As pressure builds to expand Medicaid, state's safety-net hospitals feel the pinch

UF Health in Jacksonville is just about to open a satellite hospital on the city’s Northside with 92 beds and cutting-edge specialties sure to be welcomed by underserved neighborhoods far from the nearest ER.

The move is seen as not only a boon for the growing Northside, but also a way for UF Health (formerly known as Shands) to subsidize its downtown location.

That’s because UF’s Jax campus is not only the academic teaching hospital for the region, but it has also long served as the area’s “safety net” facility.

But that net is fraying.

The state’s decision not to expand Medicaid to low-income patients has severely constrained UF Health, so much so that the Jacksonville Civic Council, a group of local heavy hitters comprised of current and former CEOs, has taken on the hospital’s funding problems as a top-of-mind issue to study — and try to influence.

“It’s dire, even if the doors are not closing tomorrow,” says Kevin Hyde, former Jacksonville city councilman and managing partner at Foley & Lardner. Hyde is chairing the Civic Council’s task force on UF Health’s finances.

“Their cash on hand is not anywhere near what you would expect an entity of their size to have. It’s very constrained.”

Hyde says that’s not due to poor management by hospital leadership.

“When you have a disproportionately high percentage of patients who are not able to pay, those costs must be absorbed,” he said. “And we understood the likelihood of Medicaid expansion is small in this political environment, so we are looking for alternatives.”

The solution? Hyde says the Civic Council is looking at whether it would be feasible to create a hospital taxing district in Duval County, similar to the ones that fund safety-net hospitals in Miami-Dade and Hillsborough counties.

That would be a heavy lift, requiring first legislative approval to hold a local referendum, then getting such a measure before voters.

Hyde says the issue goes beyond UF Health, saying other local hospital CEOs have told his group there would be a catastrophic “ripple effect” impacting patient care across the First Coast should anything happen to the region’s main teaching and indigent-care hospital.

“We as a community should not think of this as just a place where indigent patients go. It’s an integral part of our local health system and its failure would create a ripple effect that would impact all of us.”