Legislature makes it easier for new hospitals to gain approval
The Legislature votes to streamline the certificates-of-need application process Orlando Sentinel
By Jason Garcia
May 3, 2008 — The Florida Legislature unanimously approved a bill Friday designed to make it easier for new hospitals to gain approval from state regulators -- a measure sought by Gov. Charlie Crist.
The bill streamlines the application process for what are known as "certificates of need," which hospitals must obtain before they can build or open. It also makes it harder for rival hospitals to delay the process by challenging a decision by state regulators to award a certificate of need. For instance, any party that challenges a decision and loses would have to pay the applicant hospital's legal fees, up to $1 million.
Crist began the legislative session calling for the process to be abolished altogether, in hopes of encouraging more competition among hospitals. Initially reluctant House Republicans approved a modified version of the bill as part of a deal negotiated with Crist on separate health-insurance and dentistry-regulation legislation.
Also on Friday, the Legislature approved a bill allowing Florida to steer nearly $2 billion of state-employee retirement money to in-state companies in high-growth, high-wage industries.
A top priority of the state's business lobby, the bill (SB 2310) authorizes, though does not force, the state to invest as much as 1.5 percent of Florida's retirement-system pension plan assets -- or about $1.8 billion -- in growth and technology businesses based in Florida. Among the industries the fund is authorized to invest in: space technology, aerospace and aviation engineering, renewable energy, and life sciences.
The package also creates a $40 million cash prize -- half to come from the state, half from private sources -- to encourage private advances toward a reusable space vehicle that could ultimately replace NASA's aging space shuttle.
Sponsored by state Sen. Jeremy Ring, a Democrat from Margate and early executive at Yahoo!, and state Rep. Frank Attkisson, R-St. Cloud, the bill was approved unanimously by the Senate. It had cleared the House earlier in the week on a 117-1 vote.
House, Senate OK Repeal Of 2 Health Care Programs Tampa Tribune
By Catherine Dolinski
May 2, 2008 — Distributed lawmakers neared agreement with Gov. Charlie Crist on a compromise plan to lower the uninsured rate, the chambers passed legislation that could end two health care programs that serve 40,000 vulnerable Floridians.
Crist has been pushing a plan to lower the rate of those without health insurance by offering low-cost, limited-benefits policies to those without coverage. Although the Senate embraced and approved that plan, the House advanced its own legislation that not only contained Crist's proposal, but contained a separate plan that would create a little-regulated marketplace of health care products that the uninsured could access through their employers.
Crist and senators have faulted the House plan as dangerous to consumers and too bureaucratic and costly, since it entails the creation of a public-private corporation to oversee the little-regulated "farmer's marketplace" of health care products. The chambers and Crist have been negotiating intensely, and Thursday, Crist said he was willing to sign legislation that includes the farmer's marketplace plan, so long as the House agreed to certain "conditions" he would not specify.
Senate health care budget chief Durell Peaden said late Thursday that all issues had been resolved, and that the legislation was expected to surface today with more oversight by state insurance regulators. "Somewhere along the line, they're going to have some jurisdiction."
House Healthcare Council Chairman Aaron Bean had a slightly different perspective, saying that an agreement was near but not quite sealed. As part of the ongoing "trade deal," he said, the House had agreed to accept a Senate bill to revise hospital regulation, a watered-down version of a plan put forth by Crist.
On the same day those negotiations neared a close, House lawmakers adopted a Senate bill that repeals the Medicaid Medically Needy and Medicaid Aged and Disabled programs.
Last month, House Speaker Marco Rubio and Senate President Ken Pruitt decided to take $300 million from a state trust fund to save the Medically Needy program, which covers lifesaving treatments for the chronically ill, and the Medicaid Aged and Disabled program, which covers medical costs that Medicare does not for low-income elderly residents.
Under pressure to cut more than $1 billion from the state's health care budget in response to plummeting state revenues, House and Senate lawmakers had proposed cutting most funding for both programs.
When Senate budget chief Lisa Carlton and House budget chief Ray Sansom announced April 23 that they would spend $300 million in one-time trust fund dollars to save the programs, patients and health care providers showered them with thanks.
"I'm a little overcome with emotion right now," said Mary Ellen Ross, a 55-year-old liver and bone-marrow transplant recipient from Delray Beach who leads the Florida Transplant Survivors Coalition. "Without this care, and without this program, I would certainly have a shortened lifespan."
On Thursday, Ross was outraged to learn that lawmakers had approved a repeal of the programs, effective July 1, 2009. In the case of Medically Needy, the program would sunset for all but pregnant women and children; the Aged and Disabled program would disappear entirely -- unless next year's Legislature chooses to reinstate and fund the programs.
"I feel raped," said Ross, who called it "back-door politics" and said she had no confidence that a future Legislature would act to restore the programs. For years, she said, the Legislature has tried to eliminate funding for those programs. "They're signing the death warrants of 40,000 people," she said.
Bean said lawmakers had to sunset the programs, leaving their fates up to the 2008 Legislature, because the trust fund dollars were nonrecurring. Legally, he said, sunsetting the programs was the only way to spend the dollars on otherwise recurring programs.
Rep. Loranne Ausley, D-Tallahassee, said she remains worried about leaving the fate of the programs so uncertain.
"I'm very concerned about it," Ausley said. "We can't bind future Legislatures."
Bean said he believed that lawmakers would act to preserve the programs next year.
"I am very confident they're going to find a way next year to get it done."
Health spending should be top priority Tallahassee Democrat Editorial
April 21, 2008 — With copies of the proposed $66.2 billion state budget in the hands of weary lawmakers in the waning days of their regular session, it's important that they not just throw up their hands and accept what their negotiators have handed them without taking a hard, last look at spending for health care.
If there's one thing that's painfully clear, it's that the proposed budget in this economic downturn is lean and mean. The question is how mean the final budget will be, particularly as it affects the most vulnerable Floridians — people whose lives depend on continued state support.
Regardless of party affiliation, political philosophy or personal style, every lawmaker must ask him or herself whether the infirm, the elderly and the uninsured — and poor pregnant women — are throwaways or people who matter. As testy and worn-out as legislators may be, it's imperative that in their test of wills and egos they not let their differences place already high-risk Floridians in even greater peril.
This is especially critical with regard to plans to provide broader access to health-care coverage for the 20 percent of Floridians — 3.8 million people — now without it.
House and Senate leaders last week wisely agreed to use $300 million in trust accounts to reduce the effects of more than $1 billion in cuts to important health-care programs. But the House and Senate remain at an impasse over whose proposal for the uninsured will become law — Gov. Charlie Crist's "Cover Florida" plan, which the Senate unanimously supports, or the House plan called "Florida Health Choices," or some hybrid of the two.
For $150 or less per month, Mr. Crist's plan would provide basic benefits for primary and urgent care by requiring insurers to provide more options. The House proposal is designed to be more market-oriented, but would cost taxpayers more than $1 million in start-up costs, which critics say is unreasonable when the state is making deep cuts in human services.
Both Mr. Crist and House Speaker Marco Rubio say expanding access to health care is at the top of their agendas, which is encouraging. But a Miami Herald report on Tuesday said that Mr. Rubio was "preparing to scuttle" any compromise if the House plan wasn't part of the package.
While it may be admirable that the speaker feels so strongly about the ideas that emerged from his chamber, failure to compromise on the backs of some of Florida's most vulnerable citizens is not. Particularly now.
On Monday, health researchers forecast that, amid the national economic slide, every percentage-point increase in unemployment would increase the ranks of the uninsured by 1.1 million. In Florida, which already has the third-highest uninsured rate in America, the impact would be especially painful.
Another study, by the nonprofit Robert Wood Johnson Foundation, said employer-based health-care premiums have increased 10 times faster than family incomes in recent years, swelling the ranks of the uninsured in Florida and elsewhere.
Regardless of what happens in the final week, this session will be remembered mostly for pain. If lawmakers deepen the pain for those who can least endure it, they should be ashamed — especially since the health coverage they and their families receive is courtesy of the taxpayers.
