House Speaker Dean Cannon and budget-writers revealed some broad brush strokes Thursday for how the House will craft next year’s state spending plan — embracing Gov. Rick Scott’s call for a $1 billion boost in public school funding, but rejecting his call for deep cuts in Medicaid payments to hospitals.

Cannon’s release of spending allocations for budget subcommittees also may heighten pressure on the state Senate, where Senate President Mike Haridopolos, R-Melbourne, and budget chief J.D. Alexander, R-Lake Wales, have talked about possibly delaying final action on a budget until later this spring.

Cannon, though, also seemed to try to find a middle ground — assuring lawmakers in his budget memo that “contingencies” could be included in a final spending plan that made changes if the economy brightens, or worsens.

 ”These contingencies will provide self-executing direction on how to enact reductions or provide additional spending authority, without accessing reserves, should circumstances change,” wrote Cannon, R-Winter Park, who is a lawyer, by profession.

Alexander, who declined to say much about the House approach, said the Senate did plan to move ahead with its budget work. But he said leaders there were still concerned about economic shifts that might effect the spending plan, which takes effect July 1.

Still, Alexander said the House’s idea about building in proposed cuts as contingencies, “is another option to deal with this concern.”

While Scott built his $1 billion public school increase by cutting almost $2 billion in Medicaid spending, the biggest share coming in cuts to hospitals, Cannon outlines a different course.

He said the House wouldn’t go along with Scott’s plan to overhaul immediately the way hospitals get reimbursed for treating poor, elderly and disabled Floridians. But Cannon hinted that deep reductions in general government, transportation and environmental programs would be deployed, instead, by the House to find school dollars.

The House also pulls close to $300 million from state trust funds for use elsewhere in the budget – double what Scott proposed diverting from these accounts. But the House has to set aside as much as $100 million for tax breaks in the coming year, topping the roughly $35 million the governor has proposed. 

The Florida Education Association, the state’s largest teachers’ union and a powerful ally of the Legislature’s outnumbered Democrats, were cool to the House’s proposal. Andy Ford, the FEA president, said the proposed school increase doesn’t come close to offsetting the $1.3 billion in cuts imposed by Scott and lawmakers last year.

Scott’s proposal would boost average per-pupil spending by $142, to $6,372, which is still well below the record $7,126 reached in 2008, before the recession forced deep cutbacks. Classroom spending currently is at its lowest level in six year.

“Every child in Florida deserves a high-quality neighborhood school – and it’s within our means to provide one,” Ford said. “But we must understand that investing in our children pays the highest dividends…This proposal puts a small bandage on the gashes inflicted with last year’s budget. We need to do better.”

 

With the Senate poised to pass an elections overhaul opposed by the League of Women Voters and other voting-rights groups, a labor union leader prompted Senate Democrats to ask loads of questions not just to find out more information about the bill (HB 1355) but to help prepare for lawsuits.

“The questions you ask lays the basis and foundation for the challenges on this,” Florida AFL-CIO president Mike Williams advised the Senate Democratic caucus this morning.

The sweeping elections package includes such strict regulation of third parties conducting voter registration drives that the League of Women Voters will likely no longer participate, the league’s lobbyist Jessica Lowe told the caucus.

Much of the caucus discussion this morning centered around a Medicaid overhaul crafted in secret by GOP House and Senate leaders over the past few days. The bill (SB 1972) is slated to be heard today in the Senate although it has not yet been released to the public. Senate HHS chief Joe Negron, R-Stuart, who’s crafting the proposal, spoke with Democrats this morning about it but failed to win support.

Democrats who wanted to file amendments to the bill were told they can’t until the original bill is filed.

The Senate plans to move ahead with an overhaul of  Florida’s Medicaid program Thursday — reviving an issue that went underground weeks ago, after the House and Senate approved rival plans.

Senate President Mike Haridopolos, R-Merritt Island, offered no details of what he described as an emerging compromise proposal. He also shrugged off questions about why the plan to revamp health coverage for 2.9 million low-income, elderly and disabled Floridians could only be settled far from the eyes of the public.

“There won’t be any new issues in there,” Haridopolos insisted. “We’ve been discussing it for two years.”

Senate health and human services budget chief Joe Negron, R-Stuart, and his House counterpart, Rob Schenck, R-Spring Hill, have been saying discussions were going well.  But neither would say a word about the talks.

