Get ready for another fight about cutting spending on Florida’s health and human services programs.
Stuart Republican Joe Negron, who is the Senate’s top health budget writer, said Thursday that Medicaid could cost roughly $300 million more than expected this year and will need an infusion of nearly $1 billion next year to meet growing expenses.
With the struggling economy limiting new tax dollars, that likely means the House and Senate in 2012 will replay a divisive debate from this spring’s legislative session about balancing the health and human services budget.
Negron and another influential senator, Niceville Republican Don Gaetz, have already said they want to scrutinize what they describe as “soft services.” As an example, Negron said he would be willing to cut spending on adult mental-health and substance-abuse treatment programs to help pay for services for developmentally disabled people.
“We’re in a situation now where we’ve got to make some hard calls,” Gaetz said Thursday during a meeting of the Senate Health and Human Services Appropriations Subcommittee.
But Sen. Eleanor Sobel, D-Hollywood, said problems such as high unemployment are driving additional demands on the Medicaid program.
“It’s not growing in a vacuum,” Sobel said. “It’s growing because of the economic times we’re in.”
Health-budget officials from the House and the governor’s office also have made clear during the past week that they expect more cuts when the legislative session starts in January.
But House and Senate negotiators took far-different positions during the 2011 session about which programs should be cut — positions that already are showing signs of re-emerging for the coming year. The House, for example, fought Senate proposals to make deep cuts in mental-health and substance-abuse programs.
Similarly, House Health Care Appropriations Chairman Matt Hudson, R-Naples, said this week he considers proposals to cut the high-dollar Medically Needy and Meds-AD programs as “non-starters.” The Senate this spring suggested cutting those programs, which serve sick and old people who don’t qualify for typical Medicaid coverage.
“I’m not going to do it,” Hudson said.
Negron, the chairman of the Senate Health and Human Services Appropriations Subcommittee, said state analysts will finalize Medicaid spending projections during an Oct. 17 meeting.
But he said preliminary estimates show Medicaid spending this year topping budgeted amounts by $286 million to $346 million. Also, he said a preliminary estimate indicates the state would have to spend an additional $983 million next year to keep up with such factors as growing Medicaid enrollment.
The House and Senate made the largest health and human-services cuts this year by chopping hundreds of millions of dollars from the Medicaid payment rates for hospitals and nursing homes. Longer term, they approved a plan to move to a statewide Medicaid managed-care system to try to control costs, but it remains unclear when — or if — the federal government will agree to that plan.
The Republican-controlled Legislature has long rejected proposals to raise taxes to bring in more money. Negron said he is concerned that higher Medicaid spending takes away money from other programs, such as education and transportation.
“As you can see, the Medicaid budget continues to crowd out our ability to fund other important priorities,” Negron said.
Part of the budget discussion came as Negron’s subcommittee heard a presentation about the Agency for Persons with Disabilities’ plans to deal with chronic shortfalls.
The agency has a $10.5 million deficit from the 2010-11 fiscal year and is trying to find a way to reduce spending by $55 million to balance this year’s budget.
APD Director Mike Hansen said the agency is moving forward with a new system, known as iBudgets, that will use a formula to determine how much money each beneficiary should receive for services. Hansen estimated that 60 percent of the people will see a reduction in services under the new system.
“We have to live within the amount of money you have given us,” Hansen told the panel.
But Senate Minority Leader Nan Rich, D-Weston, raised concerns that the system could involve cuts to services such as training programs and transportation.
“That’s a whole change of life for these people,” Rich said.
By Jim Saunders
