 or fewer cases, but 40% of wards were served by guardians with caseloads of more than 30 cases. Active caseloads for professional guardians ranged from 1 ward to an outlier of 275 wards. OPPAGA interviewed officials in four states; these officials emphasized the importance of collecting accurate, statewide guardianship data and reported that data cleanup is a challenging step in that process. Both Pennsylvania and Minnesota created statewide guardianship portals that allow guardians to enter required reports online and allow court staff to monitor and oversee guardians’ activities; Nevada is developing a statewide portal, and New Mexico collects statewide data using unique status codes in its existing case management system.

Source: OPPAGA

States across the country are adopting Assisted Outpatient Treatment (AOT) programs at a record pace, bolstered by nearly $150 million in federal funding since 2016. AOT laws authorize courts to mandate community mental health treatment, including psychotropic medication, for individuals with lived experience of mental health conditions, typically without a judicial finding of current dangerousness or incapacity to make rational treatment decisions. Proponents praise AOT as a means of addressing unmet treatment needs, reducing homelessness, and curbing violence. Yet, they extend state authority to override competent treatment refusals based on speculative predictions of future dangerousness and questionable assertions of efficacy. This article provides the first comprehensive, empirical examination of the two primary justifications for AOT; the first, coined the “thank-you theory,” theorizes that involuntary treatment restores a person’s autonomy and that recipients will, in hindsight, be grateful for it. The second is a consequentialist argument: AOT is warranted when an individual lacks insight into their need for treatment, their condition poses a risk of future harm, and the expected benefits of treatment outweigh the harm to personal liberty. These theories depend upon three assumptions: (1) that individuals lack meaningful autonomy prior to involuntary intervention, (2) that recipients are generally grateful in hindsight, and (3) that AOT reliably produces beneficial outcomes. Drawing from quantitative and qualitative empirical studies, the article finds each unsupported by strong evidence. The article then proposes two alternative paths. First, it suggests a narrowing of AOT criteria through stricter consent requirements, procedural justice enhancements, and restrictions of eligibility to target populations. Second, it endorses the global shift away from involuntary community treatment toward high-quality, voluntary community-based services.

Source: University of Florida Levin College of Law

EDUCATION

Dual enrollment allows students to take postsecondary coursework and simultaneously earn credit toward a high school diploma, a career certificate, an associate or baccalaureate degree. There is a growing consensus that dual enrollment should be more than just an early taste of college; it should serve as a purposeful pathway to career-connected postsecondary education and training, particularly for students who might not otherwise go to college after high school. But to realize the potential of this approach, the business model for dual enrollment must enable colleges and K-12 schools to scale practices for improved outreach, better course alignment, individual advising and planning, and high-quality instruction and support in a way that is financially sustainable but does not shift the cost burden to students and families. The report shows how, even in states that provide little or no direct funding for dual enrollment, colleges are shifting from the conventional low-cost model, which involves lighter student support but generates less downstream revenue, to one that requires higher upfront costs but generates more downstream revenue by providing increased supports that propel more students to pursue postsecondary education after high school. Accompanying the report is an inquiry and action guide that includes instructions, activities, and discussion to help college leaders conduct a self-study and gap analysis, identify needed resources, and plan allocation strategies to implement priority improvements at scale.

Source: Columbia University, Community College Research Center

Extreme heat poses challenges for an increasing number of schools each year. This analysis across three years of six states’ fall testing administrations found that math scores decrease significantly on hotter test days, with significant negative effects on test scores for temperatures 80°F and above. The largest effects were observed on 101° to 110° days, when students experienced decreases in math scores of approximately 0.06 standard deviations. We also found that a hotter testing day relative to a school’s average testing temperature in a term had a small but negative effect on math scores. Importantly, we found that schools that serve higher poverty student populations (or have greater than 75% eligible for free or reduced-price lunch) are more severely affected by test-day heat than lower-poverty schools in math. These differences may be linked to disparate conditions of school facilities, as higher resourced schools may be able to prioritize updated HVAC systems. While the review did not observe the same effects in reading, the math findings underscore how environmental conditions can compound existing educational inequities. Taken together with recent research, findings suggest that systemic inequities in education extend to how schools are affected by high temperatures. Geographic factors, such as the intensified impact of heat in cities, are also important to consider. As extreme weather becomes more common, ensuring that every school can provide a safe, climate-resilient learning environment is not just a facilities issue but is fundamental to educational equity and student success.

