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Medicaid 'bills' will cost the county plenty

At 9:30 Tuesday morning, Rep. Jimmie T. Smith is scheduled to stand before the Hernando County Commission and tout the accomplishments of the 2012 Legislature. Two hours later, commissioners will consider suing the state over one of the so-called highlights.

If Smith, R-Lecanto, follows scripted talking points, he will elaborate on more money for schools (though not enough to make up for last year's cut); less government regulation, no new taxes, and reforms to personal injury protection insurance. Smith also sponsored successful bills forcing state workers to take drug tests and asking the feds to kill the designation of Kings Bay as a manatee refuge.

But the most relevant talking point will come later from County Attorney Garth Collier. It will follow the talking point of Budget Director George Zoettlein, who three weeks ago warned commissioners of a ballooning budget deficit now exacerbated by Florida House Bill 3051. That is the legislation, supported by Smith, (and Rep. Robert Schenck, R-Spring Hill, but objected to by Sen. Mike Fasano, R-New Port Richey) that forces counties to pay disputed Medicaid bills, regardless if Tallahassee made a billing mistake.

Collier's talking point surrounds unfunded mandates and a lawsuit from the Florida Association of Counties and 22 individual county governments seeking to overturn HB 3051. He wants to know if commissioners will join the suit for a minimal investment.

Here's why he is asking: HB 3051, signed into law March 29 by Gov. Rick Scott, is projected to cost Hernando County $2.6 million at a time when the county already anticipates a $6.9 million shortfall due to a continued decline in property values.

If the county doesn't pay its estimated share of the $325.5 million in disputed Medicaid bills statewide, the state will withhold the $2.6 million from Hernando's share of sales tax collections over the next five years.

The reverberations are significant. Commissioners, after multiple years of wage freezes, job cuts, reduced services and using reserves to balance the budget, already are telling the sheriff and other constitutional officers to plan on sharing more of the budget pain. Meanwhile, a Moody's Investors Service report warned of potential credit rating troubles for counties if they lose access to the revenue-sharing dollars. That means it could cost more to pay off future debts.

Commissioners shouldn't expect much sympathy from Smith. He already heard about it while talking to the Citrus County Commission.

"The general consensus is it's a 10-year debt. This may not be a great system, but even in the private sector you have to pay your debts,'' Smith said. "You need to clear the books, fix the system and try to move forward.''

The definition of "debt'' is part of the dispute. Under state law, counties are required to contribute when one of their Medicaid-eligible residents stays more than 10 days in a hospital or moves into a nursing home. Medicaid is the federal, state and locally financed health care coverage for the poor.

Smith's 10-year debt statement references the $325.5 million worth of disputed bills that accumulated over the past decade. Except, some counties' audits discovered the state frequently misidentified where patients lived or doubled-billed for some patients' treatments.

Scott, in signing the bill, promised the Agency for Health Care Administration staff would meet with representatives of each of the 67 counties to hear their grievances. Regardless, this new law is akin to allowing someone to start garnishing your wages before a court determines the legitimacy of the bills being submitted for payment.

"These guys don't get it in Tallahassee in regards to the impact back home when they propose, vote and sign into law legislation that will affect the county budget and ultimately the taxpayer in the end,'' Sen. Mike Fasano said in an email to the Tampa Bay Times after Pasco County lamented its $3.5 million budget hit.

Apparently, the no new tax crowd in Tallahassee cares little if the counties have to raise taxes to cover the disputed bills.

And, no matter the final outcome, the ensuing brouhaha is the kind of government spending that angers plenty of taxpayers.

The public is financing both sides of this legal battle over the public's money.

Medicaid 'bills' will cost the county plenty 04/21/12 [Last modified: Monday, April 23, 2012 1:50pm]
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