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Hospitals on edge as lawmakers weigh cuts to Medicaid in Florida

The nurses and doctors at Brandon Regional Hospital worried Lakota Lockhart wouldn't make it when he was born.

"I remember nurses saying, 'Come on, baby. Take a breath,' " said Lakota's mother, Krystal.

Lakota, now 7, was born with a disorder of the central nervous system that causes him to stop breathing when he falls asleep. The condition affects only 1,500 people in the world.

Sometimes, Lakota has access to private health insurance. But when his father is out of work, he relies on Medicaid. The public health insurance program provides Lakota, who lives in Plant City, the most access to specialists and therapists, Krystal said.

"Commercial insurance just isn't meant for the coverage and the type of care that he needs," she said.

But as Florida's lawmakers look for places they can cut the state budget, fearing a revenue shortfall in coming years, Medicaid spending could be on the chopping block.

The Florida House and Senate have proposed saving the state money by reducing what hospitals get from Medicaid. Including state dollars and the money the federal government kicks in, those cuts range from $300 million to nearly $800 million next year.

Rep. Jason Brodeur, R-Sanford, who chairs the House health care budget committee, vowed the cuts wouldn't make it harder for families like the Lockharts to use Medicaid.

"It would be more of a burden to those hospitals that provide services to Medicaid patients," he said.

And, Brodeur said, the cuts are just suggestions made as part of an exercise ordered by legislative leaders. It won't be clear until this week whether they make it into the budget.

But Rep. Nick Duran, D-Miami, who has run a statewide association of free clinics for the poor and a nonprofit meant to help people enroll in health coverage under the Affordable Care Act, said it's a bad time to even consider taking money out of Medicaid.

He pointed out that Congress has been looking at dramatic changes to the federal Medicaid program.

"Why are we making these kinds of decisions before we know exactly what is in front of us?" Duran said. "We're talking about funding that immediately impacts families, that impacts individuals, their ability to be healthy, to produce and to be active in their communities."

Bruce Rueben, president of the Florida Hospital Association, agreed.

"It's hard to understand the rationale in making deep cuts to Medicaid at a time when the whole funding system from a national standpoint is at great risk," he said.

Health and human services make up more than one-third of Florida's $82 billion budget. If the Legislature wants to make cuts to the state's spending plan, it's tough to do that without slashing health care. The proposals under consideration reflect across-the-board cuts by reducing hospital payouts for Medicaid patients.

But every dollar state lawmakers cut has a much larger impact on the amount of money available to hospitals that treat Medicaid patients.

That's because the federal government matches much of the state money funneled into the program. So a $100 million cut by the state suggested by the Senate would actually take out another $157 million in federal money. So the total hit would be $257 million away from hospitals.

While Brodeur said low-income patients who rely on Medicaid would not directly feel cuts to Medicaid, Rueben worries that the hospitals that are most hurt will be the ones that serve the most Medicaid patients. When Medicaid reimbursement shrinks, he said, hospitals are likely to shift the burden of paying for services more and more to those with private insurance.

"Hospitals have to find a way to shift some of the unmet cost from those who don't pay at all or from government payers," he said. "It's a hidden cost on Florida businesses and those who have their own insurance."

Still, he warned, some hospitals will find they have to shutter some services that aren't used often or can't make ends meet. And programs that help the poor most of all are often the first to go, he said.

For the Lockharts, who came to Tallahassee in early March to urge lawmakers not to cut the Medicaid budget, the closure of rarely used hospital services is scary. Lakota gets better access to care under Medicaid because a program for children with particularly serious diagnoses lets him see therapists and specialists more often than commercial insurance plans, which tend to have limits.

Sen. Anitere Flores, R-Miami, who oversees the Senate's health care budget, said some of the potential cuts are tied to Florida's decision not to expand Medicaid.

In a bid to encourage Florida to provide coverage for more low-income people, the federal government cut a pool of money that reimbursed hospitals for charity care. But Florida decided not to expand Medicaid, and had to set aside state dollars to offset the cuts.

That money may be on the chopping block, Flores said.

Flores said there are other parts of the budget lawmakers should consider cutting first, though.

Which ones?

"I'm open to suggestions," she said.

Contact Michael Auslen at Follow @MichaelAuslen.