Pasco County would owe another $2 million to the state under a proposal to increase the counties' share of Medicaid costs for nursing home patients.
Like other Florida counties, Pasco has kicked in $55 a month for each of its Medicaid patients living in a nursing home. That rate has not changed in the nearly 30 years since the state implemented the federal insurance program for the poor — even as health care costs have soared.
But in the face of another tight financial year, Gov. Charlie Crist directed state agencies to cut proposed budgets by 10 percent.
The Agency for Health Care Administration proposed pulling in an extra $67 million by nearly quadrupling counties' share of the Medicaid nursing home costs.
Counties would now owe $202 per patient each month.
The final decision lies with the Legislature.
Pasco County's annual cost would go from $700,000 to $2.6 million under the proposal, county officials estimate. That additional money would come from the general fund, which has been hard hit by shrinking property tax revenue.
Fighting the proposal is one of the top priorities next year for the Florida Association of Counties, which is bristling at what it considers an attempt by the state to shift more of its bills onto local governments.
"We would always argue that any increase would put an added burden on counties, but there's a difference between gradually increasing the costs and tripling the cost," said Cragin Mosteller, the association's spokeswoman.
And Pasco officials are making their objection to the proposal one of their top priorities for the local legislative delegation, which will have its annual meeting next month.
Commissioners are asking local legislators to fight the increase or, at least, implement it in phases over several years.
Assistant County Administrator Dan Johnson said the proposal should be viewed in the context of other state mandates, which have increased county payments on everything from juvenile justice programs to recycling.
"You need to look at the big picture," he said. "Every year, the state passes on its costs to us."
Statewide, the total price tag for caring for the 40,000 Medicaid patients in nursing homes was around $2.5 billion in 2008-2009, according to an agency report.
"When the governor tells us to cut our budget by 10 percent, we look at all the avenues," said agency spokeswoman Tiffany Vause.
Vause said the agency made a similar proposal in recent years, but it didn't go anywhere.
Though counties pay more of a share of the Medicaid nursing homes services than they did about 25 years ago — $13.3 million in 1982-1983 compared with $25.3 million in 2007-2008 — their percentage of the program's total cost has shrunk from nearly 7 percent to less than 2 percent.
That's because total Medicaid costs for nursing home care jumped from $201 million in 1982 to $2.4 billion in 2007.
"It's passing the buck, starting with the federal government," said state Sen. Mike Fasano, R-New Port Richey.
He said that Florida's status as a "donor state" — it sends more money to the federal government than it gets back — often leaves state officials leaning on local governments.
"There will be a lot of debate about this," he said. "I'm going to do everything I can to minimize the impact on our local counties. They're struggling already."
Jodie Tillman can be reached at firstname.lastname@example.org or (727) 869-6247.