Medicaid – Florida Politics

Rick Scott’s Medicaid numbers come under fire

When it comes to health-care math, sometimes the numbers don’t add up for Florida Gov. Rick Scott.

As Scott’s administration this week submits a request to the federal government to trim the amount of time people have to apply for Medicaid coverage, the state’s estimate of $98 million in savings associated with the change has come under fire from health-care providers who contend the impact is much greater. Providers also allege that the number of people impacted will exceed the 39,000 projected by the state.

The providers’ arguments are bolstered by a 2017 letter sent to the federal government by the secretary of Scott’s Agency for Health Care Administration. The letter described savings associated with the change as high as $500 million.

That contradiction, however, is not the first time that a Medicaid cost analysis by the Scott administration has been called into question since he became Florida’s chief executive officer in 2011.

“I would say that Governor Scott’s Medicaid numbers should be carefully and independently analyzed,” said Joan Alker, executive director of the Georgetown University Center for Children and Families who has extensively studied Florida’s Medicaid program. “I certainly regard them with a healthy degree of skepticism.”

Scott, who is running this year for U.S. Senate, made his fortune in health care and understands its many nuances. He led the Columbia/HCA hospital company before it forced him out amid an investigation into federal health care fraud. Scott was never charged in the case, but the company paid a then-record $1.7 billion fine.

John Tupps, a Scott spokesman, defended the governor’s handling of the Medicaid program, which will total about $28.3 billion in the upcoming year.

“The bottom line is that Florida’s Medicaid program is operating at the highest level of quality in its history,” Tupps said. “These claims are unfounded and have zero impact on the services that Florida delivers to patients.”

But the Scott administration’s cost analyses sometimes have not made sense to Medicaid experts or health and social-service providers in the trenches.

Florida’s disabled community cried foul just months after Scott’s election after the governor ordered his chief inspector general to conduct a review of what is known as the home and community-based waiver program at the state Agency for Persons with Disabilities. The March 2011 report included budget information which, critics maintain, inflated a deficit at the agency by $75 million.

In 2012, Scott contended Florida’s Medicaid costs would increase by $1.9 billion if the state were to expand Medicaid under the federal Affordable Care Act. The contention was disputed at the time by state economists and was later revised.

In 2017, Scott announced Florida had been approved for $1.5 billion in each of the next five years for the Low Income Pool program, which funnels additional money to hospitals that serve large numbers or poor and uninsured patients. Scott also praised President Donald Trump’s administration for its willingness to work with the state.

So-called LIP funding is a supplemental Medicaid program and, like other programs, requires local matching dollars to draw down federal funds. In Florida, that match has come from counties and local hospital taxing districts whose interest in continuing to put up the funding waned after the Barack Obama administration restricted how LIP dollars could be spent.

At a press conference following the announcement, Scott dismissed concerns that the local matching money would fall short and that the full $1.5 billion wouldn’t be available, saying at the time Florida would “get more flexibility in a lot of things with regard to the Medicaid program.”

But the final tally of LIP funding in fiscal year 2017-2018 is about $731 million, less than half of what is available, because of a lack of matching money.

Tupps dismissed the criticisms and placed blame on hospitals. He said Scott negotiated the $1.5 billion LIP program and “it’s up to them to draw down the federal funding.”

Moreover, Tupps said the announcement that Florida would have $1.5 billion isn’t inaccurate because “this is year one of a five-year commitment.”

The latest dispute centers on a proposal to trim a length of time people have to apply for the Medicaid program from the current 90 days to a maximum of 30 days.

Federal law requires states to cover the costs of medical bills incurred up to three months prior to the time people apply for Medicaid. So long as people qualify for Medicaid and the services are covered, the hospital, doctor and nursing-home bills that accrue during that period will be absorbed.

The longstanding policy, officially known as “retroactive eligibility,” protects the poor from unpaid medical bills that they cannot afford and helps ensure that hospitals and nursing homes are paid for services they offer to Medicaid-eligible people.

Earlier this month, AHCA said 39,000 people would be impacted by a switch to a 30-day period and that it should save $98 million. That’s a drastic reduction from the $500 million in savings that AHCA Secretary Justin Senior said could be saved in a March 2017 letter he sent to former U.S. Department of Health and Human Services Secretary Tom Price.

