House and Senate negotiators could not reach agreement Friday about key issues in the roughly $30 billion health and human services budget, including Medicaid rate cuts for hospitals and nursing homes and spending on substance-abuse and mental-health treatment programs, reports Jim Saunders of the News Service of Florida.
The unresolved issues now go to Senate Budget Chairman JD Alexander, R-Lake Wales, and House Appropriations Chairwoman Denise Grimsley, R-Sebring, who will spend the weekend trying to finalize the 2012-13 state spending plan.
Negotiators, however, resolved a series of other disagreements Friday, such as deciding to limit Medicaid beneficiaries to six emergency-room visits a year. They also ditched a short-term proposal that would have shifted more Medicaid beneficiaries into HMOs and avoided cuts in a program that helps young adults who have been foster children.
The decisions emerged during three meetings of a House and Senate conference committee held throughout . The negotiators had made little progress earlier in the week, as they grappled with what could be the most-complex part of the state budget.
“If you look at where we were 48 hours (ago), big step in the right direction,” House Health Care Appropriations Chairman Matt Hudson, R-Naples, said Friday night after the final conference committee meeting.
With the state facing repeated budget shortfalls in recent years, hospitals and nursing homes have faced a series of Medicaid rate cuts. On Friday, the chambers remained apart on how to respond.
The Senate on Friday proposed a 7 percent, or nearly $292 million, cut in hospital rates. The House had earlier proposed that same amount, but revised its proposal to call for a 6.75 percent, or $281 million, cut.
Senators, meanwhile, have focused on trying to shield nursing homes from significant cuts. In its latest proposal, the Senate suggested a 1.25 percent, or $38 million, cut in nursing home rates, while the House is seeking a 1.75 percent, or $53 million, cut.
Hudson said he thought a 1.75 percent cut was “pretty palatable.” But Senate Health and Human Services Appropriations Chairman Joe Negron, R-Stuart, has repeatedly said he wants to protect nursing homes from cuts.
“I felt very strongly that I wanted to have a very minimal nursing-home cut,” Negron said after suggesting the 1.25 percent reduction.
The two chambers have bigger differences — financially and philosophically — about funding for mental-health and substance-abuse treatment programs. Negron has called for deep cuts as a way to help fund other health- and human-services programs, while the House has balked.
In the latest proposals, the Senate called for cutting adult mental-health programs by $33.5 million and adult substance abuse programs by $13.2 million. That is more than double the House’s proposal to cut $13.5 million in adult mental-health and $5.4 million in adult substance abuse.
Facing an overall budget shortfall, legislative leaders have long made clear they would need to make cuts in health- and human-services programs for the upcoming 2012-13 fiscal year.
Some of the cuts will affect businesses or institutions, such as hospitals and nursing homes. But others would more directly hit people who receive aid from state programs.
For example, the House and Senate agreed Friday to limit emergency room visits for non-pregnant adult Medicaid beneficiaries to six a year. That move will save about $46.7 million.
The House, however, dropped a proposal to make a nearly $11.7 million cut in the Road to Independence program, which provides support to former foster children. The cut would have led to cutting off aid to the former foster children at age 21 instead of age 23.
The Senate, meanwhile, dropped a proposal to shift potentially hundreds of thousands of people enrolled in what is known as the MediPass program into Medicaid HMOs or other managed-care plans. That proposal would have been a short-term step as the state moves in the future toward statewide enrollment in managed care.