Our view: A shameful failure
Legislature slashes programs for elderly, poor, public safety and schools Florida Today
April 30, 2008 — In good budget years, Florida lawmakers give out lavish tax breaks that benefit business and the wealthy.
In bad budget years, services for the poor and elderly, public safety and education are slashed.
That unscrupulous history is repeating itself this week as House and Senate budget chiefs finished work on a $66 billion-plus budget deal to be approved by Friday when the legislative session is to end.
It's true spending cuts were inevitable as Florida stumbles through the second year of a slump and declining state revenues.
It's also true lawmakers made a few compromises to avoid drastic service cuts, such as taking $355 million from a $2 billion reserve fund to shore up county health departments and programs for the medically needy.
But they took the action only at the last minute and after being shamed into it by outcry from advocates, who rightly protested eliminating care for the most vulnerable was akin to murder.
And they refused to protect priorities like public safety, other health and child welfare programs and education by digging deeper into rainy day funds.
Or by taking sensible revenue-raising steps to fill the $3 billion budget gap.
They could have included repealing some of the $18 billion in tax breaks given to the state's wealthiest residents when the intangibles tax was nixed in 2006 under former Gov. Jeb Bush, joining other states in agreeing to collect taxes on Internet sales, or boosting taxes on cigarettes.
Here is just some of their handiwork:
Some $19 million slashed from last year's spending for protections for abused and abandoned children in foster care. That includes at least $1 million in direct cuts for Community Based Care of Brevard, which oversees foster care and adoption services for the Space Coast.
And no money for new adoptions, meaning children will languish in foster care, according to Patricia Nellius-Guthrie, executive director of CBC.
Or to keep a growing numbers of kids aging out of foster care from ending up homeless because they have no supports for the transition to independent living.
Those hits are part of larger reductions of roughly $100 million in budget dollars for the Department of Children and Families, meaning heavier loads for caseworkers and more vulnerable kids slipping through the cracks.
DCF Secretary Bob Butterworth rightly has described the deep funding drop for child protection as the equivalent of "a contract on kids."
Ironically, the same budget leaders who nixed Gov. Charlie Crist's request for $13.3 million in stipends for families that adopt foster children found $2 million to continue paying for a hot line and pregnancy crisis centers that advise women not to have abortions, showing that ideology trumps commonsense in Tallahassee.
April 29, 2008 — What’s wrong with Tallahassee? Is there no adult supervision in the political romper room called the Florida Legislature? Are our elected lawmakers really prepared to end the session this week by passing out an almost criminally negligent state budget that will do incalculable harm to Florida's education, health care, social service and criminal justice institutions?
This is far and away the worst session we've ever witnessed. We cannot recall ever seeing lawmakers conduct themselves in such an irresponsible manner and with so little apparent regard for the future of Florida and the well-being of its residents. The consequences of lawmakers' failure to take their responsibilities seriously will be dire and far-reaching.
It is not possible to eliminate millions of dollars from the court system and eliminate hundreds of public defender, state attorney and probation officer positions without endangering the public safety.
It is not possible to reduce per-student funding by $140 from the previous year without throwing the public schools into turmoil.
It is not possible to reduce Medicaid reimbursement rates by hundreds of millions of dollars without crippling the ability of "safety-net" hospitals like Shands to provide life-saving indigent heath care for needy Floridians.
It is not possible to slash millions of dollars from foster care and other child welfare programs without putting already vulnerable children at greater risk.
It is not possible to reduce state spending by $4 billion in the space of a year without wreaking havoc on the lives of countless Floridians.
Lawmakers blandly say such ruthless cuts are dictated by Florida's poor economy. But this is a Legislature that has slashed taxes by billions of dollars over the past decade while economic times were good. Now, when Florida's young, elderly, sick and unemployed are most in need of public assistance, lawmakers callously dismiss their needs while endlessly chanting the mantra "no new taxes no matter what."
Meanwhile, this being an election year, they busy themselves grandstanding on a never-ending line-up of ideologically and politically motivated bills.
Want to take your gun to work? Fine. Want an official state license plate glorifying Christianity? No problem. Want to throw yet another roadblock up in front of women who choose abortions? Make them get ultrasounds first.
Why not outlaw truck ornaments that look like bull testicles? And let's ban baggy pants in the schools? And don't forget to protect teachers of conscience from being "forced" to teach evolution.
All of the above may make for lousy, constitutionally suspect and even silly public policies. But they are wonderful fodder for 30-second sound bite re-election ads and campaign bumper stickers.
This Legislature is a disgrace. In this final week of the session lawmakers are willfully putting at risk the health, safety and welfare of their constituents. Meanwhile, Gov. Charlie Crist remains largely silent and passive, as though he has little or no leadership role in the debacle that is unfolding in the House and Senate.
Advocate for 'most vulnerable' citizens warns budget cuts could be lethal Tallahassee Democrat By Jim Ash
April 21, 2008 — Some wear tubes in their throats. Others depend on a machine for every breath. Many can't speak, can't walk or turn over in bed. If they have a family, their needs are too overwhelming to live at home.
They are some of the "most vulnerable" citizens that lawmakers pledge to protect this week as they negotiate more than $4 billion in budget cuts while holding the line on tax increases in an election year.
Under the spending plans released so far, advocates warn that for thousands of Floridians with cerebral palsy, mental retardation, autism and other crippling conditions are in danger. Many of them depend on Medicaid and the Florida ICF/DD Community Residential Program, and "intermediate care facilities," for survival.
Proposed cuts of between $19 million and $6 million to the program's $246 million budget are examples of the difference between dispassionate debate on numbers in the Capitol and cold reality back home, the advocates say.
"We're asking for a humane and compassionate response to the needs of Florida's most vulnerable citizens," Jim McGuire, executive director of a facility in Fort Lauderdale, said at a Capitol protest last week. "I ask the leadership of this state to accept this ethical and moral responsibility."
For the 72 disabled residents living in three "cluster" facilities in Tallahassee, the cuts will mean fewer staff members available for round-the-clock care, including vital moving every few hours to prevent potentially deadly bed sores, said James Weeks, vice president of Sunrise Community.
"All of these cuts will be in staff, they are 75 percent of our budget," Weeks said. "The cost of your light bill doesn't change."
The developmentally disabled aren't the only vulnerable Floridians who would feel the sting of the budget cuts.
The news got worse last week when a House social-services spending chairman announced that the $1.1 billion in cuts to health programs proposed by the House would have to go even deeper, by $82 million.
An exasperated Rep. Aaron Bean, R-Fernandina Beach, told reporters he didn't know where else he could cut.
"My focus now and my mission is to bring the House a bill that brings the reduction across the health care footprint," he said. "It's not my intent to close a group home for the developmentally disabled but to make them tighten their belt."
Some of the belt-tightening could be lethal, warns Tony Carvalho, president of the Safety Net Hospital Alliance of Florida, which includes 14 teaching, public and children's health care systems.
Carvalho points to a Senate proposal that would eliminate an optional program in Medically Needy for 24,000 elderly and severely and permanently disabled Floridians, some of whom are transplant recipients who need $6,000 a month for life-saving anti-rejection drugs.
Others with failing organs need state coverage to help qualify for a transplant in the first place, Carvalho said.
"Some of these people will be in life-threatening situations," Carvalho said.
The House would cut $238 million in Medicaid reimbursements to hospitals, the Senate $148 million. The hospitals are already losing money treating Medicaid recipients, Carvalho said.
"The very best thing that can happen is that the people who will lose eligibility will end up in an emergency room for their care, if they can get it. We don't support the reimbursement reductions because we don't think they're good public policy. But the elimination of eligibility for some of these programs, you just can't do that."
Cutting Medicaid programs, either through reimbursement rates or eligibility, doesn't make economic sense, advocates say. Where the state proposes to wipe $300 million off its ledger, the true cut is closer to $700 million, because of the loss of $400 million in federal money that comes with the program. Carvalho and others argue that the difference will be made up in local communities and the average Floridian who will see health insurance premiums rise to make up for the difference.
Sen. Don Gaetz, R-Niceville, agrees.