Senate Rules Chairman John Thrasher, R-St. Augustine,  said earlier this week that to approve a Medicaid revamp now — in the waning days of the session — would be inappropriate.  Instead, Thrasher said he expected a special session to be called in coming weeks.

The House and Senate both want to put most Medicaid patients into managed care programs in a bid to save money. But similarities end there.

The Senate would’ve divided the state into 19 regions,based on state court circuits. The House proposed eight regions, with Palm Beach County included with Broward, Martin, Glades and Hendry counties.

The Senate excluded developmentally disabled Floridians now served by Medicaid — a stance Haridopolos hinted Wednesday night he expected to hold in the soon-to-be-sprung compromise plan.

With House-Senate budget talks stalled — or, at least far from the prying eyes of Floridians — House Speaker Dean Cannon said Monday that prospects for an on-time finish Friday are dimming.

Hundreds of millions of dollar in health and human services programs, an overhaul of Medicaid, and scores of lesser issues are dividing lawmakers.

“My gut tells me it’s going to be a photo-finish,” said Cannon, R-Winter Park. “I certainly hope we can get done on time. But it’s more important that we get it done right than we get it done quickly.”

Already Cannon’s puzzling about how to head into overtime — if chances for the photo-finish fades. Lawmakers could extend the session by a day, conclude all bills but the budget Friday and return to the Capitol next week for a budget vote, or — who knows?

“By talking about that, I don’t want to give anyone the impression that I don’t think it’s possible we don’t get done on time,” Cannon conceded.

Senate budget chief J.D. Alexander, R-Lake Wales, also said Monday night that odds were getting long for an on-time finish Friday.

He’s been fuming about the House failing to move forward with decent offers — especially on health and social services spending, where hundreds of millions of dollars in differences divide lawmakers in the state’s Medically Needy program, Medicaid Aged and Disabled prescription drug services, and rates for hospitals, nursing homes and HMOs.

“Hopefully,we’ll be able to get it wrapped up soon,” Alexander said. “That’s our great desire.”

A recurring subtext to settling on a $67-billion-plus budget that closes an almost $3.8 billion shortfall is Gov. Rick Scott’s steady push for a cut in the state’s corporate income tax. Senate President Mike Haridopolos, R-Merritt Island, said he didn’t expect the reduction to happen.

Scott has suggested he might veto any budget that didn’t include the business tax break.

 ”My song has not changed one bit from 10 weeks ago to today,” Cannon said. “It’s just an awfully heavy lift.”

Cannon said lawmakers have explored the idea of structuring a corporate income reduction around exempting some lower-income businesses from the levy. But the speaker acknowledged he didn’t know how that might be received by Scott.

“We’re going to write the best general appropriations act we can with the money we’ve got, and we’ll see where it goes from there,” Cannon said.

As budget talks on health and human services appropriations stalled, the Senate is moving forward with its Medicaid overhaul. Senate GOP leaders have not scheduled the immigration bill for Saturday, although only two hours of notice are required to add it to the agenda.

The Senate will take up its proposal (SB 1972) on Saturday along with dozens of local bills and Senate confirmations of Gov. Rick Scott’s appointees. But no word yet on whether the chamber will address immigration reform, still in flux as Senate Budget Chief J.D. Alexander, now shepherding the bill (SB 2040), weighs his options.

The House and Senate are both looking to put most of the state’s 2.9 million Medicaid patients into HMO-style plans. But differences abound between the two approaches. The Senate would divide the state into 19 regions, based on state court circuits; the House proposes eight.

The chambers are far apart on immigration reform as well. The House’s Arizona-style plan is on hold as the Senate considers a more moderate approach.
(more…)

A Medicaid rewrite that would steer 2.9 million low-income sick and elderly Floridians into managed care programs across 19 still-to-be-established regions cleared its first hurdle Wednesday in the state Senate.

The Health Regulation Committee approved the measure 11-0, despite concerns from some lawmakers that the legislation threatens many low-budget, community care providers who currently serve thousands of elderly Floridians in their homes.

Critics said they fear these providers could be hard-pressed to win contracts and play a role in a new system dominated by large HMOs and hospital-driven Provider Service Networks (PSNs).

But Senate sponsor Joe Negron, R-Stuart, said that competition was key to assuring that Medicaid patients received better and more efficient care.

