TALLAHASSEE - To increase education spending and provide another round of tax cuts, Gov Jeb Bush wants to rein in the spiraling costs of health care for the poor.
So, even as he proposes spending $526-million more in state dollars for Medicaid, he cut $325-million in state costs.
Bearing the brunt of the changes are 900 hospitals, nursing homes and other institutions that get $308-million less than they expected for taking care of Medicaid patients.
To do that, Bush wants the Legislature to override a law guaranteeing automatic twice-yearly rate hikes for service providers.
"We say "Ouch,' again," said Rich Rasmussen of the Florida Hospital Association. "What is troubling is that these patients aren't going to go away. They're still going to present themselves."
Bush warned Tuesday that it was just the beginning of his effort to control a program that has nearly doubled in cost since he took office.
Even with the cuts, Medicaid spending would grow 8.7 percent, Bush said, less than the usual 12 percent increase.
He's asking the Legislature to authorize his staff to seek a waiver from the federal government that would allow Florida to make Medicaid look more like private insurance plans, in which patients often pay a little toward the cost of their care or have lifetime benefit limits.
"If this trend continues, it will triple in the next decade. In a year or two it will cost more than the entire state budget," Bush said. "We can't continue."
Cuts patients will notice: Medicaid, under Bush's budget proposal, would no longer pay for trips to the podiatrist or chiropractor, saving the state $5.4-million annually; no transportation for Medicaid recipients who were not disabled and live in an area with public transportation, a $7-million savings; and the state would spend $5-million less to provide private nurses for Medicaid patients at home.
Also taking a hit would be pharmacists, who would see the state pay them less to fill a Medicaid prescription, saving about $8-million. HMOs would see a 1 percent cut in their reimbursement for taking on Medicaid clients, saving $5-million. Pharmaceutical companies would be forced to offer steeper discounts on mental health drugs, saving an estimated $12.5-million. And nursing homes would no longer be paid for keeping a bed open while a resident was in a hospital, which used to cost the state about $10-million annually.
Bush proposes that the Legislature repeal a law that requires nursing homes to raise staffing levels next year from 2.6 hours per patient per day to 2.9 hours. Doing away with the requirement should save about $23-million, the governor said.
Nonetheless, Bush's proposal comes as hospitals, nursing homes and other institutions already are reeling from the state's decision earlier this month to freeze reimbursement rates for Medicaid patients, costing providers an estimated $113-million.
Providers have argued every time the state refuses to raise reimbursement it forces them to raise prices for other non-Medicaid patients.
