TALLAHASSEE — Florida lawmakers are cutting more than just dollars as they whittle more than $500-million from state government this year, they're also proposing basic changes to Medicaid that critics say will undermine care for poor patients.
The Senate approved 27-13 Thursday a bill that would eliminate special automatic cost-of-living increases in payments to hospitals, nursing homes, county health departments and intermediate care facilities for the developmentally disabled.
The measure (SB 1852) could be the first of many more fiscal conservative policy decisions thrust forward in the name of budget constraints. It drew immediate critics on the Senate floor.
"My colleague has very good intentions of trying to run our state government like a business, but we're talking about dealing with very vulnerable people in our communities," said Sen. Nan Rich, D-Weston.
While the House has not considered the change, Senate President Ken Pruitt is expected to push for it this weekend in final negotiations over the budget cuts with House Speaker Marco Rubio. House health care budget chief Aaron Bean said House leadership thought the elimination was premature.
In a health care system where many providers opt not to serve Medicaid patients because of low reimbursement rates, the plan is causing broad concern, not only because it may discourage some institutions from taking such patients but because it may diminish care for those who are served.
Medicaid provides health care coverage for some poor residents under 65, including children and the disabled who cannot otherwise afford coverage.
Nursing homes and "safety net" hospitals, which have the most Medicaid patients, will be particularly hard hit.
At All Children's Hospital in St. Petersburg, 55 percent of patients are paid for by Medicaid. Hospital leaders already are meeting with legislators to talk about the budget, said spokeswoman Ann Miller.
A widening gap
"Remember that Medicaid currently reimburses below the cost of care, so any reduction is just going to make that gap wider," Miller said.
Nursing home staffers from across the state lobbied at the Capitol Thursday, saying the fall's cuts have already pinched nursing homes' ability to keep staffing numbers up.
Certified nursing assistant Adrienne Gardner, 53, remembers the years before the state increased staff requirements, when nursing homes were so sparsely staffed that she saw unnoticed bedsores as big as her fist and tooth decay from simple lack of brushing. Things have gotten much better.
"Unless you were there 20 years ago, you couldn't possibly understand the difference we have today," Gardner said. In the wake of Medicaid reimbursement cuts in the fall, her Stuart-based nursing home had to cut back on housekeeping and get rid of activity staff members who got patients up and moving.
But Senate budget chief Lisa Carlton, R-Osprey, said the state has little choice as it faces $2.5-billion in cuts in 2008-09. The move would wipe off the books $316-million from next year's health care budget.
The elimination is "probably something we should have looked at a while ago," Carlton said, because it favors a particular segment of health care. For example, doctors don't get such automatic increases in their Medicaid reimbursement payments.
The original purpose of the automatic increase, which was generally pegged to inflation, was to pay for increased cost of fuel, insurance and every-day increases. But health care advocates said that the money generally gets used for patient care, given Florida's low Medicaid reimbursement rates.
The cost-of-living measure first arose in a Senate committee meeting on Monday. It remains the biggest difference between the House's and Senate's otherwise very similar plans for coping with a half-billion-dollar deficit for the fiscal year that ends June 30.
Democrats railed against the cuts to the future health care budget, saying it wasn't necessary to address right now.
Rich and other Democrats pointed out that nobody could say for sure how the Medicaid cut would affect state mandates on nursing homes to ensure patients get a certain number of one-on-one care hours with nursing assistants.
The Florida Senate's $508-million budget cut on Thursday included a last-minute plan to prevent state attorneys and public defenders from having to take off work without pay. Lawmakers moved $2.4-million, coming from dollars pulled from each court district's trust funds fueled from fines and fees. House leadership agreed with the move late Thursday night.
Most Senate Democrats voted against the budget, citing concerns about cuts to education and the focus on cutting without looking at ways to build up revenue.
Times staff writers Lisa Greene and Alex Leary contributed to this report.