Source: NWEANWEA

GOVERNMENT OPERATIONS

Section 216.0153, Florida Statutes, requires the Florida Department of Environmental Protection and the Florida Department of Management Services to provide a list of real property disposition candidates, which are all lands and facilities owned, leased, otherwise occupied, disposed of, and/or in the surplus process by all state agencies, water management districts, universities, and colleges. The properties are listing in four categories; 1) Candidate for Disposition — Identified by the current manager as no longer needed and unmanaged properties that may be available for surplus pending a completed review; 2) Candidate for Disposition, Government Noticing Activities — includes parcels that are in the noticing process or noticing has been completed and responses are being reviewed and evaluated; 3) Disposition, Process Review Activities — Premarketing evaluations and approvals, available for sale to the public, actively being marketed for sale or available for exchange only; and 4) Disposition, In Process — This includes property that is currently under contract. As of June 30, 2025, there were 268 properties that were candidates for disposition or in the disposition process, containing an estimated 263 acres with an estimated value of $9.8 million. In the same period, there were 142 properties that were candidates for disposition or in the disposition process, containing an estimated 27,511 acres with an estimated value of $56.9 million. For Fiscal Year 2024-25, 11 Board of Trustees properties were disposed of, with six being sales, four being transfers, and one being an exchange of property. The total revenue received from the dispositions was $9.6 million, involving over 700 acres of land.

Source: Florida Department of Environmental Protection

Research shows that almost half of taxpayers who itemize deductions on their tax returns are not aware that charitable donations can reduce their taxable income. Furthermore, taxpayers often use their average tax rate as an estimate of their marginal tax rate, which leads many to underestimate how much charitable giving could reduce their taxes. A taxpayer’s incentive to donate is related to their marginal tax rate, which is the highest rate applied to someone’s income. When taxpayers underestimate their marginal tax rate, they often donate less because they underestimate how much it could reduce their taxes. Extending the charitable deduction deadline to tax filing day would allow taxpayers to consider the benefits of additional donations while calculating their taxes. Currently, a donation made in January 2025 can be deducted only when a taxpayer files their tax return in the spring of 2026. That means it would take more than a year for a taxpayer to see the effects of their charitable giving. By comparison, a tax-day deduction would let people who donate in April 2026 see a reduction in their taxes owed almost immediately, helping them become aware of their charitable deductions. Tax preparers or tax software could also help facilitate this by showing taxpayers how their taxes owed would change with additional donations. A tax-day deduction is tax-efficient for the government because it promotes charitable contributions without increasing the subsidy. Research on tax-day deductions implemented in the wake of a natural disaster showed that the policy increased charitable giving. The benefits of a tax-day deduction outweigh the drawbacks. The 2017 Tax Cuts and Jobs Act substantially increased the standard deduction, reducing the share of taxpayers who itemize mainly to those with higher incomes.

Source: Urban Institute

On average, early educators in the United States earn low wages and have few employer-provided benefits. Inadequate compensation may deter people from entering the field and may contribute to high turnover, possibly exacerbating the supply shortage. This article focuses on analyzing pre-pandemic Census Current Population Survey data to compare privately employed early educators and public K–8 teachers with bachelor’s degrees along several dimensions of job quality. Consistent with other research, this article finds that compared with public K–8 teachers with bachelor’s degrees, private early educators with similar work patterns and educational attainment earned less and lacked critical employer-sponsored benefits such as health insurance and retirement accounts. When looking at job quality, researchers find that only 3.7% of private early educators with bachelor’s degrees had a good job (one with a decent wage, employment-based health insurance, and retirement benefits), compared to nearly 51% of public K–8 teachers. The combination of low wages and inadequate benefits explains why so few early educators were employed in good jobs. Although public K–8 teachers, like private early educators, were disproportionately women, they were much more likely to hold a good job, reflecting better access to decent wages and health and retirement benefits.

