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Health-Care News Casts Doubt on Budget

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

  The Florida Senate unanimously approved an $80.4 billion budget on Wednesday, hours before the state's health-care agency said the federal government had suspended negotiations on a $2.2 billion pot of money that is part of a conflict between the House and the Senate.

The announcement of a break in the talks between state and federal officials cast further doubt on whether the Legislature could finish its work on the budget in time for the scheduled May 1 end of the session.

At the center of the discussions is the Low Income Pool, or LIP, program, which funnels additional money to hospitals and other health providers that serve large numbers of poor and uninsured patients.

The Agency for Health Care Administration has been trying to hammer out an agreement with the federal Centers for Medicare & Medicaid Services that would allow for an extension of a revamped version of the program, which expires June 30, the day before the new budget would take effect.

In a statement released late Wednesday, AHCA Secretary Liz Dudek said her department had been told Tuesday that the federal official leading the talks won't be available for two weeks. She called it "sudden and disappointing news."

"AHCA's conversations with CMS had been productive and positive until this point," Dudek said. "For CMS to discontinue LIP negotiations now is troubling and could signal the abrupt end of this federal health-care program in Florida."

Even if the federal government were to eventually give the state the go-ahead for a new LIP program shortly after negotiations resume, it could be a tight for legislators to hammer out the differences between the Senate and the House --- which is expected to approve its own budget Thursday --- and finish by the end of the month.

Before those House and Senate conference meetings can begin, leaders of the two chambers have to agree on the allocations set aside for each area of the budget. Currently, the LIP funding and another $2.8 billion for an alternative to Medicaid expansion make the Senate's health-care budget $5 billion larger than the House's plan.

Senate President Andy Gardiner, R-Orlando, conceded that the news from the federal government could complicate plans to finish the session.

"It becomes somewhat of a challenge, but anything's possible, because at some point you've got to start getting to allocations," Gardiner said.

Senate Appropriations Tom Lee, R-Brandon, said the uncertainty surrounding LIP raised questions about how lawmakers can move forward with budget negotiations.

"Now the question is do we spend all of this money on all of the priorities that exist from the plaza level to the House to the president of the Senate and all of the 160 members of the Legislature and learn later on that this is a real problem, this isn't going to happen, and now we've spent the money," Lee said.

The House, which is expected to pass its $76.2 billion spending plan Thursday, has omitted the LIP funding until the state reaches an extension agreement with the federal government. And House leaders have vowed not to approve the Senate plan to use Medicaid expansion money from the federal Affordable Health Care Act, better known as Obamacare, to help lower-income Floridians purchase private insurance.

Even before the announcement about LIP negotiations, House leaders appeared to be digging in on that point.

"We're going to take (it) day by day," House Speaker Steve Crisafulli, R-Merritt Island, said when asked how the session could get done on time. "I've got a long-term lease, so if we have to stay here for a while, we'll be here for a while."

Speaking about the budget, senators said their plan to restructure LIP and set up the insurance program for lower-income Floridians is the responsible way to deal with the potential problems in health care.

"We're ready to sit down and have a discussion," said Gardiner, who has faced attacks from conservative groups over the proposal. "There are those that will rely on mail pieces and political fodder. But the Senate, we're prepared to address it."

But in fiery remarks on the House floor Wednesday, House Appropriations Chairman Richard Corcoran said the blame lies with the federal government for not providing the state enough leeway.

"It's not about taking the federal money," said Corcoran, R-Land O' Lakes. "This is another grand lie around this whole process. There's not inflexibility among the Legislature. There's not inflexibility among the House of Representatives. The inflexibility rests squarely with the Obama administration."

Lawmakers also skirmished about other parts of the spending plan. The Senate rejected an amendment to its budget that would have barred Attorney General Pam Bondi from continuing the state's involvement in a lawsuit challenging President Barack Obama's decision not to prosecute millions of people in the country illegally.

Sen. Darren Soto, the Orlando Democrat that sponsored the amendment, noted that the Senate had approved in-state tuition for some of those undocumented immigrants last year.

"Our state dollars shouldn't be paid so that (Florida) can undermine a program that we support," Soto said.

Some Republicans countered that it was dangerous for lawmakers to meddle in Bondi's office.

"This isn't really about how you feel about immigration issues in America today," Lee said. "This amendment is about how you feel about the Legislature's role in the separation of powers that (is) embedded in our Constitution."

In the House, Rep. Alan Williams, D-Tallahassee, proposed an amendment to the House budget that would have given state workers a 3 percent raise, before withdrawing it.

"But what I hope we will do in conference, even if it's 1 percent: show our commitment and dedication to those state employees and say, you know what? You've done a great job. We want to compensate you for that," he said.

Asked after the session whether he was open to a raise for employees, Crisafulli sounded dubious.

"If Rep. Williams wants to file an amendment to pull money away from health care or education or something like that we can certainly have the conversation," he said.


News Service senior writer Dara Kam and reporter Jim Turner contributed to this report.