He's fighting proposed cuts to a $60 million program that pays for hospice care for some 46,000 dying patients on Medicaid. Eliminating the hospice option means the state is turning its back on the $50 million in savings attributed to the alternative program for the terminally ill, Gaetz said.
"Dying people aren't going to get better and they're not going to wander off into the woods," Gaetz said. "They're going to end up in acute care hospitals. This is one of the cuts that will immediately, and I mean immediately, create more expense."
Florida would also be turning its back on a unique history, Gaetz said. Florida was the first state in the nation to recognize the hospice option when former Gov. Bob Graham signed legislation in 1979. In the 1980s, Gaetz lobbied Congress to write hospice coverage into the federal Medicare and Medicaid programs. Gaetz built his business fortune in the hospice movement, but has since sold all of his interests.
"This is a real irony because it all began in that same House chamber where they are now considering the cut," Gaetz said.
House budget chairman Ray Sansom, R-Destin, told reporters last week that Floridians facing a grinding recession are cutting back their personal spending, and they expect state government to do the same.
But he acknowledged that as Republicans hit the campaign trail, they may have trouble explaining some of the proposed health care reductions.
"These are some of the issues that are sometimes hard to answer," he said. "It can always be used against you."
Medicaid Cuts - This Is Going to Hurt
Lawmakers struggle with vitally needed programs that are too costly not to cut. The Ledger (Lakeland)
By Stephen Nohlgren
April 21, 2008 — Florida taxpayers keep Evelyn Williams alive by paying for kidney dialysis.
Ralph Pineiro's liver transplant succeeded because Medicaid bought antirejection drugs.
Tina Cohen fights off leukemia with state-aided chemotherapy.
This week, the Florida House and Senate will try to lop at least $1 billion off health care budgets. Dozens of programs will come under the knife. Thousands of Floridians like Williams, Pineiro and Cohen will be left to wonder:
What will happen to me?
Cutting Medicaid, the health care program for poor people, is no easy task.
Slash services too much, and fragile clients land in nursing homes and hospitals, driving up costs instead of saving money.
Federal matching funds pay more than half of Medicaid's bills. So when the Legislature cuts back $100, clients lose more than $200 in services.
"If we don't spend that money, it just goes to another state," says advocate Karen Woodall. "We already paid the taxes. It's just in Washington. If we don't bring it back into the state, then we've just lost it."
Nevertheless, large budget deficits make Medicaid hard to ignore. Its $16 billion cost was nearly one-fourth of all state spending last year. Absent a tax increase, legislators have to cut Medicaid or cripple education and other essential services.
Here is a sampling of possible cuts, and people whose lives might change.
Medically Needy
Almost 20,000 clients.
House cut: $170 million.
Senate cut: $233 million.
Tina Cohen noticed the first pain while dieting for her high school prom.
It was chronic leukemia. Modern drugs can keep it at bay, maybe forever, but they cost $5,000 a month.
Doctor visits, bone marrow tests and other complications push her medical bills toward $50,000 a year.
Cohen, now 21, lives in Brandon with her 2-year-old son and boyfriend. Chemotherapy "was crippling at first," Cohen says. "It's really nasty stuff."
She has squeezed in a few small telephone jobs between nausea and taking care of her son, but that rarely brings in much.
Her boyfriend works in a pawn shop and earns less than $30,000 a year. They can't cover her expenses but they earn too much to qualify for regular, poor people Medicaid.
That's where Florida's "Medically Needy" Medicaid steps in. It helps when catastrophic expenses overwhelm incomes.
"Nobody will insure me. Only the state will," Cohen says.
One health maintenance organization she called "told me I would have to pay $500 a week, and they wouldn't pay the prescriptions."
Without chemo drugs, she says, "I run a big risk of winding up in the hospital. The cancer would attack my body and possibly kill me over time."
Ralph Pineiro, a 56-year-old Tampa resident, lost his liver a year ago to hepatitis C from old blood transfusions.
Medically Needy buys the $2,500-a-month antirejection pills that protect his new liver.
Pineiro, who gets $1,100 a month from Social Security, will qualify for Medicare disability later this year, and get his drugs that way.
For now, Florida fills the gap.
Pineiro is typical of many transplant patients, says Tony Carvalho of the Safety Net Hospital Alliance of Florida. Many are disabled with a multitude of complications. Medicare usually kicks in after two years, but people often can't wait that long.
Just to get on a transplant waiting list, people must demonstrate that they can pay the cost of aftercare, Carvalho says.
"Hospitals are not going to perform a quarter-of-amillion-dollar operation to put someone on the street who cannot then afford their drugs."
"If Medically Needy gets taken away, people are going to die."
Inpatient and outpatient care
2 million potential clients.
House rate cut: $330 million.
Senate rate cut: $205 million.
Evelyn Williams' life turned upside down seven years ago at age 16.
A bad heart valve, brain aneurysms, strokes, seizures and failing kidneys robbed her capacity to work, even at her old Dunkin' Donuts job.
Her meager disability check makes her poor enough to qualify for traditional Medicaid, which pays for kidney dialysis three days a week at Fresenius Medical Center in Tampa.
The four-hour treatments are exhausting, Williams says. Throw in bus rides going and coming, and it's all she can do to care for her twin boys, 4, and daughter, 3.
Williams' treatments cost the center $155 a pop, says Fresenius vice president Robert Loeper. Medicaid pays $125. The company compensates by soliciting donations and dipping into other revenue streams.
The Legislature now plans to drop dialysis reimbursement to $90, as part of a broad range of rate cuts to outpatient and inpatient service providers.
"We'll be losing $10,000 on nursing care and medical supplies alone," says Loeper.
Fresenius will continue to serve Williams and other current Medicaid clients, he says, but may have to turn away new ones.
"A lot of facilities are going to say, 'That's it. I can't take any more Medicaid patients or go bankrupt. They can stay in the hospital, where Medicaid pays $1,000 a day.' "
Williams would like to get a kidney transplant, get off dialysis and make her own way in the world. But she didn't work enough to qualify for Medicare disability, so she is stuck with lower-paying Medicaid.
Transplant hospitals and doctors, now in line for their own Medicaid rate cuts, may not accept her.
Nursing homes
Roughly 45,000 clients.
House cut: $278 million.
Senate cut: $164 million.
Bernice Goodman, 86, looks forward to exercise group three days a week at Palm Garden of Largo. She and fellow residents spend 20 minutes lifting legs, marching in place, stretching arms and rotating ankles.
"It helps me not get stale and sit in the room all the time," says Goodman, who has suffered three major strokes.
Such exercise classes are now under the budget-cutting gun, as are movie nights, dances and other activities that spice up a nursing home day.
Medicaid pays for more than half of Florida's nursing home residents. Proposed rate reductions could reach 10 percent.
Florida has some of the country's best nursing homes because high mandatory staffing for nurses and nursing assistants. That's the hands-on care.
So when money gets tight, homes must cut other staffers: activities workers, social workers, housekeeping, food service workers, maintenance.
Even that may not be enough, given the magnitude of current proposals, says industry spokesman Ed Towey.
"The average facility is under-reimbursed by Medicaid by $12.24 per patient, per day," he says. "You now add a $17.50 cut to that and you will see what we saw in 1998," when Medicare cut reimbursement. "Bankruptcy filings, facilities announcing that they are closing, and then your hospitals are going to fill up with people who can't get into nursing homes."
Palm Gardens executives have not decided where they would cut back. Bernice Goodman hopes that the exercise leaders, Diane and Erica, won't leave.
"I feel loved by all of them," Goodman says. "My daughter-in-law told me they are spoiling me. I said, 'Yes they are.' "
Eliminate hospice benefit: House proposal only, $52 million.
Eliminate MEDS-AD program: Senate proposal only, $237 million. (This serves about 24,000 aged and disabled people not eligible for Medicare whose incomes are just a bit too high for regular Medicaid. The cut would leave many without any insurance option.)
State’s budget crunch to hit Medicaid benefits
Most vulnerable face unkindest cuts of all Fort Myers News-Press
By Jennifer Booth Reed
April 20, 2008 — Ron Tourony of Fort Myers wants what most young men want: an education, a good job, a home of his own.