Senior said claims that accrue during the 90-day period are paid outside of the state’s Medicaid managed-care system. That means Florida pays for “uncoordinated and potentially inappropriate utilization of medical services.”

Months later, the Scott administration floated the proposal to the Legislature for consideration during the 2018 Session. Ultimately, the $98 million reduction was included in the new state budget that begins July 1.

At two public meetings this month, health-care providers testified that they believe the change in policy will lead to much larger reductions in spending than the $98 million the agency cited.

“It does appear low from what we’re seeing anecdotally, but I don’t have the numbers to back that,” said Stephen Harris, vice-president of payor and government affairs for Tampa General Hospital.

What Harris does know is that Tampa General discharged 4,200 “straight Medicaid” patients last year, meaning they were not enrolled in Medicaid HMOs. And while he hasn’t conducted an analysis of each of those patients to determine when they applied for Medicaid, Harris suspects many of them were enrolled retroactively.

Mallory McManus, a spokeswoman for the Agency for Health Care Administration, defended the $98 million figure and distributed backup details showing how the agency reached those conclusions.

But the agency provided no backup data on how it reached the $500 million estimate it touted as savings in 2017. Moreover, the agency now says the figure is irrelevant.

But when pressed for an answer, McManus attributed the huge difference to the Legislature’s decision to exclude pregnant women and children from the policy change.

“As you know, the majority of the Florida Medicaid population is children,” she added.

But the chances of McManus’ explanation being accurate are nil because excluding pregnant women and children wouldn’t lead to such a large reduction in the estimate, Alker said.

“While children account for about half of Florida’s Medicaid enrollment, they constitute only 20 percent of total spending. And the good news is that most kids don’t spend time in the hospital or in nursing homes — both of which are very expensive and likely the drivers of retroactive eligibility spending,” Alker said. “Thus, the likelihood of a huge chunk of retroactive eligibility spending being due to children is close to zero.”

The Agency for Health Care Administration used 2015 data in coming up with the $98 million projection. A News Service of Florida analysis of the 2015 data shows that bills for poor and elderly people who don’t qualify for Social Security account for about half of that total. Another $31 million is attributed to bills for elderly patients who qualify for both Medicare and Medicaid.

That’s not surprising to Tampa General’s Harris, who also worries that, if the retroactivity change is approved by the Trump administration, it would become more difficult for hospitals to find skilled nursing facilities that are willing to accept patients that hospitals want to discharge.

“Knowing that the patient is Medicaid eligible is a big deal,” he said. “If we can’t tell them (nursing homes) that, it makes it more difficult for us to place them.”

AIDS foundation fights getting shut out of Medicaid

The largest nonprofit AIDS health care provider in the nation is at risk of being blocked out of South Florida’s Medicaid market.

AIDS Healthcare Foundation attorneys filed a written protest and requested a hearing after its managed-care division was not among the health plans selected to negotiate with state Medicaid officials to continue providing care in Miami-Dade, Broward and Monroe counties beginning in 2019.

As of March 1, nearly 2,000 people in South Florida with HIV or AIDS were enrolled in Positive Healthcare, the managed-care plan.

“It is inconceivable that such an experienced plan would have its proposal to continue operating as an HIV/AIDS specialty plan scored so low compared to other plans without the same experience or provider network,” Jeffrey Blend, Positive Healthcare assistant general counsel, wrote, noting that it scored well below other plans that responded to a state contracting process known as an “invitation to negotiate.”

Agency for Health Care Administration Secretary Justin Senior denied the request for a hearing this week, saying the issues weren’t ripe for challenge because the state hadn’t finalized negotiations.

The dispute comes as part of a broader process by the Agency for Health Care Administration to award new contracts in the state’s Medicaid managed-care system. Total five-year contracts could be worth up to $90 billion, with contracts awarded to health plans in different regions of the state.

The state issued its invitation to negotiate, the second under the Medicaid managed-care program, in July 2017. The winning bids are expected to be announced on April 16. The state will transition from current health plans under contract to new plans at the end of 2018, according to state documents.

