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HHS budget cuts coming; how big?

Sen. Joe Negron has warned for weeks that cuts are coming to health and human-services programs. Big cuts.

Today, the chairman of the Senate Health and Human Services Appropriations Subcommittee will release an initial budget proposal spelling out the details.

Negron, R-Stuart, said last month that health and human-services programs could face $1.5 billion in cuts, as lawmakers struggle to close a budget shortfall for the 2011-12 fiscal year. New estimates Friday added about $135 million to the shortfall in the overall state budget, bringing the total to roughly $3.8 billion.

In the past, dealing with such shortfalls has led to cuts in Medicaid rates for hospitals and nursing homes. But Negron also has indicated he is considering cuts in areas such as the Medically Needy program, which serves people who have severe medical conditions but do not meet ordinary Medicaid qualifications.

During a meeting of state analysts earlier this month, Negron's staff director, Mike Hansen, made clear the Senate is looking at reducing spending on the Medically Needy program. One possibility is to provide only physician services to Medically Needy patients, cutting more-expensive costs such as hospital care.

"We've got to make cuts, and if we can't get some money out of this (the Medically Needy program), we've got to get it out of something else,'' Hansen said.

But hospitals are opposed to such cuts, arguing that Medically Needy patients still will need more-costly care --- but likely would not have other ways to pay for it.

Negron also drew opposition recently when he suggested that some mental-health and substance-abuse treatment programs could be targeted for cuts.

In comments to a House committee Friday, Department of Children and Families Secretary David Wilkins said cuts to such programs could have a ripple effect that would increase costs in the child-welfare system. At least in part, that is because children might suffer if parents have untreated mental-health or substance-abuse problems.

Another potential money-saving idea is privatizing state mental hospitals in Macclenny, Chattahoochee and Gainesville. The idea has drawn heavy opposition from Baker and Gadsden counties, where the Macclenny and Chattahoochee hospitals are major employers.

"A lot of these communities, that's the only source of industry,'' said Rep. Alan Williams, a Tallahassee Democrat whose district includes parts of Gadsden County.

But Jorge Dominicis, president of Geo Care Inc., which has contracts to run other state hospitals, appeared before Negron's committee this month and promised that privatization would save money for the state. He estimated the savings at 6 to 14 percent.

Negron's proposal, which will be released this afternoon, is the first of several steps in creating a health- and human-services budget for the fiscal year that starts July 1. At each step, the proposal could change.

The full Senate will have to approve the HHS spending plan as part of an overall budget. Meanwhile, the House will draw up a different version of the budget. So far, the House has not released its initial proposals.

Ultimately, House and Senate negotiators will have to reach agreement on a final budget before bringing it back for votes in both chambers --- likely to occur near the end of the 60-day legislative session. The budget then will go to Gov. Rick Scott, who has line-item veto power.