But Tourony, who has muscular dystrophy, needs state medical help to achieve that, and his coming-of-age arrives at a time when lawmakers intend to slash Medicaid, the state health insurance for low-income and disabled residents.
Tourony turns 21 in October, and when he does, he loses the children’s Medicaid services that pay for 10 hours a day of nursing care, doctor visits and other medical help. He needs an attendant because his movement is limited — he has just enough mobility to steer his power wheelchair and use a computer — and because he has a tracheotomy tube. His mother, a country club food and beverage manager, cares for him when his nurses’ shifts end. Tourony wants to transition into a Medicaid program for adults, but he hasn’t found one that will meet his needs. And the picture is getting worse.
Lawmakers this week begin negotiating $4 billion worth of budget cuts, half of which are proposed to come from health care. Without the cuts, the state would spend about $16 billion on Medicaid this year. Just under $5 billion of that comes from general revenue, however. The rest is from local taxes and federal funds.
The proposed cuts to Medicaid decimate programs for adults who are completely disabled, who suffer from catastrophic illnesses like cancer, who have had organ transplants, who have developmental delays and live in group homes, who live in nursing homes or who need hospice.
That has patients and the organizations that provide their care quaking.
“There are two versions of the budget. One is bad, the other is horrible,” said Ed Towey, a spokesman for the Florida Health Care Association, a nursing home trade group.
The Senate wants to cut $164 million out of the daily rate paid to nursing homes; the House suggests a $278 million cut. These come on top of a $75 million hit the homes took earlier this year.
Lee County’s 17 nursing homes would lose $4 million in the Senate budget and $6.7 million in the House.
About 60 percent of nursing home residents are on Medicaid, Towey said. Homes are required to take a certain percentage of them as a condition of licensure. The state also recently toughened laws regulating patient-to-staff ratios, and there’s no talk of changing those, Towey said.
He predicts homes will file for bankruptcy. They did 10 years ago when hit with similar cuts.
Related is a provision that slices between $6 million and $19 million from a Medicaid community residential program for people with developmental disabilities such as cerebral palsy, mental retardation and autism.
For the 30 severely disabled residents who live in two facilities in Cape Coral, the cuts will mean fewer staff members available for round-the-clock care, including moving patients every few hours to prevent potentially deadly bed sores, said James Weeks, vice president of Sunrise Community Inc.
“All of these cuts will be in our staff; they are 75 percent of our budget,” Weeks said.
The House has proposed ending hospice reimbursement for Medicaid patients. The Senate keeps the coverage in place.
“We are very concerned by the fact that it will end up costing the state more money to care for dying Medicaid patients,” said Samira Beckwith, executive director of Hope Hospice and Community Services.
She predicted terminally ill patients will land in emergency rooms, likely multiple times, as their diseases progress.
“It’ll be a revolving door through the ERs,” she said.
A day of in-home hospice care costs $150 compared to the hundreds of dollars a hospital bed costs per day, Beckwith said.
Hospitals are bracing for assaults from multiple fronts. Hospice is only part of it.
Lee Memorial Health System could lose between $7 million and $8 million if lawmakers eliminate Medicaid’s medically needy and adult disabled programs, according to data provided by the Safety Net Hospital Alliance of Florida. Lehigh Regional Medical Center could lose between $412,182 and $459,520.
Those are the provisions that cover people with catastrophic illnesses, organ transplants or permanent disabilities. About 44,000 Floridians are covered under them. They are among the programs Tourony has explored in his search for government help meeting his needs.
“If the state no longer funds these programs, the individuals will still show up for hospital care when they need it, and under the laws and our mission, we will be expected to provide the care. Their needs do not go away,” said Sally Jackson, Lee Memorial’s director of community projects.
The patients, then, shift to the growing caseload of uninsured.
That’s not the only Medicaid cut. Lawmakers are also eying general Medicaid reimbursement reductions to hospitals.
Under the House budget, Lee Memorial loses $5 million; under the Senate it’s $3 million. Lehigh Regional would lose $202,046 and $124,006, respectively. Hospitals already subsidize Medicaid services, Jackson said. The government pays about 75 cents on the dollar.
What irks Tony Carvalho, executive director of the Safety Net Hospital Alliance, is that Florida is not just cutting from its own budget. It’s forfeiting federal money, too. The less Florida spends on Medicaid, the less the federal government will contribute to the program. Lee Memorial, for example, would lose an additional $6 million to $8 million in federal matching money if the state trims its Medicaid spending, according to Carvalho’s analysis.
“It is not smart business. It is contrary to the intent of where America is going,” he said.
The hospital alliance is urging lawmakers to dip into the $2 billion Lawton Chiles Trust Fund and preserve Medicaid programs.
Lisa Margulis, executive director of the consumer advocacy group Florida CHAIN, said lawmakers should also consider an increased tobacco tax.
“It’s really a great way to reduce smoking and tobacco related illnesses and preserve these programs that are really a lifeline for people with serious illnesses,” she said.
— Jim Ash of The News-Press Capital Bureau contributed to this report.
Medicaid a target as Florida seeks $1-billion in health cuts St. Petersburg Times
By Stephen Nohlgren
April 19, 2008 —Florida taxpayers keep Evelyn Williams alive by paying for kidney dialysis.
Ralph Pineiro's liver transplant succeeded because Medicaid bought antirejection drugs.
Tina Cohen fights off leukemia with state-aided chemotherapy.
This week, the Florida House and Senate will try to lop at least $1-billion off health care budgets. Dozens of programs will come under the knife. Thousands of Floridians like Williams, Pineiro and Cohen will be left to wonder:
What will happen to me?
Cutting Medicaid, the health care program for poor people, is no easy task.
Slash services too much, and fragile clients land in nursing homes and hospitals, driving up costs instead of saving money.
Federal matching funds pay more than half of Medicaid's bills. So when the Legislature cuts back $100, clients lose more than $200 in services.
"If we don't spend that money, it just goes to another state," says advocate Karen Woodall. "We already paid the taxes. It's just in Washington. If we don't bring it back into the state, then we've just lost it."
Nevertheless, large budget deficits make Medicaid hard to ignore. Its $16-billion cost was nearly one-fourth of all state spending last year. Absent a tax increase, legislators have to cut Medicaid or cripple education and other essential services.
Here is a sampling of possible cuts, and people whose lives might change.
Medically Needy
• Almost 20,000 clients.
• House cut: $170-million.
• Senate cut: $233-million.
Tina Cohen noticed the first pain while dieting for her high school prom.
It was chronic leukemia. Modern drugs can keep it at bay, maybe forever, but they cost $5,000 a month.
Doctor visits, bone marrow tests and other complications push her medical bills toward $50,000 a year.
Cohen, now 21, lives in Brandon with her 2-year-old son and boyfriend. Chemotherapy "was crippling at first," Cohen says. "It's really nasty stuff."
She has squeezed in a few small telephone jobs between nausea and taking care of her son, but that rarely brings in much.
Her boyfriend works in a pawn shop and earns less than $30,000 a year. They can't cover her expenses but they earn too much to qualify for regular, poor people Medicaid.
That's where Florida's "Medically Needy" Medicaid steps in. It helps when catastrophic expenses overwhelm incomes.
"Nobody will insure me. Only the state will," Cohen says. One health maintenance organization she called "told me I would have to pay $500 a week and they wouldn't pay the prescriptions."
Without chemo drugs, she says, "I run a big risk of winding up in the hospital. The cancer would attack my body and possibly kill me over time."
Ralph Pineiro, a 56-year-old Tampa resident, lost his liver a year ago to hepatitis C from old blood transfusions.
Medically Needy buys the $2,500-a-month antirejection pills that protect his new liver.
Pineiro, who gets $1,100 a month from Social Security, will qualify for Medicare disability later this year, and get his drugs that way.
For now, Florida fills the gap.
Pineiro is typical of many transplant patients, says Tony Carvalho of the Safety Net Hospital Alliance of Florida. Many are disabled with a multitude of complications. Medicare usually kicks in after two years, but people often can't wait that long.
Just to get on a transplant waiting list, people must demonstrate that they can pay the cost of aftercare, Carvalho says.
