Florida budget leaders will have to decide how to structure about $651 million in Medicaid cuts for hospitals and also will grapple with issues such as how much money nursing-home residents should keep each month for personal needs.
A conference committee on health and human-services programs finished work after a late morning meeting Saturday and "bumped" unresolved issues to Senate Appropriations Chairman Jack Latvala, R-Clearwater, and House Appropriations Chairman Carlos Trujillo, R-Miami.
The conference committee agreed to cut $250 million in state-general revenue funding for Medicaid care in hospitals. That translates into a $651 million overall cut when federal matching funds are added. But the committee did not agree how the cuts would be structured, which can be an important issue in the complex Medicaid funding system.
Gov. Rick Scott recently announced that $1.5 billion also would be available for the Low Income Pool program, which provides additional money to hospitals that serve large numbers of poor and uninsured patients. But state and federal health officials continue discussing details of how the "LIP" money could be used.
Because of the uncertainty about what are known as "terms and conditions," the conference committee has not included LIP money in the budget. Instead, it tried to reach agreement on a process for using the money after federal and state officials finalize the terms and conditions.
Broadly, the House and Senate are proposing a process that would lead to the state Agency for Health Care Administration submitting a budget amendment to the Legislature that would request release of the funds after the terms and conditions are finalized. The request would have to detail issues such as how the LIP money could be used and how it would be distributed.
But a snag emerged Saturday because of a wording difference between the House and Senate about approval — or rejection — of the request submitted by the Agency for Health Care Administration.
The wording difference involves whether one of the legislative chambers could reject the budget amendment — or whether rejection would require a decision by both the House and Senate. A House proposal offered Friday would allow rejection by only one chamber, while the Senate wants to require both chambers to be in agreement.
"The House's proposal — and I'm hoping that this was just maybe a grammatical error, sometimes we get our 'ors' and our 'ands' mixed up — but in the House's proposal, it was to propose that essentially either chamber could have veto power over what the other would do as far as the implementation of the Low Income Pool," said Sen. Anitere Flores, a Miami Republican who is the Senate budget chief on health and human-services issues. "I'm hopeful and I imagine that, of course, that's not what the House would be proposing."
Numerous health and human-services issues were bumped Saturday to Latvala and Trujillo. Any issues that they cannot resolve will then go to Senate President Joe Negron, R-Stuart, and House Speaker Richard Corcoran, R-Land O' Lakes.
An overall state budget needs to be finished Tuesday for the legislative session to end as scheduled Friday because of a constitutionally required 72-hour "cooling off" period. The new budget will take effect with the July 1 start of the fiscal year.
Before bumping up the health and human-services issues Saturday, senators also raised questions about a House plan that would reduce what is known as a "personal needs allowance" for Medicaid-funded residents of nursing homes and other facilities. The allowance is an amount of money that residents are able to keep each month for needs such as clothes, haircuts and toiletries.
House Health Care Appropriations Chairman Jason Brodeur, R-Sanford, said longstanding state law set the personal-needs allowance at $35 a month. But during the past three years, lawmakers have increased it to $105 a month.
The House has proposed setting the amount at $70 a month, while Senate budget negotiators want to keep it at $105.
Sen. Rob Bradley, R-Fleming Island, said it has been a priority of the Senate to make sure people in nursing homes have money for personal needs. But Brodeur said the $70-a-month amount would still be the seventh-highest in the country.