Source: U.S. Bureau of Labor Statistics

HEALTH AND HUMAN SERVICES

The federal Affordable Care Act (ACA) introduced the medical loss ratio (MLR) requirement to the individual, small group, and large group markets with the stated goal of improving the value and affordability of health insurance benefits by capping insurers' profit margins and administrative costs. The requirement requires insurers to spend a large percentage of premium revenue on medical services—80% for individual and small group plans, and 85% for large group plans—thereby limiting administrative costs and profits to the remaining 15-20%. In 2025, approximately 24 million individuals obtained health insurance through exchanges, with four out of five (19 million) enrollees' monthly net premiums at $10 or less after subsidies. These enrollees received an estimated $98 billion and $107 billion in subsidies in the form of premium payments to insurance companies in 2024 and 2025, respectively. If an insurer's medical loss ratio falls below the required thresholds, the ACA requires refunds to be paid to enrollees. These refunds have totaled hundreds of millions of dollars—$192.2 million to 2.7 million enrollees in 2012 and $491.0 million to 3.6 million enrollees in 2023. Yet, in many cases, these payments go to enrollees whose premiums were already almost entirely subsidized by the federal government, even though the government was the party that paid the extra premium. While more regulatory oversight and transparency may temporarily ease these consequences, they cannot feasibly address the medical loss ratio requirement’s structural flaws that distort insurer incentives. In the short term, policymakers should at least consider a range of options to mitigate the medical loss ratio requirement’s negative impacts on competition and patient choice. For example, in markets with robust competition and for small/new entrants, they should allow medical loss ratio relief, such as a reduction in required thresholds or a time-limited suspension.

Source: RAND Corporation

Sleep problems have been identified as a risk factor for suicidal thoughts and behaviors during adolescence, yet a lack of longitudinal mechanistic investigation into contributing factors (e.g. cognitive functioning) limits understanding of the temporality and specificity of this relationship. This study investigates the impact of sleep problems on subsequent reported suicide attempt, and whether risk-taking and decision-making moderate this relationship. This analysis utilized data from waves 6 (14 years) and 7 (17 years) in the Millennium Cohort Study, a UK population-representative longitudinal study of youth born between 2000 and 2002. Self-reported sleep items assessed at 14 years were used to calculate total time in bed on school and non-school nights, social jetlag, sleep onset latency, and frequency of night awakenings. Self-reported attempting suicide was measured at 17 years.. Shorter total time in bed on school and more frequent night awakenings were prospectively associated with subsequent reported suicide attempt, even when controlling for demographic and clinical covariates. Rational decision-making moderated the association between night awakenings and attempted suicide. Shorter total time in bed and more frequent night awakenings heightened suicide risk in adolescents, and this latter relationship was modified by rational decision-making. These results provide insight into the etiology of adolescent suicide behavior and highlight sleep deprivation and fragmentation as potential preventative targets for suicide attempts.

Source: Sleep Advances

Physician organization (PO) affiliation with health systems and its association with health care disparities for dual-eligible Medicare and Medicaid beneficiaries, who face significant barriers to care, remains underexplored. The research team set out to estimate the association of health system affiliation with disparities in quality of care and health care utilization for dual-eligible beneficiaries relative to non–dual-eligible Medicare beneficiaries and to decompose these associations into within-PO and between-PO components. This cohort study used data from 2013 to 2019 on primary care POs and beneficiaries enrolled in traditional Medicare from April 2024 to March 2025. Eight quality measures assessing receipt of preventive services, chronic condition management, medication adherence, and care coordination and continuity and 5 measures of health care utilization in different settings and with different physician specialists.. Health system affiliation by primary care POs was associated with both positive and negative associations with disparities for dual-eligible beneficiaries and did not reduce the largest preaffiliation disparities. Health systems must strengthen their care delivery models to expand access to specialists and avoid exacerbating disparities in follow-up care. Health systems could identify factors associated with improved care at high-percentage dual POs for replication.

Source: JAMA Network


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POLICYNOTES
A publication of the Florida Legislature's Office of Program Policy Analysis and Government Accountability. Click here to subscribe to this publication. As a joint legislative unit, OPPAGA works with both the Senate and the House of Representatives to conduct objective research, program reviews, and contract management for the Florida Legislature.

PolicyNotes, published every Friday, features reports, articles, and websites with timely information of interest to policymakers and researchers. Any opinions, findings, conclusions, or recommendations expressed by third parties as reported in this publication are those of the author(s) and do not necessarily reflect OPPAGA's views.

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