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Why's the budget in a stalemate? Hospital cuts




With a key budget deadline looming late Tuesday, lawmakers’ negotiations were stalled in large part over disagreement on one of the largest issues the state funds: Hospital funding.

While the House and Senate came to an agreement last week that would cut $650 million from hospitals’ payments through Medicaid, they still haven’t agreed on how to put those cuts — or a potential $1.5 billion boon in Low Income Pool funds approved by the federal government — into effect.

“The health care budget is the biggest one left, some issues tied to that,” House Speaker Richard Corcoran, R-Land O’Lakes, said. “LIP, hospital cuts, all of those things.”

House and Senate budget negotiators have not met publicly about the health care budget since Saturday afternoon, while they have moved closer toward agreement in other areas of the budget. At that weekend meeting, neither chamber ceded ground on the formula to use to determine the cuts.

The devil is in the details of a highly technical — but massive — part of the state’s $83 billion budget.

The House has pushed an across-the-board 7 percent cut to Medicaid rates, plus cuts to supplemental funding meant to reimburse hospitals that take on the largest share of unpaid charity care.

The Senate, meanwhile, has pushed only for cuts to the supplemental funding.

“That’s something that is still a little bit in disagreement,” Senate Health and Human Services Appropriations chairwoman Anitere Flores, R-Miami, said, echoing remarks she made throughout the budget process that she thought that was an issue that would likely be settled later in the weekend by the top budget chairmen or the House speaker and Senate president.

By Tuesday, they still hadn’t made a deal.

And Flores, asked on her way into the Senate chamber if she would stop to talk about the budget, said, “No,” before rushing into the chamber to vote on an environmental bill.

How the Legislature decides to cut Medicaid is almost as important as how much they decide to cut. The formula they settle on will determine whether the brunt of the cuts are on the backs of safety net hospitals that take on the lion’s share of Florida’s Medicaid patients and charity care or on the remaining private hospitals.

The House plan would hit the safety nets a little less dramatically because of the across-the-board cuts it includes. But Flores said the Senate plan would be balanced out by the Low Income Pool authorized by the Trump administration to repay hospitals for uncompensated care.

Florida’s safety net hospitals have historically gotten the most from that pool.

The feds have authorized a $1.5 billion LIP, paid for by local taxes and federal funds. However, that is the “upper limit,” said House Health Care Appropriations chairman Jason Brodeur, R-Sanford. 

The size of the pool depends almost entirely on the rules that the federal and state governments agree on.

Flores and Brodeur were hoping that the terms of the new LIP program would be agreed upon by Monday.

“If that is not the case, then we probably do need to look at this entire issue,” Flores said Saturday.

That is the second piece of hospital funding that the House and Senate had not agreed upon by Saturday: How will the Low Income Pool — regardless of how large it is — be redistributed?

Brodeur said he wants the Agency for Health Care Administration to create a formula, decide on which hospitals will see extra funding and submit it to the Legislature, where either Corcoran or Senate President Joe Negron, R-Stuart, could unilaterally veto it.

The Senate, however, has advocated for the Legislature writing a formula for distributing LIP now, to be put into place once the money is in the state’s hands. Flores offered Saturday to follow the House’s lead as long as both chambers would have to agree to veto AHCA’s proposal.

But other senators have since raised concerns about the Legislature handing over the authority to decide how LIP would work to Gov. Rick Scott’s agency.

Photo: House Health Care Appropriations chairman Jason Brodeur, R-Sanford, and Senate Health and Human Services Appropriations chairwoman Anitere Flores, R-Miami. (Michael Auslen | Times/Herald)