"Hospitals are not going to perform a quarter-of-a-million-dollar operation to put someone on the street who cannot then afford their drugs."
"If Medically Needy gets taken away, people are going to die."
Inpatient and outpatient care
• 2-million potential clients.
• House rate cut: $330-million.
• Senate rate cut: $205-million.
Evelyn Williams' life turned upsidedown seven years ago at age 16.
A bad heart valve, brain aneurysms, strokes, seizures and failing kidneys robbed her capacity to work, even at her old Dunkin' Donuts job.
Her meager disability check makes her poor enough to qualify for traditional Medicaid, which pays for kidney dialysis three days a week at Fresenius Medical Center in Tampa.
The four-hour treatments are exhausting, Williams says. Throw in bus rides going and coming, and it's all she can do to care for her twin boys, 4, and daughter, 3.
Williams' treatments cost the center $155 a pop, says Fresenius vice president Robert Loeper. Medicaid pays $125. The company compensates by soliciting donations and dipping into other revenue streams.
The Legislature now plans to drop dialysis reimbursement to $90, as part of a broad range of rate cuts to outpatient and inpatient service providers.
"We'll be losing $10,000 on nursing care and medical supplies alone," says Loeper.
Fresenius will continue to serve Williams and other current Medicaid clients, he says, but may have to turn away new ones.
"A lot of facilities are going to say, 'that's it. I can't take any more Medicaid patients or go bankrupt. They can stay in the hospital, where Medicaid pays $1,000 a day.' "
Williams would like to get a kidney transplant, get off dialysis and make her own way in the world. But she didn't work enough to qualify for Medicare disability so she is stuck with lower-paying Medicaid.
Transplant hospitals and doctors, now in line for their own Medicaid rate cuts, may not accept her.
Nursing homes
• Roughly 45,000 clients.
• House cut: $278-million.
• Senate cut: $164-million.
Bernice Goodman, 86, looks forward to exercise group three days a week at Palm Garden of Largo. She and fellow residents spend 20 minutes lifting legs, marching in place, stretching arms and rotating ankles.
"It helps me not get stale and sit in the room all the time," says Goodman, who has suffered three major strokes.
Such exercise classes are now under the budget-cutting gun, as are movie nights, dances and other activities that spice up a nursing home day.
Medicaid pays for more than half of Florida's nursing home residents. Proposed rate reductions could reach 10 percent.
Florida has some of the country's best nursing homes because high mandatory staffing for nurses and nursing assistants. That's the hands-on care.
So when money gets tight, homes must cut other staffers: activities workers, social workers, housekeeping, food service workers, maintenance.
Even that may not be enough, given the magnitude of current proposals, says industry spokesman Ed Towey.
"The average facility is under-reimbursed by Medicaid by $12.24 per patient, per day," he says. "You now add a $17.50 cut to that and you will see what we saw in 1998," when Medicare cut reimbursement — "Bankruptcy filings, facilities announcing that they are closing, and then your hospitals are going to fill up with people who can't get into nursing homes."
Palm Gardens executives have not decided where they would cut back. Bernice Goodman hopes that the exercise leaders, Diane and Erica, won't leave.
"I feel loved by all of them," Goodman says. "My daughter-in-law told me they are spoiling me. I said, 'Yes they are.' "
Other large cuts
• Medicaid HMO rate cut:
• House, $96-million.
• Senate, $55-million.
• Eliminate hospice benefit, House proposal only: $52-million.
• Eliminate MEDS-AD program, Senate proposal only: $237-million. (This serves about 24,000 aged and disabled people not eligible for Medicare whose incomes are just a bit too high for regular Medicaid. The cut would leave many without any insurance option.)
Stephen Nohlgren can be reached at nohlgren@sptimes.com or (727) 893-8442.
Deep cuts in DCF programs looming The Bradenton Herald
By Carol Marbin Miller
April 19, 2008 —Florida child-welfare administrators are being asked to cut tens of millions of dollars from safety-net programs for vulnerable children at a time when kids may be at greater risk.
Reports of child abuse and neglect rise during periods of economic hardship, studies show. With Florida's economy widely believed to be in recession, calls to the state's child-abuse hotline were up 17 percent in March over the previous year.
But lawmakers are considering deep cuts to the very programs in the Department of Children & Families and other agencies that support struggling families or enable the state to determine which children are most endangered.
As lawmakers confer over details, about $1 billion in social service and healthcare reductions are likely. Cuts to children's services, which would total more than $100 million, have already had an effect: They have convinced a Miami-Dade foster mom that she won't be able to afford to adopt the severely disabled 7-year-old she has cared for over the past six years.
"'We don't have money' - that's all you hear. 'We don't have money,'" said Kim Rowe, 48, a legal secretary who took Courtney in six years ago when her parents' chronic drug abuse led to serious neglect. Rowe has been struggling ever since to provide for the girl, who has severe cerebral palsy and mental retardation and cannot eat without a feeding tube.
"These cuts are going to be absolutely devastating," said Broward Circuit Judge John A. Frusciante, who has presided over child welfare cases for a decade. "We are sacrificing the future for what is perceived to be an emergency at the moment. It will come back to haunt us."
'Contract on kids'
On Friday, members of the House requested another $83 million in cuts to the state's health and human services budget. The savings might come from making it more difficult for poor families to receive Medicaid, an insurance program for the needy, or by eliminating the state's medically needy program for children.
DCF Secretary Bob Butterworth has called the cuts the equivalent of "a contract on kids," and suggested some children may die as a result of them.
"How can any legislator go home after making these cuts?" Butterworth said. "Don't you think their mothers would say: 'I didn't raise you this way?' "
Lawmakers have proposed about 5 percent in reductions to DCF's $2.9 billion total spending plan - about $126 million in cuts in a House bill, or $108 million in a Senate package.
DCF already has trimmed $30 million from the current year's budget. At a court hearing Friday, lawyers and a Broward judge quibbled over who would pay for an investigation into conditions at a troubled shelter for foster kids, with one lawyer saying: "I'm not supposed to use the F-word in court - funding."
Other departments, such as the Agency for Workforce Innovation, which pays for child care, the Department of Juvenile Justice and the Agency for Persons with Disabilities also are facing deep cuts.
Leaders of both the House and Senate say they have been backed into a corner by dire economic times and have shown leadership when forced to make tough choices over the budget.
"The main principle we have put behind this budget is we can't spend money we don't have," said House Majority Leader Adam Hasner, a Delray Beach Republican.
Gov. Charlie Crist said the legislative process is not yet over, and he is hopeful "we will be able to do more" for children.
"We want to make sure we protect the most vulnerable among us," said Crist, who wants lawmakers to use money in trust funds avoid making some of the healthcare budget cuts.
But he added lawmakers "have a very difficult job," and this year is much harder for everyone than years when "it's real easy up here to just dole out money when it's flying in."
Abuse reports rising
Florida's economic woes have driven more families onto the economic margins, analysts say. Requests for food stamps statewide in March increased by almost 19 percent from the previous year, with 229,785 additional families seeking help, according to DCF records.
A host of academic studies have shown children to be at greater risk of harm when their parents are unemployed or struggling, and that the risks lessen when parents are better off.
During the economic boom of the mid-1990s, for example, the number of children living in poverty declined dramatically nationwide, said Fred Wulczyn, director of the Center for State Foster Care and Adoption Data at the Chapin Hall Center for Children at the University of Chicago. At the same time, reports of child abuse and neglect declined.
"There is no doubt that when the economy takes a significant downturn, we see neglect go up," said Paul Vincent, a child-welfare specialist credited with turning Alabama's foster care program into a national model.
Details of the cuts
Proposed cuts to Florida's child-welfare programs, part of an effort to reduce the state budget by as much as $5 billion for the fiscal year that begins July 1, include the following:
Savings of $4 million by cutting 71 child-abuse investigators statewide. DCF administrators say the layoffs will increase the time it takes for an investigator to visit children who may have been abused or neglected, increase caseloads and possibly result in a backlog of incomplete investigations.
Cuts of about $13 million from a statewide program that pays child-care bills for thousands of Florida parents so they can continue to work. Without the subsidies, advocates say, thousands of working poor families face difficult choices, including leaving their young children home alone.
