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Hospital wars and Jeb's $300m Medicaid reform time bomb

Unknown until just a few days ago: The Medicaid reform plan Gov. Jeb Bush pushed in 2005 requires Medicaid reform to be implemented statewide next budget year. If not, the state will lose upward of $300m of the $1 billion in hospital money known as Low Income Pool funds.

But all's not lost for the state. Because the federal government is temporarily paying more of the Medicaid tab under Barack Obama's stimulus plan, the state has a surplus this year of about $246 million, according to the Safety Net Hospital Alliance.

And since legislators are talking about the need to save money this year for the future, the Safety Net Hospital Alliance wants the state to bank the money. Easy, right? Not really. This is Medicaid we're talking about and not much is easy.

Due to confusing Medicaid rules, some of the biggest charity care hospitals (Miami's Jackson and Tampa General are one and two) would lose more in the future than they would gain currently from the Medicaid surplus. And it's vice versa for some private hospitals such as Baptist and Adventist systems, according to an analysis from the alliance's lead lobbyist, Tony Carvalho.

So the private hospitals want the cash now because they get cut less later.

Then there's politics. Carvalho helped establish the LIP council, but Hospital Corp. of America led a successful charge this year to boot him and other hospital-funding gurus off the advisory panel under the argument that lobbyists shouldn't have a say in how public money is spent on their clients. To move the legislation, HCA hired a team of lobbyists itself and formed a "citizen's group," Floridians for Government Accountability, that has yet to account for just how much HCA gave it.