In its protest, Positive Healthcare alleged that “upon information and belief” the state is negotiating with two other specialty plans for the treatment of HIV-positive people in the South Florida regions 10 and 11: Clear Health Alliance and United Healthcare of Florida Inc.

Like Positive Healthcare, Clear Health Alliance already is a contracted specialty health plan that’s available for HIV-positive people. United Healthcare has contracts for long-term care services and traditional managed care but not specialty care, such as HIV or AIDS.

Michael Rajner, an activist living with HIV in Broward County, said he wasn’t aware that Positive Healthcare was at risk of losing its Medicaid contract but said that “could be harmful for people living with HIV that have enjoyed access to that plan and particular providers because it could force them to establish a new relationship with a new physician, and that doesn’t benefit patients.”

The Legislature passed a sweeping rewrite of the state’s Medicaid program in 2011, requiring nearly all beneficiaries, from the cradle to the grave, to enroll in managed-care plans. Eleven managed-care organizations, including Positive Healthcare, were awarded contracts after the state’s first invitation to negotiate.

For contracting purposes, the state is divided into 11 regions. State law establishes a minimum and maximum number of plans that can operate in each of the 11 regions. Positive Healthcare operates only in Broward, Miami Dade and Monroe counties.

Positive Healthcare isn’t the only managed care plan currently under contract that has been snubbed in the second round of bidding. Molina Healthcare disclosed in a recent Securities and Exchange Commission filing that its Florida subsidiary, Molina Healthcare of Florida, was invited to negotiate a new contract only in the Miami-Dade region.

Molina Healthcare of Florida currently has contracts in eight regions, and Medicaid premiums from the plan accounted for 8 percent of Molina Healthcare’s projected revenues in 2018.

The filing noted that the company “intends to take all appropriate actions to both protect its rights and ensure continuity of care for its members,” according to the filing.

Republished with permission of the News Service of Florida.

State seeks changes in Medicaid program

For the third time in less than a year, Florida is asking the federal government to amend a sweeping Medicaid “waiver,” including seeking permission to add community mental-health providers to the list of those able to participate in a supplemental Medicaid funding program.

“We think this is a great thing to do,” said Melanie Brown-Woofter, interim president and CEO of the Florida Council for Community Mental Health. She noted that, if approved, the change could result in a projected $15.7 million increase in funding for community receiving facilities that treat patients for mental-health and substance-abuse disorders, including opioid addictions.

But under federal law, the state can’t submit proposed amendments without first allowing the public to comment. To that end, state Agency for Health Care Administration officials are holding a meeting at 3:30 p.m. Wednesday at the agency’s Tampa office.

Along with the change dealing with funding for mental-health providers, the state also wants permission to trim from 90 to 30 the number of days that Medicaid will retroactively cover beneficiaries’ health-care bills before they become eligible for Medicaid. Florida wants that change — which would only impact non-pregnant women 21 and older — to become effective July 1. If approved, the state would save about $38 million in general-revenue dollars and $98.4 million in combined state and federal funds.

Florida also is seeking to modify an existing policy on hospital ownership to recognize health-care facilities with regional perinatal care centers to tap into supplemental funds. The change would benefit Bayfront Health in St. Petersburg.

The supplemental funding issues deal with the Low Income Pool program, which provides additional funds to hospitals that serve large numbers of poor and uninsured patients. The program is comprised of funds from Florida and the federal government. But Florida doesn’t use state tax dollars for its required match. Instead, the state calls on local governments and local health-care taxing districts to provide “intergovernmental transfers” to fund the program.

Florida lawmakers agreed to direct $19.8 million in the coming year toward community central receiving systems, with a requirement of 50 percent local match, or about $10 million, Brown-Woofter told the News Service of Florida.

If the federal government approves the proposed changes, she said, the $10 million in local match could draw down another $15.7 million in so-called LIP funding. Brown-Woofter said the increased funding could either be used to enhance treatment services or to increase the number of community central receiving systems in the state.

Rules surrounding LIP funding have changed in recent years, making it less lucrative for hospitals to participate, and the state hasn’t been able to collect enough local match money to fully fund the program.

The Donald Trump administration last year authorized a $1.5 billion LIP program when it approved what is known as Florida’s Medicaid “1115 waiver,” but the state only collected enough money from counties for a $730.6 million program this year.

