Government

Medicaid Overhaul Dead; Budget Talks Continue

By: John Kennedy News Service of Florida | Posted: April 26, 2010 12:01 AM
House and Senate leaders confirmed Sunday what had become increasingly obvious in recent days: The proposed Medicaid overhaul is dead for this year.

“I still believe it is good policy,” said Rep. Denise Grimsley, R-Lake Placid, chairman of the House Health Care budget committee, and an architect of the sweeping House proposal that would push the state’s 2.7 million Medicaid recipients into managed care over the next five years.

“We will just have to bring it back next year,” Grimsley said.

The ambitious Medicaid rewrite faded into history Sunday as budget-writers struggled to conclude budget negotiations. While not having much of an immediate impact on spending, the disputed Medicaid plan stood as an obstacle that needed to be cleared from the budget landscape, lawmakers conceded.

“It’s where we expected it” to end, said Senate budget chief J.D. Alexander, R-Lake Wales.

But even with Medicaid out of the picture, dozens of spending provisions separated House and Senate budget negotiators, with some issues that appeared settled remaining officially open to further talks. And the talks went on – with a 5 p.m. deadline between Alexander and his House counterpart, Rep. David Rivera, R-Miami, scrapped in favor of continued negotiations between the budget leaders.

The pair set midnight Sunday for sending any remaining issues to Senate President Jeff Atwater, R-North Palm Beach, and House Speaker Larry Cretul, R-Ocala. But even that deadline looked fluid – with both budget chairmen conceding they could continue working through Monday.

Budgets will likely have to be on the desks of lawmakers sometime Tuesday to assure an on-time finish to the session Friday.

Meanwhile, budget negotiators Sunday settled a host of issues, including a 7 percent reduction in the state payment rate to hospitals treating indigent patients – a $96 million reduction that followed a $76.7 million cut in payments to nursing homes, and a $39.3 million general revenue reduction for HMOs.

An effort to exempt from the 7 percent cut rural hospitals and St. Petersburg’s All Children’s Hospital and Miami’s Children’s Hospital remained in play between the House and Senate going into Sunday night.

In education, state funding and terms for a revamped Bright Futures scholarship program was approved. The Legislature is moving to increase the SAT requirements for both the top and secondary awards, as lawmakers try to rein-in the cost of the scholarship program which covers tuition for about half of the state’s college students.

Budget negotiators haven’t settled public school financing, but are working to keep per-pupil spending close to its current, $6,866-level. That’s roughly a middle-ground between the House’s proposal to cut school dollars by $52-per-pupil and the Senate looking to boost spending by $38 for each child in a classroom.

The two sides Sunday also agreed to exclude from the budget revenue from the $7.50 saltwater fishing license fee approved just last spring. The fee was expected to be paid by some 120,000 anglers – but drew widespread criticism from Florida’s cane-pole fishing community, leaving lawmakers to push for repeal this year.

Even with some areas of agreement, the House and Senate continued to scrap over myriad details with dollars attached and “proviso” language that describes how money must be spent.

The Senate hasn’t surrendered in its effort to give school boards authority to increase property taxes by .25 mills without a voter referendum. The House rejects the idea and has already pushed back the Senate’s bid to build into school budget allocations money from these increased property taxes, which 42 of the state’s 67 counties approved last year.

Sometimes, the disputes took on a personal touch.

Rivera, a candidate for Congress, said the House will not retreat in its push to exclude human stem-cell research from such science carried out at state universities, sending the Senate back to effectively take it or leave it. He also is pushing to include a budget provision that would ban state-sanctioned travel to countries considered a “sponsor of terrorism,” a move similar to legislation he earlier sponsored aimed at banning university travel to Cuba.

While Rivera promoted those measures, Alexander said he was satisfied with budget language that puts the Department of Management Services under the authority of the governor and Cabinet – a heightened level of oversight for a state department he earlier wanted broken apart and scattered among other agencies.

Alexander has turned into a fierce DMS critic after the agency was unable to provide a list of state-owned property. Other budget bills now being advanced require DMS to provide such an inventory no later than Sept. 15 each year.

Alexander also endorsed a budget bill provision that gives the University of South Florida-Polytechnic priority to lease vacant land and buildings at the state’s former G. Pierce Wood mental hospital in DeSoto County. Alexander, a major advocate for USF-Poly in his home Polk County, denied Sunday he was positioning for a branch campus of the school, but instead is looking to help the school obtain new facilities at an underused site.

But the biggest move Sunday – the official end of the Medicaid rewrite -- was in the makings for weeks.

Indeed, the Medicaid proposal was probably doomed when House leaders unveiled the plan with just a scheduled three weeks remaining in the legislative session. The Senate had already approved its own effort to overhaul Medicaid which, although dramatic, paled compared to the House approach.

Neither side worked toward a real consensus, but it wasn’t until Sunday that leaders took the idea off the table.

“You’ve got to start this type of thing early,” said Sen. Durell Peaden, the Senate’s Health and Human Services budget chief. “It’s going to take educating everybody up and down the state to work.”

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