Christine Jordan Sexton
Though lawmakers have already agreed to $717 million in health care funding with the passage of the Live Healthy package last week, House and Senate budget conferees still must resolve how to spend about $16 billion across the state’s various health-related agencies.
House Health Care Appropriations Subcommittee Chair Sam Garrison predicted that cancer funding, rate increases for nursing homes and hospital Medicaid supplemental payments could be the more difficult issues to resolve.
His counterpart, Senate Appropriations Committee on Health and Human Services Chair Gayle Harrell, didn’t disagree.
Both chambers have included in their proposed spending plans increased funds for the Cancer Research Innovation Program. First established in 2023 by First Lady Casey DeSantis, the funding aims to provide opportunities to break down long-standing silos between researchers, cancer facilities and medical providers to improve cancer research and treatment.
The House proposes spending significantly more money than the Senate. The House has $80 million in state and federal funds for cancer innovation, while the Senate budget proposes spending just $30 million.
“We’ve got some work to do on cancer funding, we are a little bit apart there,” Garrison said.
Harrell saw the spending gap between the chambers’ budgets a bit differently, though.
“Their allocation is much higher than ours,” she said. “It’s still under consideration at this point.”
As the chambers began negotiations, the House had proposed a $124 million bump in payments for nursing homes and the Senate had proposed none. The House then upped its initial proposal, about a 4% rate increase, to a 6% increase instead Monday night, during the first round of negotiations. The 6% hike is a $185.8 million increase.
“I think 6% is a reasonable starting point,” Garrison told Florida Politics. “And given the challenges that our nursing homes have faced with inflation and all the other things, and considering how totally dependent they are on state funds — they are obviously critical to the well-being of our seniors — so that was a priority for us.”
Harrell said the Senate is reviewing the nursing home payments but noted that the Legislature has made nursing homes a priority.
“We are looking at that issue but they got a significant increase last year and it was not the first time we made significant increases,” Harrell said. “We have a lot of priorities and there are so many needs out there that will be considered.”
As the Legislature navigates the last two weeks of Session, House Speaker Paul Renner and Senate President Kathleen Passidomo on Monday agreed to budget allocations, or the top-line spending amounts across the various budget silos, such as health care, general government and education.
The budget, also called the General Appropriations Act, is the only bill the Legislature is required to pass each year. A final vote on the budget cannot take place until 72 hours after it’s been distributed to the 160-members of the Legislature.
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 House and Senate also take different approaches to the use of supplemental Medicaid payments for Florida hospitals.
The House wants to change the law to ban hospitals from receiving Low Income Pool (LIP) or Graduate Medical Education (GME) supplemental payments if they don’t also participate in a supplemental payment program called Direct Provider Payment (DPP).
DPP is the newest Medicaid supplemental payment program. It was designed to bridge the difference between Medicaid reimbursement rates that providers are paid and the actual costs of providing the care.
Combined, 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.
Like all supplemental Medicaid programs in Florida, the required state match needed to draw down additional federal Medicaid dollars comes from local intergovernmental transfers (IGTs). The state doesn’t spend any general revenue on the supplemental payment programs.
Private hospitals that cannot contribute IGTs have benefitted from LIP payments. That is not the case with DPP, though. To participate in the DPP program, private hospitals also must contribute to the costs. To do so, all the private hospitals in a Medicaid Region must agree to the tax. Hospitals in Pasco and Pinellas counties though have been unable to reach an accord on the self-assessment, which blocks them from participating in the DPP payments.
In turn, those hospitals have turned to the Legislature for additional funding.
Garrison said in January that the Legislature shouldn’t be assisting non-DPP participating hospitals by giving them additional funds.
But Harrell said it isn’t that easy.
“That issue is very much up in the air, “she said, noting that hospitals have been receiving LIP payments for years. “The risk of losing access to LIP is so significant.”