Brown-Woofter said she spoke with hospital groups before lobbying the Legislature about community receiving facilities being made eligible for LIP money.

“They said go for it,” Brown-Woofter told the News Service.

The Trump Administration in August 2017 extended the waiver through June 30, 2022. The waiver allows the state to run its mandatory Medicaid managed-care program, as well as the Low Income Pool.

Before the final waiver was approved, the Agency or Health Care Administration had already submitted an amendment requesting it be altered to require people with cystic fibrosis and brain and spinal cord injuries to enroll in the Medicaid managed care program. A second amendment was submitted in September to require people with AIDS to enroll in the mandatory managed-care program.

Prior to the waiver, the state cared for those people through smaller Medicaid waiver programs.

In addition to the Tampa meeting, state Medicaid officials will hold a meeting April 3 in Tallahassee. Moreover, the state has been soliciting public input on the proposed changes since March 21.

As of Tuesday, AHCA spokeswoman Shelisha Coleman said the state had received 45 comments from the public regarding the proposed changes.

New state budget lands on Rick Scott’s desk

The clock is now ticking on Gov. Rick Scott to act on his final state budget.

The Legislature sent a newly passed $88.7 billion fiscal plan to the governor’s office Wednesday, giving Scott 15 days to decide the line-by-line fate of how lawmakers want to spend money, from big-ticket items such as education and health care to numerous local projects backed by individual lawmakers.

Asked when Scott might act on the budget, a spokesman responded Wednesday in an email, “We’ll keep you updated on this.”

The budget (HB 5001), which was approved by the House and Senate on Sunday, was among 47 bills formally sent Wednesday to Scott, who cannot seek a third term in November.

The 452-page budget, among other things, would increase public-school funding by $101.50 per student, provide $100.8 million for the Florida Forever land preservation program and offer a $130 million increase in Medicaid funding for nursing homes. The spending plan will take effect July 1, the start of the 2018-2019 fiscal year.

Last year, Scott used his line-item veto pen to slash $410 million in projects across the state, saying they failed to “provide a great return for Florida families.”

Included on the 2017 chopping block were $20.9 million for citrus-canker payments in Broward County and $16.5 million for similar payments in Lee County.

Legislators had agreed to pay the money to compensate residents in a class-action suit who had lost orange, grapefruit and other citrus trees as part of a Florida Department of Agriculture program to stop the spread of deadly citrus-canker disease. Attorneys for the homeowners raised property-rights arguments in challenging the department’s actions, and a judgment was entered in 2008.

Scott wrote in a letter to Secretary of State Ken Detzner that he vetoed the citrus-canker money due to ongoing litigation.

Legislators this year included $22 million for citrus-canker payments in Broward County and $30 million for similar payments in Palm Beach County.

Along with the budget, other bills that reached Scott desk on Wednesday included:

– HB 21, which would take a series of steps to try to curb the state’s opioid crisis. The bill includes limiting opioid prescriptions to three or seven days for many patients.

– HB 1165, which would revamp state laws about approving trauma centers. The bill comes after years of legal and regulatory fights about new trauma centers.

– HB 1011, which would require homeowners’ insurance policies to make clear that they do not cover flood damages and that policyholders might need to consider buying flood insurance.

– HB 7099, which would ratify a rule requiring nursing homes to have generators and 72 hours of fuel. The Scott administration issued the rule after the deaths of Broward County nursing-home residents following Hurricane Irma.

– HB 1013, which would seek to keep Florida on daylight saving time throughout the year.

– HB 155, which would designate Florida cracker cattle as the official state heritage cattle breed.

Republished with permission of the News Service of Florida.

FHCA lauds lawmakers for nursing home budget increase

Lawmakers got praise from the Florida Health Care Association Thursday for upping funds to nursing homes in the 2018-19 state budget.

“FHCA applauds the Legislature for making the quality care of our frailest elders a priority. We want to especially thank Senate President Joe Negron, who has long been a champion for nursing home residents. Under his leadership, this year’s budget includes almost $130 million in increased Medicaid funding for nursing homes,” said FHCA Executive Director Emmett Reed.