Trims of $7 million - rather than adding $16.8 million, as Crist has requested - from a program to support foster kids who turn 18 and "age out" of state care with no family. Many of the kids, a recent study found, end up homeless or in jail, and most of the girls already have children of their own. The cuts could affect 600 young adults.
Reductions to the budgets of Florida's 19 community foster care agencies by nearly $19 million. The community-based care agencies, or CBCs, provide child welfare, foster care and adoption services to about 37,000 children throughout the state. In recent years, three of the agencies have failed.
Trims of $16.6 million from a program that helps support former foster children who are adopted. Many of the kids are disabled or have psychiatric impairments and require such services as speech and physical therapy, mental health treatment, tutoring, after-school care and medication.
Without the subsidies, said Fran Allegra, who heads the Our Kids private foster care agency in Miami, some CBCs will find it difficult, if not impossible, to persuade families to adopt children, especially kids with special needs.
"A lot of people really depend on that for help," said Alvin Patterson, a Richmond Heights man who adopted a disabled child from foster care five years ago when the girl was 11. Patterson and his wife, Mable, also foster other children with special needs who were abused or neglected.
A cut in his state subsidy, Patterson said, would almost certainly mean less food on the family's table and fewer clothes for the kids to wear. The children probably will not be able to have birthday parties or occasional trips ice skating or to Chuck E. Cheese for pizza.
"We'll have to make sacrifices," said Patterson, who stays at home to care for the foster children, some of whom have disabilities or psychiatric impairments. "There are going to be some cutbacks."
For Kim Rowe and Courtney, sacrifice and scraping by have become standard operating procedure.
When Rowe needed a van with wheelchair access for her severely disabled foster child, her colleagues at a Miami law firm hosted a Hawaiian-themed fundraiser to help pay for it.
And when Rowe needed a special chair to bathe Courtney, and a lift to hoist the girl into it, a Miami judge who oversaw the girl's foster care case convinced her uncle to pay for it.
In recent months, the state has decreased the number of hours Courtney receives nursing care, and Rowe still is fighting with the state for specialized equipment that would help the little girl develop, both physically and mentally.
State Health Care to Take Bigger Hit The Tampa Tribune
By Catherine Dolinski and Russell Ray
April 18, 2008 — After proposing about $1.1 billion in cuts to Medicaid and other health care programs, House members were stunned to learn Thursday that they are going to have to slash another $83 million.
It was the darkest of the day's budget revelations that came from House and Senate leaders, who dribbled out several key agreements that they had reached even before starting to meet in conference over a final spending plan.
The House leaders' agreement to budget $83 million less for health care than they had initially proposed brings the chamber closer to the Senate's deeper cuts to those programs.
House and Senate lawmakers were already preparing for tough conference negotiations over heavy cuts to sensitive programs such as hospice for Medicaid patients and the Medically Needy program for transplant, cancer and other chronically ill patients. Those and many other tough cuts are being proposed this year due to plummeting state revenue.
"We've already made cuts that are absolutely devastating," said Loranne Ausley of Tallahassee, ranking Democrat on the House Healthcare Council. "We've said over and over again - people are going to die. I just cannot imagine where anyone is going to come up with $83 million in additional cuts."
Those concerns extended across the political aisle.
"To take yet another a hit like this was not something that I wanted to hear," said Rep. Bill Galvano, R-Bradenton.
At the same time, Senate leaders agreed to declare a week's sales tax holiday for back-to-school, as well as to roll back millage rates for the schools' portion of property taxes.
Worth $23 million, the sales tax holiday will last seven days instead of last year's 10 and will cover clothing and supplies, but not books. The state's sales tax holiday for purchasing hurricane preparedness supplies was cut.
"It's a big disappointment; I know a lot of people always count on that as far as getting their supplies," said Rep. Peter Nehr, R-Tarpon Springs, who sponsored the hurricane holiday bill this year. "But the overall good of the state has to override that."
The need for more health care cuts, however, brings more questions than answers for Healthcare Council Chairman Aaron Bean, who said he does not know yet where the cuts will come from.
Bean noted that 80 percent of state dollars spent on health care draws down a federal match. That means an $83 million cut in state dollars could cost as much as $100 million in federal dollars.
Bean, R-Fernandina Beach, said he is going to try to minimize the loss of federal money somehow.
The agreed-upon amount of state general revenue for health care - $7.12 billion - is actually more than the $7 billion proposed initially by the Senate, noted Nan Rich, vice chairwoman of the Senate Health and Human Services Appropriations Committee.
But the House has so far refused to consider the Senate's proposed use of $159 million from the Lawton Chiles Endowment for health care.
Also on Thursday, Senate budget chief Lisa Carlton, R-Osprey, confirmed that the House and Senate have agreed to buffet sharp cuts to education and other social programs by taking $270 million in Department of Transportation trust funds and $330 million from a $541 million DOT fund generated by taxes on real estate transactions.
"In five years it'll build right back up to the $541 million" as real estate sales rebound, she said.
Senate transportation chief Mike Fasano, R-New Port Richey, said the compromise is better than the House plan, which would have stripped more than $600 million from DOT trust funds. "As our economy gets better, it will be less of a hit," he said.
Environmentalists got a bit of good news Thursday when House leaders agreed to full funding of the $300 million Florida Forever program. Initially, the House had proposed no funding at all next year for the land buying program designed to protect Florida's pristine lands.
Rich, vice chairwoman of the Senate Environmental Preservation and Conservation Committee, said she welcomes funding for the program, but not ahead of - or instead of - health care for children, seniors and the disabled.
GOP Rep. Rene Garcia, R-Hialeah, said he was optimistic that more money would materialize for health care before negotiations.
"Because I cannot imagine going home with cuts like this," he said.
Reporters Catherine Dolinski and Russell Ray can be reached at (850) 222-8382 or cdolinski@tampatrib.com.
Florida hospitals cringe at proposed cuts to Medicaid St. Petersburg Times
By Lisa Greene
April 16, 2008 — Paying patients could face higher hospital bills and more crowded emergency rooms if proposed state budget cuts to Medicaid take effect, Tampa Bay area hospital leaders said this week.
Hospitals may also have to end some services or cut back on planned expansions, they said.
"This is going to have a devastating impact," said John Dunn, spokesman at Tampa General Hospital. "There aren't many businesses that could absorb a hit of $18-million to $26-million and not get badly bruised."
To cope with the state budget crisis, lawmakers have proposed cutting millions of dollars in hospital care for the poor. The Senate would cut more than $506-million, while the House would cut more than $468-million.
Lawmakers want to reduce the amount the state pays hospitals for patients of Medicaid and two special programs, the Medically Needy program and the Medicaid program for the aged and disabled.
Hospitals that offer the most care for the poor would be hit hardest.
"It's a terrible year," said Tony Carvalho, president of the Safety Net Hospital Alliance of Florida. "I've never seen anything like this. The type of programs that are being cut are pretty disappointing."
For example, more than half of the patients at All Children's Hospital in St. Petersburg are on Medicaid. The hospital stands to lose up to $9.8-million, or nearly 5 percent of its operating budget.
Tampa General stands to lose more money than any hospital in the state except for Miami's Jackson Memorial.
Such a large cut might hurt Tampa General's credit rating, Dunn said. The hospital also fears its emergency room costs will rise, because poor people affected by the other cutbacks in medical assistance programs will be more likely to wait for care until they have a health crisis.
Hospital leaders are especially frustrated because cutting the state's Medicaid budget means losing even more money in federal matching funds. For instance, under the House proposal, Tampa General would lose $8.3-million in state funds and $10.3-million more in federal dollars.
"It's very hard to support the logic of that, where you give up that federal matching money," said Arnie Stenberg, chief financial officer at All Children's.
Stenberg and others said it's hard to decide where to cut, because a hospital isn't a typical business.
"We're doing everything we can to avoid having reductions in our core programs," he said. "You can't just pick something and say I'll quit doing the ER, or I'll quit doing trauma, or I'll quit doing transplants."
