Meet the people who help decide the largest area of the budget: Health and human services spending

TALLAHASSEE, FLA. 1/5/23-Rep. Sam Garrison, R-Fleming Island, chairs the House Health Care Appropriations Subcommittee, Thursday at the Capitol in Tallahassee. COLIN HACKLEY PHOTO

The Legislature has decided on Senate and House budget conferees who will hammer out health care and social services spending for the Fiscal Year 2024-25 budget.

Legislative leadership announced allocations for the various budget areas and that the entire budget would contain around $48 billion in general revenue. The agreed-to state spending level for health and human services is around $16 billion, more than any other area of the budget. Much of that money will be matched by federal dollars, bringing overall spending to a much higher level.

The conferees that will hammer out the health and human services spending for the Senate are: Sens. Gayle Harrell, Bryan Avila, Dennis Baxley, Lauren Book, Jason Brodeur, Danny Burgess, Colleen Burton, Tracie Davis, Ileana Garcia, Joe Gruters, Darryl Rouson and Corey Simon.

The House conferees for health care spending are: Reps. Sam Garrison, Shane Abbott, Carolina Amesty, Robin Bartleman, Kimberly Berfield, Berny Jacques, Lauren Melo, Michele Rayner, Michelle Salzman, Allison Tant, Dana Trabulsy, Chase Tramont and Marie Woodson.

The House and Senate often are at odds over Medicaid rate increases, and those issues typically are unable to be agreed to at the conferee level and are “bumped” to either the House and Senate Appropriation Committee Chairs, or often the House Speaker and Senate President.

Many of those issues, though, already are agreed on, and funding is included in the Live Healthy proposals (SB 7016, SB 7018) that passed the Legislature last week. SB 7016 has a $717.1 million-plus price tag, while SB 7018 directs for the next decade a $50 million appropriation for the creation of a Health Innovation Fund.

But lawmakers haven’t agreed on all Medicaid spending levels. One of the larger unresolved issues is nursing home reimbursement. The House included nearly $124 million in additional funds for a nursing home rate increase in its proposed spending plan, while the Senate hasn’t included a rate hike for nursing homes in the coming year.

The budget conferees also must agree on the details in two implementing bills: SB 2518 and HB 5301.

The House proposal appears to be aimed at hospitals in Pasco and Pinellas counties that have been unable to agree on a self-imposed tax designed to generate local funds needed to participate in a supplemental financing program called Direct Provider Payment or DPP. The House bill would prevent hospitals that aren’t participating in the DPP program from receiving payments from two other Medicaid supplemental financing programs — the Low Income Pool (LIP) and Graduate Medical Education (GME).

Combined, the DPP, LIP and GME account for $5 billion in supplemental Medicaid payments made to Florida hospitals that provide care to the poor, elderly and disabled.

Garrison, the Chair of the House Health Care Appropriations Subcommittee, told Florida Politics in January that the DPP program is an integral part of the state’s hospital financing system and that levying the tax isn’t optional.

“This is serious. Health care matters to the communities that rely on these institutions, especially folks that do high Medicaid and lots of charity care,” Garrison said.

To date, the Senate has rejected that idea.