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Idea finds its way into, out of budget

Sometimes a bold idea rises up in Tallahassee and like a rocket disappears just as quickly.

It happens so fast, it's hard to determine whose idea it was in the first place.

Tucked inside Gov. Jeb Bush's new $55-billion budget proposal is, or was, a plan to cut health care costs by eliminating Medicaid coverage for chiropractic and podiatrist visits. With Medicaid a fiscal monster growing at 12 percent a year and eating up a fourth of the state budget, Bush wants to rein in costs.

The proposal's estimated savings to the state: nearly $6-million a year.

But low-income adults on Medicaid presumably would have to seek an appointment with an orthopedic surgeon to have that backache or ingrown toenail examined and pay for it themselves.

Whose idea was this, anyway?

Not mine, Gov. Jeb Bush says.

And, he added quickly, it won't happen.

"I'm not sure there was a whole lot of discussion about it," Bush said Thursday. "I don't remember having a discussion about it. So when it became known, we've committed to the folks interested in chiropractic services being reimbursed by Medicaid that we would support that."

Bush's budget director, Mike Hansen, told senators in a briefing last week that one of the ways to control Medicaid costs is to cut coverage for optional treatments not covered by federal law, such as chiropractic and podiatry visits.

Medicaid recipients don't have much clout in Florida's Capitol. But chiropractors do. It didn't take long for an influential lawmaker to take action.

He is Republican Sen. Dennis Jones, the majority leader from Pinellas County who also is a chiropractor. Jones said he was taken aback by the proposal when he saw it last week. He said Medicaid costs for chiropractic and podiatry visits have not exceeded budget targets for the past decade.

"Why would you penalize these professions when they've stayed within their budgets for 10 years?" Jones asked. (He said only a tiny fraction of his practice is Medicaid recipients, about 1 or 2 percent.) Jones hunted down Bush's health care Jones hunted down Bush's health care advisers and met last week with Medicaid director Bob Sharpe, deputy chief of staff Alan Levine, budget director Hansen and legislative affairs director Jim Magill.

"Not one of them could tell me why that recommendation was ever made," Jones said. "They all thought it was an oversight. Or a mistake."

Oversight? The idea got into Bush's budget somehow. It's right there on page 46.

Bush's Agency for Health Care Administration (AHCA), the state agency that runs the Florida Medicaid program, has since claimed responsibility. AHCA is looking for ways to save money to absorb the projected $1.4-billion growth in Medicaid next year.

"We're always looking at ways to make Medicaid a little bit more sustainable," said AHCA spokeswoman Jessica Cary.

Jones dismisses the possibility, whispered in the Capitol halls, that the chiropractic proposal was a retaliation for Jones' harsh criticism of the way Bush handled last year's medical malpractice fight. Levine at one point sent out an e-mail criticizing senators, and called Jones "a real issue."

Jones said Levine was "a little more involved in that debate than a staff person needed to be." But he believes the Medicaid cost-cutting proposal on chiropractors was an oversight and not a gotcha.

No hard feelings, Jones says. After all, Bush is willing to set aside $4.5-million to start a chiropractic school at Florida State University.

"I'm just hoping for a session that's a lot less contentious than last year," Jones says.

_ Steve Bousquet is the Times' deputy capital bureau chief.

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