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Nursing Homes, Safety Net Hospitals Win In Budget

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
Steve Lambert
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

Nursing homes will get a $130 million bump in Medicaid payments, and residents who live in the facilities will get nearly a 25 percent increase in a monthly stipend they can use for personal needs, under a state budget deal finalized Thursday.

Under the spending plan, the state during the upcoming year would spend $37.1 billion across six state health-care and social-service agencies. Nearly $9.9 billion of that amount would be state general-revenue tax dollars, compared to the $9.4 billion during the current year.

The Agency for Health Care Administration, which houses Florida’s Medicaid program, would gobble up the majority of the funding, accounting for $29.2 billion in spending during the fiscal year starting July 1. The Department of Children and Families is the second largest agency, accounting for $1.7 billion.

Senate Appropriations Chairman Rob Bradley said the personal allowance for nursing home residents has long been a priority of senators, and this year’s budget increases the amount from $105 to $130.

“These are our most vulnerable folks in our nursing homes,” Bradley, R-Fleming Island, said. “They don’t have lobbyists. They’re not a special interest. They just have folks like all of us here in the Legislature to fight for them.”

The $130 million bump in Medicaid spending for nursing homes comes at a time that the Legislature is requiring nursing homes to have generators and enough fuel to cool facilities during emergencies. That requirement stems from the deaths of residents of a Broward County nursing home after Hurricane Irma.

Senate President Joe Negron, R-Stuart, identified increasing nursing home funds as one of his top priorities for the legislative session, and the final spending matches the $130 million that was in the original Senate budget plan. The $130 million was also more than amounts discussed Wednesday as details of the budget deal started to emerge.

Florida later this year will start funding nursing homes through what is known as a “prospective payment system,” where nursing home rates are set based on a formula. Florida Health Care Association lobbyist Bob Asztalos said the additional funding would be available to providers who meet certain direct patient-care requirements and quality-of-care requirements in the prospective payment formula.

“You have to spend money to get the money,” Asztalos said.

Bradley defended the increased funding.

“We’re not going to apologize one second,” Bradley said adding that, “the reality is, we have a system of taking care of our elderly dependent on taxpayers’ money.”

House and Senate leaders published the proposed budget Thursday afternoon, allowing a vote on the plan as early as Sunday, following a 72-hour “cooling off” period. The budget then will go to Gov. Rick Scott, who has line-item veto power.

While the budget agreement would increase funds for nursing homes, it does not include a $350,000 to help assisted living facilities offset the costs of generators. House Appropriations Chairman Carlos Trujillo, R-Miami, said the money would have equated to about $200 for each ALF, which, he said, isn’t nearly enough to cover the costs of a generator.

But it also appears unlikely the House will mandate that ALFs have generators as Scott would like. The House hasn’t filed a bill to ratify a Scott administration ALF generator rule. And although the Senate has such a bill, the House would have to waive its rules to consider the proposal.

When asked if the House would pass the generator requirement, Trujillo said, “I don’t think so.”

Differences about health-care spending were a key reason the House and Senate failed to meet a Tuesday deadline for finalizing a budget. That will prevent them from finishing the session as scheduled Friday because of the constitutionally required 72-hour review period.

Bradley and others attributed the impasse to differences between the House and Senate on how to reimburse hospitals for treating pregnant women, the poor, disabled and elderly. The Senate wanted to eliminate the state’s long-standing policy of providing additional payments to 28 hospitals across the state that have heavy Medicaid caseloads and instead use $318 million to increase Medicaid base rates paid to all hospitals.

The move would have meant big reductions for hospitals such as Jackson Memorial in Miami and would have increased money for facilities owned by for-profit companies such as HCA Healthcare and Tenet.

The Safety Net Hospital Alliance of Florida on Thursday issued a statement thanking the Legislature for producing a budget that “puts patients before profits.”

“We are grateful to lawmakers for their continued acknowledgment that safety net hospitals ensure the highest level of care to all Floridians, regardless of their ability to pay,” Lindy Kennedy, executive vice president of the alliance, said in a prepared statement. “By leaving intact this important funding policy, legislators showed compassion for the needs of low-income elderly, pregnant women, critically ill children and fragile newborns.”

Kennedy said that over the past five years, 14 safety-net hospital systems have sustained half of the $688 million in combined net Medicaid cuts. Medicaid reimburses hospitals about 60 cents for every $1 of care provided.

“Without the enhanced payment,” Kennedy said, “safety net hospitals would have faced an even deeper financial hole caused by years of budget cuts.”

While the Senate ultimately agreed to back off its proposal to revamp hospital funding this year, Bradley predicted the issue would resurface again.

“I think that down the road we’re going to have a model that follows the patient, but for now it was more important to the Senate to make sure that we deliver on the promise to help our vulnerable elderly that are in nursing homes,” he said.

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