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With federal infusion for health care, Florida legislative leaders push to divert money

TALLAHASSEE — With billions in new Medicaid money available in federal stimulus dollars, this looked like the year that the poor, sick and elderly might get more services.

But before the federal cash has started flowing to state coffers, legislative leaders have all but decided to divert about $790 million to other areas of next year's deficit-ridden budget. They also plan to cut some health care services.

The results: 646 nursing homes will face up to 3 percent in rate cuts. About $18 million to help foster kids could go away. And about 18,000 Floridians with developmental disabilities will remain on an ever-growing waiting list for services.

Dakotah Hughes was assigned number 11,000 on the waiting list shortly after she was born in Tampa. Unable to feed herself or go to the toilet unassisted, she has had no state services for the 11 years of her life.

"It's just infuriating," said her mother, Jennifer Hughes, a special-education teacher who now lives in Orange City. "The state used to say they were going to try to clear the waiting list. Yet the money never comes. It's so frustrating."

It's not just parents and advocates who are frustrated with what many call the "shell game'' of plugging new federal money into programs — and then diverting state money from those same programs to other parts of the budget.

The chairman of the Senate's health budget committee, Durell Peaden of Crestview, blasted his fellow Republicans Monday for moving forward with a cigarette tax to be used for health care only to subtract the same amount of money — about $1 billion — from the health budget.

Add in the $790 million in stimulus money, and that means the Senate is diverting almost $1.8 billion in health money for nonhealth purposes, such as schools or prisons.

Peaden said he was the victim of a "bait and switch'' for his support of the cigarette tax.

"I was told it would go into helping people who are sick, dying and underserved," Peaden said, calling that a "deception."

The Senate's budget chief, Republican J.D. Alexander of Winter Haven, denied he gave anyone assurances about the use of the tobacco tax, which senators call a "surcharge."

Echoing other legislative leaders, Alexander says the health budget would be much worse were it not for the federal stimulus money that largely spared Medicaid and other health services from deep cuts.

Under the federal stimulus legislation, Florida could receive upward of $13.4 billion over three budget years, including the current one that ends June 30. Of that money, about $4.3 billion is available for Medicaid, a state-federal program serving 2.5 million Floridians.

The proposed House and Senate budgets both use about the same amount of stimulus cash and both transfer about the same amount of Medicaid money out.

The two chambers' budgets have some significant differences that must be reconciled before the session ends May 1:

• Revenues: The Senate's budget has a total of $2.1 billion in new fees, taxes and gambling money. The House, which is balking at a cigarette tax, proposes less than $1 billion from fees levied on everything from trash haulers to drivers.

• Bottom line: The chamber's budgets differ by $546 million. The House proposes $65.1 billion in spending. The Senate, $65.6 billion. The current-year budget is $65.4 billion.

• Trust funds: The Senate scoops up about $62 million from dedicated accounts called trust funds. The House takes $926 million, gutting some.

Both chambers slightly boost funding to the Agency for Persons with Disabilities. The Senate seeks to reprioritize the waiting list for services, but it doesn't necessarily base the rankings on need — a concern to Dakotah's mother, who would have to lose her job to qualify for some state services.

The head of the House's health budget, Republican Marcelo Llorente of Miami, said he tried to spare hospitals from provider rate cuts, unlike the Senate. He also avoided cutting money to "local service providers," who offer senior citizens and others such services as free and reduced-price meals.

"We've tried to mitigate cuts to services to the most vulnerable citizens," said Llorente. "Without the federal money, it certainly would be worse."

The House is also trimming nursing home provider rates by 2.5 percent. The Senate cuts the rates by 3 percent.

Weston Democratic Sen. Nan Rich called the shifting of Medicaid and tobacco-tax money "disingenuous'' and "unfair'' during a Monday news conference with social services advocates.

The advocates said the federal stimulus money for Medicaid should spare them from reductions, as should the fact that nursing-home providers agreed in January to accept a new tax to boost federal matching money.

Sid Schiff, a nursing home operator in Ocala and Miami, said it's not just staff who will suffer — it's the seniors they serve. And he said it's tough to explain why the state isn't using the federal stimulus money to increase health care services.

"This is how we're going to reward them," said Schiff. "We're telling them: 'You're a dinosaur. You don't matter any more. You're no longer needed.' That's almost blasphemous."

Marc Caputo can be reached at

With federal infusion for health care, Florida legislative leaders push to divert money 04/06/09 [Last modified: Wednesday, April 8, 2009 9:15am]
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