Legislators cleverly sneaked into the state budget a provision handing elderly Medicaid patients in Hillsborough and three other counties to HMOs.
Published April 29, 2004
The compromise $58-billion budget bill was delivered to legislators' desks in Tallahassee shortly after 7 p.m. Tuesday, just under 77 hours from the midnight Friday deadline for adjourning the session on time.
For senators from Hillsborough and three other counties, there was a nasty surprise. Proviso language on pages 57 and 58 of the 389-page bill commits the state to a bold experiment in which all the elderly Medicaid patients in their counties would be the guinea pigs. Every state service, including nursing homes, assisted living homes, adult day care and home-delivered meals would be delivered through an "integrated care management model." In plain English: through HMOs.
That could prove to be more cost-efficient, and not necessarily less humane, than the present fee-for-service system. The HMO industry, however, has yet to persuade the public that it is devoted to both sides of that equation. That's why Sen. Les Miller, D-Tampa, and several other senators had extracted what they took as a promise from the leadership that their counties would not be in the experiment. Sen. Dennis Jones, R-Treasure Island, filed an amendment to the implementing legislation to make sure Pinellas wouldn't be. So did Miller, for Hillsborough.
The budget bill blindsided most of them. Not Jones - as majority leader, his influence was enough to keep Pinellas out. Hillsborough, Polk, Orange and Seminole would be in, even though the merits had never been aired before the Senate health committee, on the Senate floor, or in any public hearing as required by federal law for departures, like this one, necessitating a waiver from Washington. The proposal had been discussed in House and Senate budget committees, but that does not satisfy due process as legislative rules and tradition used to define it. One of those cardinal rules, reinforced by an explicit constitutional provision, is that the budget is not the place to make new laws.
It took evil genius to sneak this one into the budget with barely three days left in the session. Under what was intended as a reform, the Constitution for 10 years has required 72 hours' notice to legislators, the governor and the public before the final vote on an appropriations bill. This meant that by Wednesday morning, any change, such as an amendment to delete the four-county experiment, would restart the clock and force the session into overtime. A safeguard meant to prohibit the "Gotcha!" game has become a device to enable it. This isn't the first time.
Miller, Minority Leader Ron Klein, D-Boca Raton, and several other senators pitched the appropriate fit on the Senate floor Wednesday morning, and by day's end had a promise from the House and the leadership to fix it. An implementing bill, not subject to the 72-hour rule, will waive the four-county requirement. The Agency for Health Care Administration will then study the idea under a Dec. 1 deadline for reporting a plan to the Joint Legislative Budget Commission. With only half the budget year remaining at that point, it is unlikely that any changes could be put into effect before the Legislature convenes again.
The key to the fix is timing; it has to be the last bill to pass. If the budget passes last, that language would prevail, scoring another broken promise. This is the reality of life in the Florida Legislature. But of course that's not how it's taught in the civics books.
