TALLAHASSEE — Trimming healthcare and road projects, Florida lawmakers Sunday put some final touches on next year’s $69 billion-plus state budget, but not before they tried to help influential hospitals in Miami, Tampa and Gainesville.
As time dwindled to finalize compromises on a range of issues, lawmakers agreed that no tax dollars could be used for travel to terrorist nations such as Cuba, and they decided that a fractional property tax increase for local school districts could be approved only by a referendum of the county’s voters.
Budget talks went smoothly most of the weekend, though discussions bogged down over healthcare because of the predicament facing the state’s largest Medicaid provider, Jackson Memorial Hospital in Miami, which faces a $230 million deficit.
Rep. David Rivera, R-Miami, the House budget chairman, offered to give the hospital $50 million more as long as Miami-Dade County agrees to specific cost savings in an effort to make the hospital financially sound.
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The Senate insisted on stricter assurances from Miami-Dade County commissioners and the local public health trust, which runs the hospital.
“I don’t want to give them $50 freakin’ million dollars only to have them blow it,” said Senate budget chairman J.D. Alexander, R-Lake Wales. Alexander also said a major House plan to expand the role of HMOs in managing Medicaid would not pass this year.
Both chambers agreed to shield Miami Children’s Hospital and All Children’s Hospital in Tampa from steep 7 percent cuts in state Medicaid reimbursement rates, but the two chambers had not agreed on a final number by late Sunday.
Under the tentative deal for Jackson Memorial, Shands Health Systems in Gainesville — near House Speaker Larry Cretul’s Ocala-based district — would receive an additional $15 million, and about 160 hospitals that provide charity care would get tens of millions of dollars more in Medicaid money.
The extra hospital money would come only if Congress votes to boost the federal share of money it sends to Florida through Medicaid, a $19 billion program. The extra Medicaid money for Florida — about $1 billion — is no sure thing in a Congress where Republicans are united in opposition to Democratic spending.
Even if the new money comes to Florida, Republicans want to put most of it toward savings, a proposal that makes Democrats uneasy. The final budget should be agreed to by today, printed Tuesday and voted on by the full Legislature on Friday.
Sunday was spent agreeing to a series of modest cuts and spending items that have real-world consequences: a $12 million reduction for the Healthy Families program, which initially faced elimination, and a $2.6 million cut to Healthy Start, both of which help families in crisis. Behavioral services for the developmentally disabled face a $2.4 million reduction.
Lawmakers will probably reduce money for substance-abuse and mental-health programs that help keep people employed, out of jail or in treatment
“The problem with half a cut is it still closes programs,” said Carole Green, a former Department of Elder Affairs secretary who lobbies for about 36 substance-abuse and mental-health providers.
Rep. Denise Grimsley, R-Lake Placid, said the reductions would be a problem because reducing prevention and treatment increases the likelihood of crime and abuse, which costs society more money in the end.
It’s not just healthcare that faces cuts. To balance the budget, lawmakers are planning to take about $500 million out of specialized “trust fund” accounts. The biggest reduction, $160 million, comes from the state’s transportation trust funds and would delay some road projects.
Alexander said he “hates” the reduction, but that it’s better than the original House plan to take about four times that amount. He said the transportation cut was a necessary evil during negotiations so that the Legislature could end its session on time Friday.