Negron said lawmakers are looking to cut $1 billion from Medicaid’s current $22 billion budget, which now represents almost one-third of the state’s recession-wracked state spending plan.

“I want this bill to be bold and transformative, rather than just sniveling around the edges,” Negron said. (more…)

A rewrite of the state’s $22 billion Medicaid program cleared the House budget committee Thursday in a party-line vote, after ruling Republicans tucked in a provision making it tougher for patients to sue doctors.

Medicaid patients injured in medical malpractice cases would be limited to a $300,000 award under the late-added measure.

Rep. Rob Schenck, R-Spring Hill, who is spearheading the House’s Medicaid rewrite, said the limitations will encourage more doctors to care for the low-income, elderly and disabled patients the program serves — if shielded from heavy legal liability.

Democrats pushed back — unsuccessfully, seeking to at least delay the vote.

Critics also said the limit would force severely injured, indigent patients to remain on state Medicaid rolls, adding costs that could have been removed if they were able to secure a malpractice settlement.

Without prospects for a substantial legal payment, trial lawyers are unlikely to pursue lawsuits involving Medicaid doctors or facilities, critics said.

“I can’t answer as to why or why not an attorney would take a case,” Schenck said. “What I’m okay with is having more providers taking care of more Medicaid recipients.”

A stark state spending plan, flush with red ink, began taking shape Monday in the state Senate, with school dollars sliced 6.5 percent and a health care proposal on track to save $1 billion in Medicaid spending, much of it from program cuts.

Health and Human Services budget chairman Joe Negron, R-Stuart, praised the Senate’s $28 billion for maintaining spending on some key program, including funding for homeless, AIDS drug assistance, and the state’s KidCare and Healthy Start insurance programs.

But he acknowledged the Senate — like the House — is ready to recast Medicaid, putting almost 3 million Floridians into managed care programs to trim costs, while also cutting services.

“We’ve heard that the current system is irretrievably broken, so we’re starting a new system,” Negron said. 

A Medicaid pilot program operating in five counties since 2006, including Broward, has been derided as a failure by many critics. But Negron said the new program will look nothing like the pilot program and will not drive frustrated patients to use hospital emergency rooms — one of the costliest venues for care.

But the Senate is banking heavily on its high-wire reform effort. In the budget unveiled Monday, hospitals would lose 10 percent of state funding for treating both in- and outpatient Medicaid recipients — cutting $450 million from the budget. 

 The Medically Needy program, an optional program long paid by the state and federal governments, would be sharply scaled back to save $230 million under the Senate budget — eliminating financial help given transplant patients and other hard-to-insure Floridians.

School funding, meanwhile, would drop 6.5 percent under the Senate plan. In the good-cop, bad-cop approach of budgeters, that’s still the mildest slice: The House has recommended a 7.7 percent per-pupil reduction, while Gov. Rick Scott called for a 10 percent drop.

Just hours before Senate budget panels begin work Monday afternoon, House Speaker Dean Cannon did his own bit of budget calculus — unveiling the amount of taxpayer cash he’s allocated to each of the state’s big spending categories.

As usual, education is getting the biggest share of dollars, $8.2 billion for public schools, alone. Close behind is Heath and Human Services, drawing $7.1 billion in general revenue, even as both the House and Senate look to trim future costs with a sweeping overhaul of the Medicaid program.

In outlining the spending in a memo to fellow lawmakers, Cannon also made some commitments. (more…)

The House version of a sweeping rewrite of Florida’s Medicaid program is poised for a vote this week — the first step toward a legislative end-game with the Senate aimed at yielding a statewide managed care program for the state’s low-income poor, disabled and elderly.

At some point, the federal government is going to have to give its OK to whatever Florida lawmakers agree on.

 But House Health and Human Services Chairman Rob Schenck, R-Spring Hill, said it’s clear state lawmakers agree the goal is to get a handle on a program on track to absorb one-quarter of the state’s roughly $66 billion budget.

“I’m more focused on changing the Medicaid model at its core for generations to come,” said Schenck, who also said “this is a new day for Medicaid.”  (more…)

House Speaker Dean Cannon says he has no immediate political ambition beyond leading the state House the next two years.

But he could have a future as a Texas hold ‘em poker player.

