Hundreds of millions in unresolved health care spending gets bumped to top legislative leaders to decide

Top Legislative leaders will decide how much hospitals and nursing homes should get paid to care for the poor, elderly and disabled.

With just days left to reach a final deal on the state budget, the House and Senate have been unable to bridge all their differences over billions of health care spending.

While the chambers were initially far apart on how to spend the money, it’s worth noting that in the Senate’s final offer, Sen. Aaron Bean had spent $14,078,119,614 in recurring general revenue, or tax dollars. That is the same amount of general revenue that Rep. Bryan Ávila agreed to spend on health and human service programs in Fiscal Year 2022-23, which begins July 1. But how the Senate and House are spending that total still remains a point of contention.

Also worth noting: That total is below the $14.2 billion that Legislative leaders authorized to spend on health care and social services.

It’s unclear how that difference will be made up.

Senate Appropriations Committee Chairman Sen. Kelli Stargel told Florida Politics Friday morning that she had not been able to review the issues that Bean and Ávila had bumped to her and Rep. Jay Trumbull to resolve.

The Florida Legislature meets annually to discuss thousands of different bills, but it only is required to pass one: The General Appropriations Act, commonly referred to as the state budget. Lawmakers have until Tuesday to finalize the budget in order to pass it by the scheduled end of Session.

The House has eliminated $75 million from the Medicaid inpatient and outpatient care. But the House budget earmarks $52 million to four hospitals in Tampa Bay and Broward County to offset the cuts.

The Senate budget doesn’t contain the cuts, nor does it contain the $52 million infusion for the four hospitals.

The chambers are in agreement that there no longer will be a pot of money used to enhance the Medicaid payments for certain hospitals that treat large amounts of charity care. There was about $309 million that was directed to the hospitals in what the Safety Net Hospital Alliance of Florida had dubbed the “critical care fund.”

While lawmakers have agreed to eliminate the fund, they could still agree to provide those hospitals increased payments in other ways. Many of the hospitals that benefited from the “critical care fund” were children’s hospitals. 

To that end, the Senate in its budget agreed to direct nearly $34 million in recurring general revenue to freestanding children’s specialty hospitals. When matched with federal funds it would be a near $85 million investment in the hospitals. Nicklaus Children’s Hospital, Johns Hopkins All Children’s Hospital and Nemours Children’s Health are the only separately licensed children’s hospitals in the state according to the website.

But it’s more than hospital payments that separate the chambers. It’s also special projects for hospitals.

The Senate budget proposes spending nearly $20 million in recurring general revenue on the H. Lee Moffitt Cancer Center and Research Institute for the next 30 years. That’s a $600 million investment.

The money is for the construction and development of Moffitt’s Pasco County life sciences park, a top priority for Senate President Wilton Simpson.

The House has not agreed to spend the money, which would help H. Lee Moffit built a new campus surrounded by a master planned wellness community. The proposed project is 40 miles from Simpson’s backyard.

The chambers are not in agreement on projects for Tampa General Hospital and Shands Jacksonville.

The chambers also are not in agreement when it comes to nursing home care.

Nursing homes are slated to get a $303.9 million increase in the Senate budget but only a $165.2 million hike in the House’s spending plan. That money comes in addition to an automatic rate enhancement that was included in the underlying Medicaid estimates agreed to by the Social Services Estimating Conference.

Christine Jordan Sexton

Tallahassee-based health care reporter who focuses on health care policy and the politics behind it. Medicaid, health insurance, workers’ compensation, and business and professional regulation are just a few of the things that keep me busy.


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