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Dueling House, Senate Health Care Budgets Include 'Some Ifs'

Stethoscope on a pile of dollars.
Creative Commons

Lawmakers have roughly three weeks to reach agreement on a budget, a period coinciding with an expected increase in Medicaid funding from the federal government.

Florida lawmakers might be getting a $10 billion influx of money from Washington and an infusion of additional state tax dollars, but the Republican-controlled House and Senate passed dueling budgets this week that would slash funding for hospitals and other health care providers and do little to help people with disabilities get off a waiting list for services.

The House on Thursday passed a $97 billion budget proposal for the coming fiscal year that includes $42.1 billion for health and human services. The Senate passed a smaller overall budget at $95 billion, but it would direct $42.3 billion to health and human services.

Lawmakers have roughly three weeks to reach agreement on a budget, a period coinciding with an expected increase in Medicaid funding from the federal government. Economists this week also projected that lawmakers will have about $2 billion more in state general revenue than expected earlier because tax collections are on the upswing after the near-crash of the economy last year because of the COVID-19 pandemic.

“There certainly are some ‘ifs’ in the health care budget,” House Speaker Chris Sprowls, R-Palm Harbor, told The News Service of Florida on Thursday, adding that “certainly the health care budget … is always a hot topic in conference (negotiations), and I expect it will be (this year).”

Included in the House’s proposed budget is $240 million in state and federal funding to pay for extending Medicaid benefits an additional 10 months to women who have recently given birth. The Senate budget doesn't include such funding.

“It’s certainly a very noble goal. It’s something we would like to do,” Senate President Wiltion Simpson, R-Trilby said when asked about the proposal, which has been championed by Sprowls. “It’s something we would like to get done.”

To help pay for the extended Medicaid benefits, the House would permanently eliminate $288 million in Medicaid payments to all hospitals. The House budget plan also includes a $226 million reduction in what are known as “enhanced” Medicaid payments to 28 hospitals that provide the largest amounts of charity care.

The Senate has proposed similar but smaller reductions. It proposes cutting hospital Medicaid payment rates by $251.2 million and reducing enhanced payments to high-volume Medicaid facilities by $77.3 million.

While Republican leaders have downplayed the hospital cuts by noting that the facilities received $1.5 billion in federal funding as part of a federal coronavirus relief package, Rep. Ben Diamond, D-St. Petersburg, said Thursday that hospitals lost $4 billion in revenue due to the pandemic.

“That means there’s been a significant gap in funding in this pandemic, and yet these folks still showed up to work every day,” he said.

The House budget would set aside $15 million to take 306 people with intellectual and developmental disabilities off a longstanding waiting list for Medicaid-funded home and community-based services under what is known as the iBudget program. More than 23,000 people are on the waiting list for services - ranging from job training to assistance with bathing and dressing to companion care - that are meant to keep them out of institutions.

Rep. Allison Tant, a Tallahassee Democrat and parent of an adult child with cognitive disabilities, criticized the spending plan for providing too few dollars to eliminate the waiting list.

“I just want to raise these issues, because what’s happening is when these kids are home in front of a TV set languishing, they are going to grow into crisis further and further every day,” said Tant, whose child has been on the waiting list for five years.

The Senate budget plan doesn’t include any additional funding to reduce the waiting list.

Meanwhile, the Senate’s proposed budget includes 10 percent reductions for most programs that receive recurring funding. As an example, that means a potential $950,000 cut for free and charitable clinics.

Meredith Smith, executive director of Community Health Outreach in Jacksonville said the West Jacksonville center gets about $50,000 annually, which helps it provide health and dental care to about 1,000 patients.

“This cut could cut us out,” Smith said.

While it might not sound like a lot of funding, Smith said she is able to stretch it.

“I was floored to hear that, especially in 2021, this is a bill on the Senate floor,” she said.

While the House and Senate spending plans include many differences, both don’t count on increased federal funding for the Medicaid program.

Due to the public health epidemic, Congress increased by 6.2 percentage points the amount of money it contributes to states’ Medicaid programs. The Biden administration has said it will extend the extra money by another 90 days, which would take it through July.

If so, that would mean Florida could receive hundreds of millions of dollars in additional federal Medicaid funds that haven’t been included in either chamber’s spending plan.

While Sprowls said he wasn't “a count your chickens before they hatch kind of person,” he acknowledged that the potential for the increased funding could change things.

“Obviously, we built our budget without that being calculated, so if they extend it, we’ll take a look at it,” Sprowls said.

Additionally, the budget does not direct any of the roughly $10 billion in federal money Florida expects to get from the American Rescue Plan Act to support health care. President Joe Biden signed the $1.9 trillion relief act last month.

House Health Care Appropriations Chairman Bryan Avila, R-Miami Springs, said the federal dollars are a “one-time shot” and couldn’t be spent on recurring health care needs.

Although the chambers could put some of the funds in reserve to pay for recurring costs, Simpson said funding Medicaid isn’t his top priority. The Senate will direct federal stimulus money to infrastructure and job development over health care.

“If you ask me, do I want to give people Medicaid or do I want to give them a job so they don’t need Medicaid, I want to give them a job so they don’t need Medicaid,” Simpson said.

Christine Sexton – News Service of Florida