With hundreds of millions of dollars riding on their decisions, House and Senate negotiators remained sharply divided Wednesday about how to balance the health and human services budget.
The House and Senate exchanged proposals that included major differences on Medicaid payment rates for hospitals, nursing homes and physicians. Also, they split on issues such as the Medically Needy program, biomedical research and mental-health and substance-abuse treatment.
Senate Health and Human Services Appropriations Chairman Joe Negron, R-Stuart, put the choices in stark terms as he huddled with fellow senators after a negotiating session with the House. Finding money to pay for one program can force cuts in another.
Its a zero-sum game, he said.
Senate negotiators were expected to make another proposal about 8:15 p.m., as lawmakers race to approve a budget before the May 6 end of the legislative session. The health and human services portion for the 2011-12 fiscal year is expected to top $29 billion, with most of that going to the Medicaid program.
One issue that quickly emerged Wednesday was a proposal by the Senate to spend $338 million to increase Medicaid rates for primary-care doctors. Negron said the proposal could help improve access to primary care, as many physicians refuse to treat Medicaid beneficiaries because of low payments.
But the House balked at the physician-rate increases -- a decision that House Health Care Appropriations Chairman Matt Hudson linked to the federal health overhaul. Hudson said the House refuses to carry out the controversial law, which calls for similar physician-rate increases in 2013 and 2014.
The reality is, Im not in a position to implement that act, the Naples Republican said.
Another hot-button issue is whether to make cuts in the Medically Needy program, which serves people who have debilitating illnesses but dont qualify for Medicaid.
The Senate on Wednesday proposed cutting $192 million from the program by eliminating coverage for hospital care. That scaled back an earlier Senate proposal that also would have eliminated prescription-drug coverage for Medically Needy patients, leaving only coverage for physician services.
But the House objects to any cuts in the program, arguing that the patients will still need hospital care for their illnesses. Hospitals fear they will get stuck with the costs.
Thats an important issue for us, Hudson said. Were not going to put more uncompensated care into our hospital system in Florida.
It also was quickly apparent that Medicaid payment rates for hospitals and nursing homes will be a key issue during the negotiations.
The Senate proposed shielding nursing homes from rate cuts, while the House proposed an 8.5 percent cut that would total $245 million.
Hospitals, meanwhile, appear certain to get hammered -- though it remains unclear how large the cuts will be. The House proposed about $373 million in cuts to hospital Medicaid rates, while the Senate proposed chopping about $438 million.
Negotiators met at 8 a.m. Wednesday and again about 12:30 p.m., swapping spreadsheets that showed dozens of differences between the chambers.
As an example, the House proposed cutting $50 million for biomedical research, while the Senate wants to fund the programs at places such as the H. Lee Moffitt Cancer Center in Tampa.
Another significant difference is that the Senate wants to cut about $248 million for adult mental-health and substance-abuse treatment programs. The House proposed about $18 million in cuts.
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