At All Children's, possible cuts might mean the hospital doesn't add beds in the neonatal unit at its new hospital. Programs to educate the public on preventing injuries or childhood obesity might be slashed. Research studies might be cut.
"We still have every intention of standing by our mission," Stenberg said. "We will care for all children regardless of ability to pay."
Other hospitals said they are less certain, although some said they might charge paying patients more.
"There is no doubt that these cuts are significant," said Lisa Patterson, spokeswoman at St. Joseph's Hospital in Tampa. "But exactly how we will respond to them, it's just too soon to tell."
St. Joseph's could lose nearly $9-million. By comparison, it costs the hospital more than $7-million each year to run its Level 2 trauma center, Patterson said.
At Bayfront Medical Center in St. Petersburg, chief financial officer Bob Thornton said the cuts "would be a crippling blow." The hospital could lose up to $6.5-million.
"The costs of providing the important care our patients need continues to rise every year, while the funding … continues to be threatened," Thornton said.
The Orlando Regional Medical Center could lose more than $17-million. According to the hospital alliance, that's equivalent to the hospital's cost for staffing 262 nurses, delivering 4,800 babies or admitting 4,300 children as patients.
As deep as the cuts for hospitals might be, hospital leaders said the impact would hurt their patients more.
"A lot of these people are the working poor," Dunn said. "They're trying to hold onto jobs. They're trying to feed their families. We're concerned about what's going to happen to them."
Lisa Greene can be reached at greene@sptimes.com or at (813) 226-3322.
Budget cuts shouldn't batter the vulnerable St. Petersburg Times
Letter to the editor
April 16, 2008 — Today, Florida is at a moral and ethical crossroads that will determine its future direction.
The Legislature (your elected representatives and senators) is in the process of finalizing the budget that will guide our lives in the immediate future. There are some indications of a very troubling trend. And we, as voting citizens, must do some soul searching in reaching answers to these trends.
If we are so opposed to abortion, then why are we so opposed to adequately funding programs for children now needing care? Why do we have to fight each session for the Medically Needy program? Just why do you think it is called the Medically Needy program? Is it morally and ethically proper to deny the terminally ill access to hospice care in their final days? How, in all good conscience, can we deny parents and grandparents decent palliative care after their decades of life in caring for us?
While there are programs and projects that can be delayed and rainy-day funds that can be accessed, just why is there such a blatant endeavor to inflict so much pain and suffering on the very old, the very poor and the very young? Have we now reached the point in governing that we, as a civilized society, have lost our care and concern, our compassion for human life? Where is the leadership of our civic and religious guardians?
I am reminded of the words of Jim Towey (former secretary of Elder Affairs) as he stated, "The state of Florida has relegated its people to the status of a Third World country." Are we now at this tipping point?
We need our voting citizens to cry out to their elected officials that such irreversible actions are unacceptable! Indeed, there are many of us who will actually be crying (for real) should such actions be allowed.
Austin R. Curry, executive director, Elder Care Advocacy of Florida, Tampa
Florida budget cuts would hurt 'oldest, sickest and neediest' Daytona Beach News-Journal
April 15, 2008 — For every dollar cut from Florida's budget, a life somewhere will be touched. Many of them will belong to the state's youngest, oldest, sickest and neediest, whose numbers grow in bad economic times.
Like Mary Ellen Ross, 55, of Delray Beach, who has been in the state's Medically Needy program since 1999, when she received a liver and bone marrow transplant?
Her joy for living is always tinged with worry that the program covering the costs for her many hospitalizations could be in jeopardy.
Medically Needy, a lifeline for 20,000 victims of accidents and catastrophic illness who don't have private insurance but earn too much to qualify for Medicaid, is one of the state services that stand to absorb a big financial hit.
The House wants to cut $170 million in spending by eliminating hospital care for people in the program. The Senate wants to limit care to pregnant women and children, saving $350 million.
In past years, legislators always managed to find funds to keep the program going. But this year, people like Ross — who recently spent three weeks in the hospital — may run out of luck.
"Being the chronically ill that we are, when we get sick with something, it's not minor," she said. "The only thought going through my mind now is that the state should print up our death certificates with the cause of death already filled in — 'lack of funds.'"
As the House and Senate begin negotiations over a state spending plan to take effect July 1, the chambers must decide where to cut between $5 billion and $6 billion in existing programs, to take into account falling revenues. They have until May 2 to reach agreement.
Also among those who could be affected is Clotilda Horta, who has diabetes and congestive heart failure. Told by doctors she can no longer work, the 46-year-old Plantation woman depends on the Seventh Avenue Family Health Center in Fort Lauderdale for the six medications she takes each day, and her twice-daily insulin shots.
"If I didn't have this place, I don't think I'd be alive," she says of the clinic run by Broward Health, formerly known as the North Broward Hospital District.
But Horta's life could change, depending on which services are cut by legislators working to put together a bare-bones $65 billion spending plan. Her medication will likely continue, but the personal medical care she now receives could be curtailed.
"It's just a fact that the poor are going to be hurt the most," said Frank Nask, chief executive officer of Broward Health. "It will reach a point where it can't continue and we run out of money to fund these programs."
The clinic where Horta gets her care is Broward County's largest, serving 52,000 poor and chronically ill patients a year and filling about 800 prescriptions daily. With Florida's "safety net" hospitals, like those run by Broward Health, having to absorb as much as a $637 million reduction in state funding, the clinic may have to cut back.
Other programs, such as Healthy Start, which provides medical care and nutritional classes for mothers and their young children, could be disbanded to ensure that people in critical need of services — like Horta and her medications — are taken care of.
"I wish I could put up a wall with the faces of all those who could be hurt," said Bob Butterworth, secretary of the Florida Department of Children & Family Services. "Some of these cuts are totally unconscionable."
The Senate has proposed an overall $1.1 billion reduction in health and social service funding for the 2008-09 budget year. The House wants to trim $800 million.
"It's time for all Floridians to ask themselves: Is this really the way you want your state to treat the most vulnerable people in your community?" said Tony Carvalho, president of the Safety Net Hospital Alliance of Florida, an organization of the state's tax-supported hospitals. "And do you really think these drastic cuts won't impact you?"
Another candidate for elimination is the Independent Living fund for foster children as they make the transition to the adult world after turning 18.
Milo Jetkins , who lives in Fort Lauderdale, gets $1,000 per month to help with rent, food and other necessities while he works toward an economics degree from Florida Atlantic University and holds down a part-time job.
The 21-year-old, who had been in 18 foster homes, said he has no place to turn for help if he loses that check. "If they're going to cut services, we need time to prepare," Jetkins said. "I don't have strong relationships with any foster parents. This is pretty much the only thing that most kids in my situation have. We don't have parents to fit the gap."
Some of the cuts being contemplated will save money this year, but could end up costing the state more in the long run. Among them are reductions in state corrections spending that could eliminate drug court programs, which offer treatment instead of prison time for first-time offenders.
"We've seen families restored, children come out of foster care. We've seen moms who have not worked anything but the streets re-establish relations with children. We've seen dads working and supporting their families," said Broward Circuit Judge Marcia Beach, who oversees the Broward drug court.
Treatment can cost as little as $3,000 per patient, and the re-arrest rate of the Broward program's participants after one year has been as low as 10 percent. By comparison, it costs $19,000 a year to house a state prison inmate, and the re-arrest rate within a year of release is 51 percent.
"I flew up to Tallahassee at my own expense to educate legislators about addiction treatment and the incredible cost savings. Money is the most important thing on their minds. Addiction treatment is a cost-savings — mega bucks," Beach said.
Cuts in the juvenile justice program could close the Girls Advocacy Project in Palm Beach County, which works with girls sent to juvenile detention in hopes of keeping them out of prison.
Tallahassee to vulnerable Floridians: Drop dead Palm Beach Post Opinion
April 15, 2008 — If a state had its priorities straight, balancing a budget on the backs of the working poor, the elderly and the disabled would be the last option. This year in Florida, it's the first option.