“With those added dollars, facilities will have more resources to retain and recruit higher-quality staff to be directly involved in the care of residents. The funding increase will also support facilities as they continue making measurable improvements to residents’ health and well-being.”

Reed also approved of lawmakers adding in $10 million to help support nursing centers as they transition to the Prospective Payment System in October, and cheered an increase in nursing home residents’ allowances.

“The additional $25 per month this increase provides will allow greater choices for residents who rely on Medicaid as their long term care safety net, helping them to pay for personal items that improve their quality of life – things like beauty services, clothing, and other personal items,” Reed said.

In addition to Negron, the FHCA chief lauded Senate budget chief Rob Bradley and House Speaker Richard Corcoran.

Reed said lawmakers who backed the increased funding “will be remembered for their effective, meaningful, and thoughtful actions for the state’s long-term care residents.”

Earlier this week FHCA praised lawmakers for approving the nursing home generator rule, which was a priority of Gov. Rick Scott, after a prolonged power outage after Hurricane Irma led to a dozen heat-related deaths at The Rehabilitation Center at Hollywood Hills.

Lawmakers will need overtime on budget

Florida lawmakers will need to go into overtime because of an impasse about hospital spending in final negotiations over a new state budget.

House Speaker Richard Corcoran, a Land O’ Lakes Republican, told House members Tuesday night that lawmakers will have to extend the Session, scheduled to end Friday, or hold a Special Session.

“Make preparations because that’s kind of where we are headed,” Corcoran said after a day of behind-the-scenes negotiations with the Senate.

Corcoran said a “best-case scenario” would be finishing the Session Saturday. But he also said it was possible the Session would be extended to Monday or that Gov. Rick Scott could call a Special Session that might start as soon as Monday.

It will mark the second year in a row that the Legislature was unable to complete its annual Session in the allotted 60 days.

Last year, lawmakers extended the Session for three days to vote on the budget and then had to return for a Special Session after Scott vetoed the public-school portion of the budget, which he deemed inadequate.

Corcoran did not detail the reasons for being unable to reach agreement.

But earlier, Senate Appropriations Chairman Rob Bradley, a Fleming Island Republican, said the House and Senate were continuing to negotiate payments to Florida’s hospitals and whether to scrap a long-standing system for a new one that would increase base Medicaid rates paid to every hospital, regardless of Medicaid patient load.

Late Tuesday morning, Bradley said it was “too early to tell” whether lawmakers would be able to reach agreement on an $87 billion-plus spending plan by midnight. Meeting the deadline would give lawmakers enough time to adhere to a mandated 72-hour cooling-off period before a final budget vote on Friday, the last scheduled day of the 2018 Session.

But when Corcoran spoke to House members about 8:15 p.m., he made clear the budget wouldn’t be done in time.

Hours later, there was still no signs of an agreement. If lawmakers fail to pass a budget by midnight Friday, it would mark the second year in a row that the Legislature was unable to complete its annual Session in the allotted 60 days.

The House’s proposed spending plan for hospitals in the upcoming year is essentially a continuation of the current year’s budget. But the Senate has proposed redistributing $318 million in Medicaid “automatic rate enhancements” currently paid to 28 hospitals with large Medicaid caseloads and use it to increase the rates paid for all hospitals.

The Senate budget also includes $50 million to offset the recurring effect of the current year’s budget cuts on hospitals. The Senate plan has been endorsed by some rural hospitals that say the additional $50 million in the Senate plan is what they need.

But the Senate proposal would reduce Medicaid payments to Jackson Memorial Hospital in Miami by as much as $58 million and Orlando Health by nearly $9 million. House Appropriations Chairman Carlos Trujillo, a Miami Republican, said the House would not let safety-net facilities such as those face steep reductions.

HCA Healthcare, a for-profit chain that owns 43 facilities in the state, could see nearly $40.5 million in Medicaid increases under the Senate plan. Tenet, which owns nine hospitals in Florida, would see a nearly $4 million increase in Medicaid payments under the Senate plan, and Community Health Systems, which owns 23 hospitals in Florida, would see as much as a $7.7 million bump in Medicaid payments.

The Senate budget also includes an additional $130 million increase in Medicaid payments for nursing homes that aren’t included in the House budget.