Cannon on Monday unveiled some dramatic House positions on the courts, pill mills, immigration and Medicaid — on the eve of the Legislature’s opening. He also delivered them using what has become a typical Cannon approach: deeply layered policy changes formed with seemingly little attention paid to those most affected.

As a rising House member, Cannon used a similar tactic in advancing measures affecting property taxes, Medicaid and offshore oil-drilling.  But unlike past years, Cannon floated his ideas out early Monday — instead of the waning hours of a legislative session. (more…)

Sen. Joe Negron wants fat Floridians and smokers to get healthy or else.

Included in Negron’s revamp of the state-federal Medicaid program – which Negron will release tomorrow – is a component aimed at what senators are calling “personal responsibility.”

Sen. Don Gaetz, a Niceville Republican who helped craft Negron’s bill, said Medicaid patients have to take control of their health care just as he had to do when his doctor told him to lose weight.

“We’re saying that an individual who’s been diagnosed as morbidly obese needs to be on a medically-directed program of weight loss to manage that health care problem that could turn into an increased taxpayer liability. The same thing with smokers,” Gaetz said.

The bill would require smokers and alcoholics and drug addicts to get treatment, Gaetz said.

Negron said his bill would include incentives for Medicaid patients to lose weight, quit smoking and stop drinking but did not give details about what they would be.

If they don’t get thinner and put down the smokes, Negron said their coverage could be cut off.

“It’s possible,” Negron, R-Stuart, said.

He said the Medicaid program currently includes a seldom-used provision that would allow the state to boot patients out.

“If you are non-compliant with your appointments, if you reject medical advice, there is a system in place under current law, which is rarely used but it has been used, …where someone would no longer receive services,” Negron said.

Healthier Medicaid patients will save the state money, Gaetz and Negron said.

“They not only compromise the quality of that person’s life they compromise the efficacy of any medical care that might be rendered but they drive up costs that are then shifted to the friends and neighbors who are actually paying the health care bill for the individual who is smoking,” Gaetz said.

The system can no longer tolerate someone “who is an alcoholic and wants to offload the medical consequences of alcoholism to the taxpayers of Florida,” Gaetz said.

State economists gave lawmakers the bad news this morning that Florida’s budget gap is expected to grow by as much as $1 billion.

The News Service of Florida filed this report earlier today:

Amy Baker, executive director of the Legislature’s Office of Eeconomic and Demographic Research, told the Senate budget committee that revenue estimators are likely to downgrade the state’s budget picture when they meet next Tuesday.

“We are starting to show improvement year over year,” Baker said. “It’s just not as strong as we’d hoped for.” Tax collections were $136 million short of expectations for the three months ending in October, with November’s findings still not final but on track to fall another $100 million down, Baker said.

Meanwhile, Medicaid forecasters will meet Friday and Baker warned, “the number is going to be big.” House budget staff on Tuesday told House members that the shortfall was on track to hit about $3.5 billion — up from the earlier $2.5 billion level.

UPDATE: Haridopolos’ spokesman said the notice announcing the informal meeting was a favor to the media to give the press a heads-up. Look for the list of invited speakers later. Because committees are not yet assigned, the Senate is not required to notice the meetings yet.

Leaders in the Florida Senate will begin Medicaid reform meetings tomorrow while in town for the organizational session/special session to override a smorgasbord of Gov. Charlie Crist’s vetoes.

Sen. Don Gaetz, a Niceville Republican who once owned the state’s first private hospice care chain, will head the day-long meeting.

A press release issued by Senate President-designate Mike Haridopolos (who’ll lose the “designate” shortly after 10 a.m. today) says Senate will “receive testimony and hear presentations from invited speakers and the public on the issue of Medicaid.”

Haridopolos, R-Merritt Island, has made a big deal out of being open and transparent and took down the doors to his office’s inner sanctum inside the president’s suite as a symbolic gesture yesterday to demonstrate his availability to his members.

But there’s no list of tomorrow’s invited speakers in the press release.

When asked, Haridopolos’ spokesman David Bishop said in an e-mail the guests will be “stakeholders.”

,

Senate President-to-be Mike Haridopolos wrapped up a three-day tour of Florida highlighting one of his priorities when he takes over the chamber in November: a total overhaul of the state Medicaid system, which he calls broken.

Haridopolos toured cities from Miami to Tallahassee by bus, flanked by GOP Senate leaders Don Gaetz of Niceville and Joe Negron of Stuart, as well as Haridopolos’ wife Stephanie, a family practice doctor in their Melbourne hometown.

