A Florida School District Buys Almost-Free Employee Care at Two County Hospital Clinics on October 1. The Federal Rule Written for Direct Primary Care Doesn't Reach It.

On October 1, school employees in Hendry County, Florida start getting their care at two clinics the county hospital already runs. Covered services carry little to no copay. The district’s announcement calls each one “a dedicated concierge health care clinic.” WGCU, the public radio newsroom that covered the launch, put the district in a trend of districts turning to “on-site or dedicated direct primary care models,” without saying which of the two Hendry chose. The posted service list runs through sick visits, wellness visits, primary care, basic labs, most X-ray imaging, cardiology, pharmacy and orthopedic care.

Concierge in the district’s words, direct primary care in the trend the newsroom placed it in. Since January, one of those phrases has a definition in the tax code, and this arrangement sits outside it.

What the district bought

The partner is Hendry Regional Medical Center. In LaBelle, employees go to the Hendry Regional Convenient Care Center on South Main Street, with care provided by Valerie Worley, APRN. In Clewiston, they go to the Dr. James D. Forbes Family Care Center on West Sagamore Avenue, weekdays 8 to 5, with care provided by Dr. Nikhil Gupta. Prescriptions come from Hendry Regional’s pharmacy at 542 West Sagamore Avenue, and the Clewiston clinic sits “on the campus of our local hospital,” in the clinic’s own words. The pharmacy will deliver to the school where the employee works.

Neither clinic is new, and both of them serve the general public today. The district’s announcement gives the LaBelle hours as weekdays 8 to 5, while the clinic’s own page posts longer ones, 8 to 7 on Monday and Wednesday plus Saturday mornings. That page also lists about a dozen providers, pediatrics, workers’ compensation, general surgery consultations, and a notice that nobody is turned away for inability to pay. What starts October 1 is a benefit at two working public clinics, not two clinics built for the district.

Superintendent Michael Swindle estimates 80 to 85 percent of employees’ medical needs will come at little to no cost out of pocket. Walk-in care is available, but the district wants something else from this. It wants staff to move their primary care to the clinics and keep it there.

“Health insurance should be something that improves the quality and culture of our employees,” Swindle told WGCU. “And I think, for the first time since I’ve even been employed here since 1993, that this truly is going to do something.”

The mechanism is simple enough. A self-insured district can pay a local provider directly instead of routing the same care through commercial insurance pricing, and an employee who uses the clinic isn’t working through a deductible first.

The purchasing structure underneath it

Hendry County is rural, and some district employees currently have to leave the county for care. A district that size doesn’t ordinarily get to build this. It got there by joining a group.

Hendry was one of the first three members of the Florida Educator Health Trust, alongside Hardee and DeSoto counties. FLEHT is a nonprofit under the Florida Association of District School Superintendents, and it exists so small districts can self-insure as a block rather than shop the fully insured market one at a time. Starting in June 2025 the membership went from three districts to 23, including Polk and Brevard. About 65,000 Florida school employees are now insured through it, roughly a third of the state’s 67 districts.

Swindle’s account of why is blunt. “When we were fully insured, our insurance premium rose every single year, from anywhere from 6 percent to 20 percent,” he told the News Service of Florida. “When we switched to the self-insured model, in the first two years that we were in it, we saved over $3 million.”

FLEHT says its districts saved more than $7.8 million in the first quarter of 2026. Read that figure for what it is: a trust reporting its own performance, against a counterfactual premium nobody paid. Andrew Spar, president of the Florida Education Association, has said publicly that he hasn’t seen it land. “So far, we have not seen any examples of a cooperative approach in which FLEHT has been able to address the out-of-control costs of health care while saving districts and employees money,” Spar said.

Kimberly Stitt, who leads the Hendry County Education Association, splits the difference. Prescription prices dropped for teachers after the district joined, she said. Family and spouse coverage is still priced where many teachers put their children on state plans instead. In August, Stitt described employee-only local clinics as a conceptual plan for the future. The benefit that starts October 1 has a different shape: two clinics the hospital already runs, open to employees and their families.

The federal definition draws a narrower line

Since January 1, 2026, “direct primary care” is not only a market term. Section 223(c)(1)(E) of the tax code defines a direct primary care service arrangement, and IRS Notice 2026-5 spells out how it works.

The care has to consist solely of primary care services delivered by primary care practitioners, and the sole compensation for that care has to be a fixed periodic fee. The notice then pulls three things out of “primary care services” by name: procedures requiring general anesthesia, prescription drugs other than vaccines, and laboratory services not typically administered in an ambulatory primary care setting. There’s also a ceiling of $150 a month, or $300 for an arrangement covering more than one person, on whether the arrangement counts as coverage that would block someone from contributing to an HSA.

Question 11 of the notice is the closest thing in it to Hendry’s fact pattern. It asks whether an arrangement qualifies when it conditions access on membership and a fixed periodic fee but bills separately for the items and services, through insurance or otherwise. The answer is no, because the fixed fee has to be the only compensation. Q-11 starts from members who have paid a fixed periodic fee, and nobody has published what Hendry pays or how, so it reads as an analogy here rather than a ruling.

On the published description, one count against Hendry’s arrangement is hard to escape. Pharmacy is in the benefit, and the notice pulls prescription drugs other than vaccines out of primary care services by name.

The orthopedic and cardiology lines are a harder question than they look. Answer 17 splits the two halves of the definition. The code defines “primary care practitioners” by reference to section 1833(x)(2)(A) of the Social Security Act, but it does not define “primary care services” by the HCPCS code list at section 1833(x)(2)(B), and the notice names only the three exclusions above. Cardiology and orthopedics are not among them. Neither the announcement nor the district’s FAQ sheet says who delivers those appointments. The two named benefit clinicians are a physician and an APRN, and every source gives that second credential as “APRN” with no role suffix, so whether it lands inside the practitioner types the statute lists isn’t on the record either. The notice doesn’t draw that boundary, so this post won’t either.

The compensation test can’t be settled from outside at all. The district announcement, the clinic FAQ sheet and the district benefits page all describe copays and services without naming what the district pays Hendry Regional.

None of that is a strike against the clinic. The definition does two separate jobs, and both are narrow. Section 223(c)(1)(E) decides whether enrolling counts as coverage that blocks someone from contributing to an HSA, and that is where the $150 monthly cap applies. Section 223(d)(2) decides whether the fee is a medical expense an HSA can reimburse, and Answer 20 says no dollar limit applies to that second question. Nothing in the district’s announcement claims either treatment. Hendry is buying something wider than primary care on purpose, and the imaging and orthopedic lines are the point rather than an oversight.

Where DPC Fits

The useful read here is about the word, not about Florida.

A DPC practice in Hendry County would be selling something narrower and more portable. One clinician, a fixed fee the patient controls, and a relationship that survives a change of employer. What the district bought is wider, cheaper at the point of care, and routed through the employer. The announcement limits it to eligible insured employees and their families, so access runs through the district’s plan.

Both can be good deals. They are not the same product, and the federal test now makes the difference checkable in about a minute. That matters most for anyone counting the market. If employer announcements that use the phrase get folded into DPC growth figures, the number stops describing DPC and starts describing every worksite clinic with a low copay.

Stitt’s unfinished business is the sharper version of the same point. Families can walk into these clinics too. What Stitt says is still priced out of reach is dependent coverage on the district’s plan, and many Hendry teachers put their children on state plans instead. A fixed-fee membership a family buys for itself answers that differently, because it doesn’t wait on what the employer offers.