Bradley said Tuesday that once the chambers agree on the hospital spending they will discuss nursing homes.

Negotiations have been completed on a $21 billion public school budget and a $7.9 billion budget for state universities and colleges, including financial aid, Bradley said. But as of Tuesday evening, lawmakers had not released the details of the agreement.

Based on earlier public negotiations, lawmakers will not increase state performance funding for universities and state colleges. That funding would remain at $245 million for the universities and $30 million for the 28 state colleges.

Senate President Joe Negron, a Stuart Republican, said Monday night he expects the university system to receive an additional $20 million that would be shared by schools that have reached “pre-eminent” status, including the University of Florida and Florida State University. The University of South Florida is also expected to achieve that status in the coming year and would share those funds.

Negron also said he expects a $20 million increase in the “world class” program, which is money shared by all the universities to attract top-level professors and researchers. Another $10 million increase would go to rewarding high-performing medical, law and professional schools.

In the public-school system, lawmakers have agreed to roughly a $500 million increase in the funding formula for the 67 school districts, which should yield a per-student increase in the range of $100 in the new academic year.

School funding was impacted by the mass shooting at Marjory Stoneman Douglas High School in Parkland, with lawmakers agreeing to spend an additional $400 million on school-safety and mental-health initiatives.

School-safety legislation (SB 7026) debated Tuesday in the House includes a $97.5 million increase for the “safe schools” program in the funding formula. It would boost the program, which helps the 67 school districts hire school resources officers, to $162 million in the 2018-2019 academic year.

The legislation also would provide $67 million to the school districts in a new mental-health category in the funding formula.

But one of the impacts of shifting more state funding to school safety may be Gov. Scott’s call for an $18 million increase in funding to help teachers buy classroom supplies. The increase sought by Scott would have boosted the annual support to $350 for each teacher, although it appears the program is likely to remain at its current level of $45.3 million, which provides $250 a year.

Rob Bradley’s fairness doctrine

Senate Appropriations Chair Rob Bradley is undertaking something seen too rarely in the Legislative process: He is actually trying to clean up and improve Florida’s health care financing policy.

Bradley, an Orange Park Republican, intends to do this by finally eliminating “auto-payments,” a payment scheme that Gov. Rick Scott described in 2015 as arbitrary, inconsistent and bearing no relationship to improving access or quality of care.

This is not the first attempt to deconstruct the auto-payment policy.

Last year, the House acted to eliminate the policy for all but a small number of public hospitals that qualify as “safety net” providers.

The House accomplished this through a formula that requires hospitals receiving auto-payment money to have a Medicaid caseload of 25 percent or more. Then they added a complicated set of additional conditions designed to direct as much funding as possible to 11 large, government-funded hospitals.

The result was that out of 28 facilities that qualified for a piece of the $318 million in auto-payment funding, 92 percent – or roughly $292 million – went to those 11 facilities.

The argument those hospitals are making now is that they treat the highest percentage of Medicaid patients. What they don’t want you know is the state already recognizes their high Medicaid caseloads through other channels.

Those same 11 hospitals received $400 million of Low Income Pool funding. They got $163 million in Medicaid Disproportionate Share payments as well.

That’s a whopping $563 million in tax dollars already.

Many hospitals in rural Florida also treat high numbers of Medicaid and charity care patients, but the LIP formula has been manipulated to direct the money to public hospitals, so those rural hospitals now get little to nothing from LIP or the Disproportionate Share program.

Overall, these large, government-funded hospitals are doing very well.

Based on 2016 data, they had an average total margin of nearly 10 percent. That compares favorably with HCA at 9.6 percent or Tenet at 6.6 percent, two for-profit hospital corporations with their own Medicaid and charity care obligations.

About 1 in 6 patients served at an HCA hospital were covered by Medicaid and the company provided $122 million in charity care services. Tenet had a Medicaid percentage of 23.5 percent and provided $33 million in charity care.

Bradley is providing much-needed leadership by attempting to end payment formulas disconnected from any incentives for efficiency or quality of care.

His approach requires a smaller total cut in Medicaid payments to all hospitals compared to last year, specifically improves Medicaid payments for freestanding children’s hospitals and provides a special allocation to fund UF Health Jacksonville, one of those 11 hospitals that truly does need additional help.

