Gov. Rick Scott met Monday with members of the Safety Net Alliance of Florida to discuss hospital funding. Hospitals have said doctors will leave the state and the poor may not get care if proposed budget cuts become permanent.
State legislators are proposing cutting supplemental hospital payments and Medicaid funding. Safety net hospitals provide almost half of the state’s Medicaid and charity care. So the cuts worry Tony Carvalho of the Safety Net Hospital Alliance of Florida. He said the state is giving up a lot of federal funding.
“The legislature, our governor has taken positions that Florida is not getting its fair share of federal dollars, particularly in the supplemental payment area," he said. "And it seems a contradiction in terms or certainly in our objective to be forfeiting hundreds of millions of dollars of federal money for a very small savings in the general revenue fund.”
About a third of Floridians are on Medicaid or uninsured. Hospitals says they are currently giving away more than $4.6 billion in Medicaid services a year. They are reimbursed 72 cents for every dollar. They say under the governor and proposed House and Senate budgets, the reimbursement rate could fall to 58 cents.
Scott has proposed cutting nearly $1 billion in Medicaid funding. The House and Senate are also proposing cuts. The House is considering slashing the rate for hospital inpatient Medicaid services by 7 percent and cutting supplemental payments. That may mean hospitals lose more than $600 million in state and federal funding next year.
The Senate isn’t proposing a rate reduction, but it is considering reducing Medicaid supplemental payments by more than $200 million loss with a federal match. Senate Health Appropriations Chair Anitere Flores said hospitals will come out ahead because of a low-income pool of funding known as LIP. LIP is made up of local government and federal matching dollars to cover the expenses of hospitals who care for the uninsured.
“We could really see it as… It’s an increase," she said. "So yeah, that’s the way the math works. Ready? I’m going to blow your mind here. Are you ready?”
Carvalho said he hopes Flores is predicting the future. He said the state is discussing full LIP funding with the federal government in hopes the federal government will restore the dollars.
“She may know something I don’t know," he said. "But I don’t think the decision has been inked yet and I think they’re still working and negotiating on the level and the terms of the low-income pool.”
Carvalho and others warn that doctor shortages in Florida will worsen if these cuts go through. The 14 public, teaching and children’s hospitals make up the majority of doctor residency positions. Florida is already short psychiatrists, primary care physicians and surgeons. Leon Haley is dean of the University of Florida College of Medicine in Jacksonville. He said they are graduating more people than there are residency slots in the state.
“Frankly, it makes little fiscal sense for Florida to invest in teaching students in medical schools without simultaneously investing in the requisite number of residency spots," he said. "To do so is to effectively spend taxpayer money to educate other state’s doctors.”
Hospitals had 313 new residency slots this year. But safety net hospitals said those positions, funded under a program created two years ago, are being undermined by the proposed cuts. They say they may scale back residency programs and other services.