Sen. Joe Negron | Credit: flsenate.gov

In any other year, a historic overhaul of the Medicaid system would have overshadowed every health issue in the Legislature.

But when lawmakers went home early Saturday morning, Medicaid might not have even been the noisiest health-related debate of the 2011 legislative session.

Lawmakers passed a nearly $70 billion budget that included deep cuts to hospitals, nursing homes and dozens of other health programs. They also squabbled for weeks before approving a last-day deal to try to combat pill mills. And they spent hours arguing about issues such as abortion and medical malpractice.

Here is an overview of health issues during the session:


MONUMENTAL CHANGE: House and Senate Republican leaders agreed for months that the Medicaid system needed to be overhauled and even how to do it: Require beneficiaries to enroll in managed-care plans.

But until the final few days of the legislative session, the details remained cloudy. Rumors ranged from an imminent deal to a need for a Medicaid special session.

That ended Thursday afternoon, when the Senate released two intertwined Medicaid bills (HB 7107 and 7109) totaling 215 pages. By Friday night, both chambers had passed the bills and readied them for Gov. Rick Scott’s signature.

If Florida gets federal approval -- a huge if -- almost all Medicaid beneficiaries will be enrolled in HMOs or other types of managed-care plans by the end of 2014. The state will be carved into 11 regions, where managed-care plans will compete for contracts and build networks of doctors, hospitals and other providers.

Perhaps no other issue from this year’s session will have a broader impact. The overhaul will affect the way millions of low-income and elderly people get health care in the future, while also trying to solve one of the state’s most complex budget problems.

“This is the biggest part of our budget,’’ House Health and Human Services Chairman Rob Schenck, R-Spring Hill, said about one of the measures. “This bill is going to save Floridians billions of dollars.’’

But the prospect of shifting almost all Medicaid beneficiaries into HMOs and other types of managed-care plans caused Democrats to line up in opposition.
They argued that a pilot managed-care program in five counties has been hampered by problems that affect patient care.

“With HMOs having to deny services in order to make a buck, I see the same problems that happened in the pilot program,’’ said Rep. Elaine Schwartz, a Hollywood Democrat who is among the most outspoken opponents.


BUDGET PAIN: Maybe the most telling moment in this year’s struggle with the health- and human-services budget came April 28 during a lunchtime meeting in the Senate Office Building.

As lobbyists crammed into the committee room, House and Senate health-budget negotiators essentially gave up. With the two sides dug in about issues such as funding for nursing homes, mental-health services and the Medically Needy program, they punted the decisions to top legislative leaders.

The final version of the budget approved Saturday morning included wide-ranging cuts. Hospitals and nursing homes, for example, will get hit with nearly $700 million in cuts to Medicaid payment rates.

The nursing-home cuts also had a spin-off effect that drew repeated criticism. Trying to ease the financial pinch on nursing homes, lawmakers reduced a nursing-home staffing requirement that was designed to help improve resident care.

“I just don’t think it’s fair to tell nursing homes that you are going to be paid less by the state, but then you have the same costs,’’ said Senate Health and Human Services Appropriations Chairman Joe Negron, R-Stuart.

But critics said the move could hurt the quality of care in nursing homes. Under it, each resident would have to receive a weekly average of 3.6 hours of direct care each day, down from the current 3.9 hours.