Let’s hope this common-sense approach is embraced by both the House and Senate.

House, Senate start negotiations on tighter budget

House and Senate leaders Tuesday night kicked off formal negotiations on a new state budget — but face hundreds of millions of dollars in unexpected costs and less tax revenue than originally thought.

Leaders held an initial conference committee meeting after announcing earlier in the day they had reached agreement on “allocations,” which are big-picture numbers for the various parts of the budget such as education, health care and criminal justice. House and Senate negotiators will use those numbers as they hammer out details of each budget area in the coming days.

The House and Senate have a week to finish the budget if the Legislative Session is going to end as scheduled March 9. A legally required 72-hour “cooling off” period means the budget will have to be done March 6. House Appropriations Chairman Carlos Trujillo, a Miami Republican, expressed confidence the Session will finish on time.

While numerous details still need to be worked out, Senate Appropriations Chairman Rob Bradley, a Fleming Island Republican, said, in part, that lawmakers plan to provide $80 million in tax cuts and will fund an expansion of the Bright Futures scholarship program, a priority of Senate President Joe Negron, a Stuart Republican.

Also, the agreement means that $543.6 million in more funding will be available in the health and human services section of the budget, which includes five agencies. Bradley, however, stressed that policy differences between the House and Senate still need to be negotiated on issues including how the state will reimburse hospitals and nursing homes in the Medicaid program.

Both chambers on Feb. 8 passed budget plans for the fiscal year that starts July 1, with the Senate proposing to spend $87.3 billion and the House proposing to spend $87.2 billion. While the overall numbers were similar, the House and Senate disagreed on myriad details.

But in announcing the allocations Tuesday, Bradley said lawmakers are grappling with unexpected costs and a lower estimate of corporate tax revenue than when the House and Senate approved their budget proposals.

The biggest change stems from lawmakers’ plans to spend at least $400 million in response to the mass shooting Feb. 14 at Marjory Stoneman Douglas High School in Parkland that left 17 people dead. The House and Senate are quickly moving forward with bills that include taking steps to boost school safety and mental-health services.

“The tragedy in Parkland changed everything,” Bradley said.

Bradley said leaders have agreed to spend $400 million and that additional money could come through the state’s school-funding formula.

“That is something that we do because you cannot put a price, obviously, on the safety of our children,” he said.

Bradley said, however, that will affect other parts of the budget, which lawmakers are required to balance each year.

“When you take $400 million and put it towards necessary efforts, that creates challenges in other areas of the budget, and we’re up to that challenge, and we will meet those challenges,” he said.

To help pay for the issues stemming from the school shooting, Bradley said lawmakers will take $200 million out of a reserve fund known as the “working capital fund” and will take money from trust funds that are normally earmarked for other purposes such as affordable housing. Also, the budget likely will include a reduced number of projects requested by lawmakers.

“We’re going to be lean on projects this year,” he said. “It’s necessary.”

The budget also will be tighter than originally thought because of a revised estimate last week of the state’s corporate income-tax revenue. Analysts said the state is expected now to bring in $167 million less in corporate taxes than estimated earlier.

Also, Bradley said lawmakers are faced with paying $100 million more in Medicaid expenses than what had been anticipated.

“These are bills that need to be paid. This is not a discretionary choice,” Bradley said. “These are bills that health providers have incurred pursuant to our obligations under law to provide these services to individuals. And so these are bills we will pay, because we pay our bills.”

Senate pitches health care alternative for veterans

A state Senate proposal would authorize Florida to begin negotiations with the federal government to see if the state could offer managed health-care programs to veterans and their families as an alternative to the health system provided by the federal Veterans Administration.

The Senate could vote on the proposal (SB 440) as soon as Wednesday.

Sponsor Rene Garcia, a Hialeah Republican, agreed Tuesday to add an amendment to make clear the proposal is not designed to expand Medicaid for veterans in Florida. Instead, he said the proposal would authorize discussions with the federal government to discuss opening access to the Medicaid managed-care infrastructure of health plans and physicians.

The bill would authorize the state Department of Veterans’ Affairs, the Agency for Health Care Administration and the Department of Children and Families to jointly negotiate with federal agencies to seek approval for a waiver, a state-plan amendment, or other approval for federal funding for the “Florida Veterans Care” program.

