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Whatever happened to DOH reorganization?

With time running short, a proposed merger of Florida health and human-services agencies appears dead this year --- and lawmakers also likely will not approve a major overhaul of the Department of Health.

Gov. Rick Scott's transition team proposed merging the Department of Health, the Agency for Health Care Administration and two other agencies. Also, the Department of Health spent months putting together a proposed reorganization plan at the request of the Legislature.

But the House and Senate have not moved forward with bills to carry out either idea. The annual legislative session is scheduled to end May 6, and senators won't even meet next week because of the Easter and Passover holidays.

Also, legislative leaders are preoccupied with a series of other difficult issues, including negotiating a tight budget, revamping Medicaid and reaching agreement on controversial changes to the state pension system.

Two Senate Republican leaders said Wednesday they have not been discussing an overhaul of health agencies. Health and Human Services Appropriations Chairman Joe Negron, R-Stuart, said he is open to the issue, but "realistically, given where we are, I'm not sure how promising it is.''

"We're focused on the budget and Medicaid reform,'' said Negron, who is a key player on both of those issues.

House Health Care Appropriations Chairman Matt Hudson, R-Naples, described the House's approach to the agency issues as the "crawl, walk, run theory.''

Hudson, who has led efforts to revamp the Department of Health, said any comprehensive changes would have a better chance of passing next year. He said, however, that lawmakers could still approve parts of the Department of Health reorganization plan.

A special House committee heard presentations Wednesday about the structure of health and human-services agencies in other states and about program operations in Florida. Officials from the Department of Health, the Department of Children and Families and the Department of Veterans Affairs took part in the meeting, though Scott's office did not.

After the meeting, House Rules & Calendar Chairman Gary Aubuchon, R-Cape Coral, said it remains possible the House could move forward with a bill dealing with health agencies. He said leaders would have to make a decision next week, and it is unclear how wide-ranging such a bill could be.

Senate Minority Leader Nan Rich, D-Weston, said she has continued to hear "inklings" about efforts to merge agencies. But if a proposal pops up, Rich said she would oppose it.

"You don't combine agencies that have different missions,'' said Rich, who long has focused on health and human-services issues. "These agencies have different missions and purposes.''

Scott's health transition team spurred controversy in December when it called for consolidating the Department of Health, AHCA, the Agency for Persons with Disabilities and the Department of Elder Affairs into a new "Department of Health and Human Services.''

The transition team said such a merger could eliminate redundancy and improve coordination among health- and human-services programs. But critics immediately likened the idea to the old Department of Health and Rehabilitative Services, which was broken up in the 1990s amid wide-ranging problems.

Meanwhile, House leaders last year pushed proposals to reorganize --- and shrink --- the Department of Health. Hudson and others argued the department is unfocused and has taken on duties beyond its core mission.

Those efforts led to the department releasing a reorganization proposal in March that called for cutting 1,608 department jobs, chopping $185.8 million from the agency's budget and consolidating divisions and bureaus. The proposal included high-profile ideas such as moving the state out of the primary-care business and eliminating a requirement that a physician run the agency.

Even if lawmakers do not pass a bill to revamp the Department of Health, some of the reorganization proposals could be approved in the state budget.

For example, the House has proposed a $10.3 million cut in funding for primary-care programs provided by county health departments. The House would target the cuts in counties that have other sources of primary care, such as federally qualified health centers.

Senate Rules Chairman John Thrasher, R-St. Augustine, said another possibility would be for lawmakers to use what is known as a budget "conforming" bill to make changes in the health agencies. Those bills include policy changes linked to topics in the budget.

But Thrasher and other legislative leaders said they are focusing on other issues, such as closing a nearly $3.8 billion budget shortfall for the upcoming year.

"I think the biggest concern we have right now is the budget,'' Thrasher said. "That's clearly the most-important thing we're doing.''

--Capital Bureau Chief Jim Saunders can be reached at 850-228-0963 or by e-mail at jim.saunders@healthnewsflorida.org.