Key Health Budget Issues Could Get Kicked Upstairs
A top budget writer said Wednesday she doesn’t expect a conference committee to settle all the differences between the House and Senate on health-care spending, leaving the issues to be decided by legislative leaders.
At the first health-care conference committee meeting Wednesday, Senate Health and Human Services Appropriations Chairwoman Anitere Flores, R-Miami, said she expects the chambers’ disparate policies on hospital funding to be “dealt with later on in session.”
The same also is likely true with differences between the chambers on nursing-home funding. House Health Care Appropriations Chairman Jason Brodeur, R-Sanford, said he would like to see the conference committee to resolve the issue but that he and Flores are “comfortable maintaining our positions until we get some more consensus from colleagues.”
The conference committee, made up of House and Senate members, will try to reach agreement on health and human-service budget issues before Friday morning. At that point, remaining differences will be sent to the House Appropriations Chairman Carlos Trujillo, R-Miami, and Senate Appropriations Chairman Rob Bradley, R-Fleming Island.
If Trujillo and Bradley are unable to reach agreement, the issues would go to House Speaker Richard Corcoran, R-Land O’ Lakes, and Senate President Joe Negron, R-Stuart. Lawmakers are trying to finalize a 2018-2019 budget by Tuesday, which would allow the annual legislative session to end as scheduled March 9.
While some big health-care issues likely will be kicked upstairs, the conference committee Wednesday made progress.
In its first offer to the Senate, for example, the House agreed to tap into a federal program that brings a $9.76 million grant to the state’s central receiving facilities.
“Having the House pick that funding up is a very, very, major win for Floridians specifically as we continue to combat mental health and substance abuse. That’s something that’s major progress, and I don’t think we had contemplated (it) so early on,” Flores says.
The House also agreed in its first offer to pick up the Senate’s proposal to trim from 90 to 30 the number of days that Medicaid will retroactively cover people’s health-care bills before they become eligible for Medicaid.
The move would reduce $98.4 million in total spending and save about $38 million in state general-revenue dollars. The federal government matches state Medicaid spending.
The House and Senate have disagreed about a Senate proposal to reduce payments to Medicaid HMOs. While the conference committee did not agree Wednesday, Flores hinted that the Senate may alter its position, which was to reduce funding to Medicaid HMOs by $230 million.
Flores says the Senate has “received more information directly” from the Agency for Health Care Administration and other sources about the impact of the proposal.
“I think that could be a major issue we could resolve at this first level,” Flores says.
The House also agreed to remove from its budget proposal money related to combating the opioid epidemic, though it continues to plan to spend money on the issue. The Senate includes its funding for the opioid issue in a substantive bill. The House announced Wednesday it also will include opioid funding in a substantive bill
When the House and Senate approved their spending proposals early this month, they based the plans on Medicaid costs and expenditures projected by state economists over the summer. But when economists met in January, they adjusted upward by $207 million spending in the Medicaid program in the coming year.
The latest estimates have Medicaid spending from July 1 through June 30, 2019, at nearly $26.3 million, or nearly $900 million more than what the state currently spends on the program for poor, elderly and disabled people.
The House and Senate have major differences on spending for nursing homes and hospitals. The Senate wants to increase Medicaid reimbursements for nursing homes by $130 million in state and federal funds, something that isn’t in the House budget.
Additionally, the Senate wants to eliminate so-called “enhanced payments” that currently are made to 28 hospitals across the state that have large percentages of Medicaid care and redistribute the money in the form of increased hospital rates. The Senate also proposed providing $50 million in new funding for hospitals.
The Senate’s proposal would result in reductions for some large community hospitals but yield a windfall for some for-profit hospital chains. The move could reduce payments at Jackson Memorial Hospital in Miami by as much as $58 million and Orlando Health by nearly $9 million, while HCA Healthcare, a for-profit chain that owns 43 facilities in the state, could see nearly $40.5 million in Medicaid increases.
Tenet, which owns nine hospitals in Florida, would see a nearly $4 million increase in Medicaid payments under the Senate plan, and Community Health Systems, which owns 23 hospitals in Florida, would see as much as a $7.7 million bump in Medicaid payments.
Meanwhile, the House’s proposed spending plan for hospitals would essentially remain unchanged for the upcoming year. Under the House proposal, for example, Jackson Memorial would have its Medicaid rates reduced by $8 million, instead of the $58 million reduction floated by the Senate. And, instead of a $40.5 million bump in its rates, HCA’s rates would be pared back by $14.6 million under the House proposal. Similarly, the House’s proposed spending plan would result in rate reductions, not increases, for Community Health Systems and Tenet.