The amendment was intended to provide comfort to House members who thought the proposal was an attempt to expand Medicaid, Garcia said.

House Speaker Richard Corcoran, a Land O’ Lakes Republican, has been steadfast in his opposition to expanding Medicaid.

The federal Veterans Administration system serves more than 1.5 million Floridians, which is the third highest population of veterans in the country. Over half of the state’s veterans are age 65 and older, according to a staff analysis of the bill.

Garcia made a plea to members of the Florida House of Representatives and Corcoran to “not stand in the way” of negotiations.

“Our veterans deserve better,” Garcia said. “Enough with using our veterans as political pawns. The time is now to ensure that we take care of our veterans.”

House committees have not heard the House version of the bill (HB 403).

Lawmakers seek more money for opioid epidemic

Two Democratic senators are pushing to increase by $25 million the amount of funding the Senate has committed to addressing the state’s opioid problems in the upcoming year.

Sen. Kevin Rader praised Senate leaders for proposing to spend $100 million on mental-health services and school-safety programs in the wake of the Marjory Stoneman Douglas High School shooting last week that left 17 people dead. But he said they also need to put more money into a plan to curb the opioid epidemic.

“It looks like we are finding a lot of mental health funding, and that’s great. And I absolutely, completely support it and it’s much needed,” said Rader, a Delray Beach Democrat whose district includes Parkland, where Marjory Stoneman Douglas High is located. “I hope in the next two weeks …. we can really put the money into the opioid funding to take an enormous bite out of this apple and really help Floridians who need it.”

Rader’s remarks came as the Legislature enters the last two weeks of the annual Legislative Session and prepares to go into budget negotiations. The Senate is earmarking about $53 million for a variety of programs for opioid treatment, outpatient care and case management, medically assisted treatment, and naloxone for emergency responders.

Senate President Joe Negron, a Stuart Republican, said Thursday he has spent “a long time talking” with Rader and Sen. Darryl Rouson, a St. Petersburg Democrat, about the opioid epidemic, and he thinks the Legislature ultimately will increase funding from the current levels.

Rader is working closely with Rouson, who has drafted a plan that directs funding to a number of different areas. They include spending $2 million on an additional seven “bridge programs” between hospital emergency departments and community-based opioid programs, spending $2.9 million for evidence-based prevention and launching a statewide media campaign, similar to the state’s effective anti-smoking campaign.

The four-page draft obtained by The News Service of Florida contains handwritten notes with numbers by each of the ideas. The proposal marked No 1 is a request to increase funding to managing entities, which have contracts with the state to coordinate care regionally, by $3.1 million to provide housing options for people who suffer from both mental health and addiction issues and are frequently jailed or require emergency room services.

The proposal does not include additional funding beyond what already is targeted for medication-assisted treatment programs. Negron though, indicated that he would direct additional dollars toward medication-assisted treatment.

“I want to make sure the prevention is directly related to tangible items that we can measure rather than just diffuse dissemination of information, which I don’t think is effective,” Negron said.

Gov. Rick Scott in May 2017 declared a state of emergency due to the opioid crisis, fueled by an increasing number of deaths associated with the drugs. A state report shows that in 2016, Florida had 952 heroin deaths, 1,390 fentanyl-related deaths, 723 oxycodone-caused deaths and 245 hydrocodone-related deaths.

To try to address the issues, the House and Senate are considering bills (HB 21 and SB 8) that would limit physicians’ abilities to prescribe opioids. Also, the state Medicaid program announced last week that it is limiting prescriptions for narcotics to a maximum seven-day supply, unless a physician determines it is medically necessary to increase the prescription.

During a discussion in a Senate committee, Rader reminded Senate Health and Human Services Appropriations Chairwoman Anitere Flores, a Miami Republican, that she acknowledged earlier the Senate hasn’t gone far enough in its recommendations for the upcoming year.

“You said, and I didn’t put words in your mouth, that this is ‘woefully underfunded and needed hundreds of millions of dollars of help as well,’ “ Rader said to Flores during a Wednesday meeting. “We just can’t keep the eye off the ball.”

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