Gov. Bush opposes using the windfall to plug a gap in the health care program, a decision that doesn't sit well with some.
By ALISA ULFERTS
Published January 7, 2004
TALLAHASSEE - To protect Florida in tough economic times, Congress sent more than $400-million in extra Medicaid money last year.
The state still has that money, but Gov. Jeb Bush does not want to use it to plug a $113-million deficit in its health care program for the poor.
Instead, he wants to cut Medicaid payments to more than 900 hospitals, nursing homes and group homes for the developmentally disabled.
The $400-million, meanwhile, will be shifted from agencies that serve the poor, the elderly and children to an all-purpose account that can be spent on anything or saved for a rainy day.
Some lawmakers are fuming.
"It's morally wrong," said Senate Democratic leader Ron Klein of Boca Raton.
Klein noted that the state just spent $369-million to lure the Scripps Research Institute to Florida. He said he was comfortable with the Scripps expense as long as the $400-million went to Medicaid.
Bush disagrees. He opposes using the unspent federal money to fill the Medicaid deficit, even though it means immediate spending cuts. Instead, he wants to save the money to help pay for Medicaid next year.
"If we use the dollars to try and plug a recurring hole, that hole will just get bigger next year," said Bush spokesman Jacob DiPietre.
Indeed, lawmakers say next year's budget is a nightmare in the making, one that involves increasing expenses as tax cuts will continue to dry up revenue.
Still, Klein said the federal money should go to urgent health care needs, such as paying hospitals what was promised and ending a waiting list for a popular children's health care program.
"These are real expenses right now that affect people's lives right now," Klein said.
At Bon Secours Maria Manor nursing home in St. Petersburg, the cut would mean a $120,000 loss. That's on top of a $600,000 deficit the nursing home expects this year, said Luanne Reese, director of marketing and planning.
"It doesn't make sense at all," Reese said.
What's especially galling, she said, is that legislators also ordered nursing homes to add nursing assistants by spring.
"It's the contradiction in, "We want you to provide quality, but we're going to keep cutting the money for you to provide quality care,' " Reese said.
Exactly how much money the state can save by cutting Medicaid payments is unclear. State health care officials say the savings will be $18-million, far less than the projected deficit, but nursing home officials say their industry could lose $27-million. Hospitals across the state are expected to lose about $8-million, said industry lobbyists.
"It would be melodramatic for me to say that $8-million is catastrophic, but if these kind of practices become commonplace, it could be catastrophic," said Tony Carvalho, a senior vice president with the Florida Hospital Association.
"We could be looking at hundreds of millions of dollars to providers if they think this is a way to save money," Carvalho said.
State legislators last year approved a slight increase in Medicaid payments to hospitals and other facilities, beginning Jan. 1, to pay for things such as inflation, wage increases and extra staffing. State officials are asking the federal government, which pays for more than half of the state's Medicaid costs, to repeal those increases by February.
Budget documents given to lawmakers suggest the cuts won't affect Medicaid patients, but a nursing home representative disagreed.
Tony Marshall of the Florida Health Care Association said jobs will have to be cut even though the homes can't legally dip below minimum nursing levels. "You either have to pay for less benefits or you have to remove a housekeeper or an activities person or a nutritional person," Marshall said.
Reese said Bon Secours has not decided what cuts it might make, but is better positioned than some nursing homes because it's part of a larger system of hospitals and nursing care centers. Other nursing homes already are planning cuts to dietary and housekeeping staffs, Reese said.
At Tampa General Hospital, officials heard months ago that the planned increase might not happen so "we did not build an increase into the budget," said spokesman John Dunn.
The issue is likely to come up Thursday, when members of a joint House-Senate committee approve midyear budget changes, including shifting the $400-million into the state's general fund.
Sen. Durell Peaden, R-Crestview, chairman of the Senate committee that oversees health care spending, plans to bring up the issue in his committee Thursday.
"These are the most vulnerable people," Peaden said. "We'll discuss it, whether or not it's on the agenda."
- Times staff writer Lisa Greene contributed to this report.