It’s not unusual for new chamber leaders to travel around the state to pump themselves up before taking the helm.

Former Senate President Ken Pruitt made a sweep of Florida in a little yellow school bus championing the Bright Futures scholarship for two years before taking over the chamber in 2006.

Haridopolos wants the federal government to approve a Medicaid waiver for Florida that would allow the state to place all of the state’s 2.7 million Medicaid recipients into managed care. It’s unlikely that Democratic President Barack Obama’s administration would approve such a maneuver, especially given Haridopolos’ and crew’s repeated bashing of federal health care reforms and their support for Attorney General Bill McCollum’s lawsuit against the White House regarding the new health care law.

Expect a major component of Haridopolos’ Medicaid revamp to include tort reform.

He told reporters today that a major problem for Medicaid providers such as hospitals is the high cost of medical malpractice insurance.

“What we’ve consistently heard during these round table discussions is that doctors who have protections against malpractice lawsuits have the ability to deliver a higher quality of care to their patients,” Haridopolos said.

Click here for a list of Gov. Crist’s vetoes

Gov. Charlie Crist slashed a record $360 million from the state’s $70.4 billion budget today, saying the projects were not properly vetted or benefited only select groups.

Crist’s vetoes include $160 million lawmakers had taken from the state transportation trust fund. Florida House leaders insisted on including the road project money to pay for per-pupil education spending.

Crist also vetoed a reduction in reimbursement rates for Medicaid nursing home providers and axed a portion of the budget that would have prohibited the use of any state funds to pay for human embryonic stem cell research.

A last-minute amendment on a sweeping health care provider bill would require Florida’s sickest Medicaid patients – those getting five or more prescriptions – to receive their drugs only by mail.

Opponents of the proposal, up for consideration this afternoon in Senate Ways and Means Committee, object that the change could harm Alzheimer’s patients, AIDS patients and others who need pharmacists to help them manage their medication.

It’s part of an ongoing battle between doctors and pharmacists over who gets to dispense drugs.

The meds-by-mail plan is being pushed by Prestige Health Choice, a physician-owned HMO that is participating in a Medicaid pilot project.

I swear I’m not picking on state Sen Joe Negron. The second blog post (after this one earlier) about him today is just a coincidence…

The Sun-Sentinel reported this week that the Stuart Republican criticized President Obama’s health care bill because it would let “middle class” people enroll in Medicaid, a health care program designed for the poor. (Negron opposes the health care bill: He encouraged Attorney General Bill McCollum to sue over it and offered a budget amendment this week to counter some parts of it.)

The federal health care reform does expand Medicaid eligibility to 133 percent of the poverty line, which is about $29,326 for a family of four.

Just a couple of weeks earlier, however, Negron told the Senate Finance & Tax Committee that his own plan to expand the state voucher program is aimed at “the poorest of the poor.”

How does Negron define “poorest of the poor”? Well, Negron’s bill (SB 2126) would let families at 230 percent of the federal poverty level — or $50,517 for a family of four — keep half of their voucher to attend private schools.

The Senate approved a sweeping overhaul of Medicaid that would require some Medicaid recipients to pay deductibles and co-payments and give vouchers to others for medical care.

Sen. Joe Negron, R-Stuart, introduced what he called the “transformative” change as an amendment to the budget (SB 2700), which drew criticism from Democrats who objected the major changes should have been debated in committees.

The proposal would give state health care officials the authority to develop a new waiver program for Florida’s $18 billion Medicaid program. Federal officials would have to approve the waiver.

Negron said the time is urgent because the federal health care reforms signed into law by President Barack Obama could significantly increase the state’s spending on Medicaid, the health care program for the poor.

“The reason we can’t put money into education into other areas of the budget is because…they just come hand us an invoice, you owe us $1.8 billion more this year.
I don’t know why it should be entitled to preferential treatment over all the other needs of the state,” Negron said. “The time right now is urgent.”

The proposal is “a wholesale change of one of the largest and most important programs in this state,” objected Democrat Nan Rich, vice chairwoman of the Senate Health and Human Services Appropriations Committee.

“This is a huge policy and appropriations issue. It does not belong passed or defeated on this floor today. It needs to go to substantive committees,” said Rich, D-Weston.

The amendment passed by a 24-12 vote.