With the Republican-led House and Senate having completed mutually heartless, stupid budgets last week - after rejecting attempts by Democrats to raise revenue by imposing tax fairness - the Legislature officially is considering cuts of as much as $637 million in health care for some of the state's most vulnerable residents. Included are indefensible reductions in the Medicaid Program for the Aged and Disabled and the Medically Needy program.
If the House, which has proposed cutting $599 million in reimbursements to hospitals that treat Medicaid patients, and the Senate, which proposed $637 million in cuts, follow through, the health of at least 50,000 Floridians will be threatened. That's the heartless part, since these Floridians would suffer needlessly. The state also would lose up to $280''million in matching federal money. That's the stupid part.
The Medically Needy program serves organ transplant recipients and other uninsured residents who suffer from serious illnesses or traumatic injuries. After medical expenses, those Floridians cannot earn more than $2,180 a year to qualify. The Legislature wants to eliminate hospital inpatient or drug coverage for adults in the Medically Needy program. So it is no exaggeration when Mary Ellen Ross, executive director of the Florida Transplant Survivors Coalition, says, "People will die without this program."
Those reliant on the Medically Needy program - especially those with organ transplants - must receive certain drugs and treatment in order to survive. Period. Ms. Ross, who received a liver and bone marrow transplant in 1999, created the coalition in December 2001 to fight the state's plans at that time to eliminate the program. "Why," she asks, "should we have to defend our lives every 12 months?"
The Legislature also would like to eliminate the Medicaid Program for the Aged and Disabled, which helps Floridians 65 or older who are totally or permanently disabled. To qualify for coverage, they must earn less than $9,152 a year.
Palm Beach County hospitals would lose up to $28.5 million from the state. Martin County would lose $1.6 million, and St. Lucie $5.8''million. That would leave more uninsured people in overcrowded emergency rooms - especially at those safety net hospitals that already provide a disproportionate share of free care. The cuts also would shift costs for indigent care to local taxpayers, through, for example, county health care districts.
Still under consideration are cuts that would end cleft lip and palate repairs for 2,000 babies and hospice care for 8,000 terminally ill Medicaid patients. Not under consideration are removing sales-tax loopholes, taxing Internet sales the same as in-store sales and making multi-state businesses pay their fair share of the corporate income tax. Not under consideration are using some reserves or money from the tobacco settlement that in previous years subsidized tax cuts for the wealthy. Those policies aren't only irresponsible. They are immoral.
Cuts will impact substance abuse treatment programs Daytona Beach News-Journal
By Deborah Circelli
April 15, 2008 — Julie St. Clair kisses her 7-year-old son's head as she describes her life just two years ago when she smoked crack cocaine, lost her job and could not see her son.
She was in such bad shape, she walked into to the emergency room with thoughts of suicide.
Her fiance, Mike Gurin, 42, had an alcohol addiction that caused him to become homeless and resort to stealing Listerine from convenience stores for a taste of alcohol.
Their life today is a sharp contrast from the days before they entered treatment programs at Serenity House.
St. Clair, 33, works as a waitress at a diner in Daytona Beach and attends Daytona Beach Community College seeking a bachelor's in business administration. Gurin works as a waiter and a manager at a restaurant in the Volusia Mall.
But the treatment programs that got them back on track — along with other substance abuse and mental health programs statewide — are at risk because of millions of dollars of proposed budget cuts.
Lawmakers coping with a multi-billion-dollar revenue shortfall are making wide-ranging cuts this year, including large amounts now spent for health- and humans-services programs.
"It's a formula for disaster for our state and for people who are just basically hanging on," said Bob Butterworth, secretary for the state Department of Children & Families. "If this budget comes down the way it's coming down, we are going to see very, very serious repercussions."
Lawmakers are expected to begin negotiations this week on a spending plan for the fiscal year that starts July 1.
The House has proposed deeper cuts than the Senate in substance abuse funding, including a $9.75 million cut in a program that provides treatment primarily to women who are trying to get off welfare, said Mark Fontaine, executive director of the Florida Alcohol and Drug Abuse Association.
The House also proposed cutting about $10.3 million from community programs that deal with substance abuse, mental health and other issues, Fontaine said.
The Stewart-Marchman Center, the area's largest substance abuse treatment agency, could lose about $1.3 million, which would cause service and program cuts across its adult services programs, including Project Warm, which lets mothers stay with their newborns and young children while going through treatment.
"These folks are going way overboard," said Chet Bell, chief executive officer at The Stewart-Marchman Center, the area's largest substance abuse treatment agency.
Randy Croy, Serenity House executive director, said his agency could lose about $500,000 if proposed cuts are approved.
If the funding cuts are made, Bell said, the state will end up spending "more money on hospitals, jails and they will put more people in the morgues."
The Senate proposes cutting about $4 million from adult substance abuse programs, but it would use one-time money to avoid making other cuts proposed by the House. But that one-year solution would leave agencies facing cuts again in 2009-10.
Those cuts along with proposals to cut child welfare funding, local and state officials fear, will cause an increase in child abuse cases.
"We already have a very small safety net, and that safety net is now going to be gone," DCF's Butterworth said.
Butterworth added that the proposals are "mean and it's nuts. It affects real people."
He said Gov. Charlie Crist gave legislators a road map to use trust funds to help with budget woes and the state should follow it.
House Healthcare Chairman Aaron Bean, R-Fernandina Beach, said substance abuse programs are like other areas of the health and human service budget that have taken cuts. He said it's "not that we didn't like them," but it just came down to a lack of available money.
"We're still looking to do all we can to restore (funding for) them," Bean said last week.
Proposed cuts also could heavily hit programs funded through the state Department of Corrections, including local programs run by Serenity House and Act Corp. The House has proposed cutting $31 million starting in July for the department's substance abuse programs, said Gretl Plessinger, a spokeswoman for the agency.
St. Clair and Gurin, who met at Serenity House and plan to marry in September, said they can't imagine where they'd be without the help they received.
They spend their weekends enjoying time with St. Clair's son, Cameron Dicus, which includes attending church and watching him bowl in a league. They've lived the past 10 months in their rented condo, one of 15 Serenity House owns throughout Volusia County. The agency rents on a sliding scale to people who have successfully completed treatment programs.
"They saved my life, but I had to do the work," Gurin said. "They build up your self esteem and confidence."
St. Clair, who had abused drugs since she was 15, now receives medication and treatment for bipolar disorder from Act. Serenity House also still checks on the couple, including doing random drug testing.
"I never knew it could be this good," St. Clair said, looking down at her son, whom she now sees every Wednesday and every weekend.
April 14, 2008 — Elsewhere on this page today, Gov. Charlie Crist makes a pitch for his plan to provide "basic preventative, primary and urgent care benefits" to uninsured Floridians.
"Granted, this coverage will not be your top-of-the-line health insurance plan," Crist concedes, noting a willingness on the part of private insurers to provide basic benefits plans for "$150 a month or less."
We hope Crist isn't being overly optimistic. With health care costs spiraling out of control, insurance costs are going nowhere but up. One result, Crist writes, is that "emergency rooms across the state are valiantly carrying the load of providing basic medical services to the uninsured."
The two hospitals that provide the most "charity" care to uninsured Floridians are Miami's Jacksonville-Memorial, and UF's Shands. But while Gov. Crist commends such hospitals for "valiantly carrying the load," the Florida Legislature is getting ready to perform radical fiscal surgery on the so-called "safety-net" hospitals.
Under the House's proposed budget, Shands would lose more than $22 million. Under the Senate's budget, the loss would be more than $23 million. Under either budget, Shands would also lose more than $12 million in matching federal funding.
Those reductions would primarily be in two Medicaid programs: Medically Needy Services, which provides catastrophic care for "working poor" Floridians; and the Aged and Disabled program, which serves low-income seniors and the disabled.
It is difficult to imagine how Shands can continue to function as a health care provider of last resort with upwards of $35 million worth of revenue cuts. Most likely it will adjust by cutting staff services and hiking prices for Floridians who do have health insurance. That would, in turn, put pressure on insurers to raise their premiums, which could doom Gov. Crist's hope of negotiating affordable rates for Florida's 3.8 million uninsured.
Lawmakers have a serious problem trying to hammer out a state budget in the face of flagging tax revenues. But the reality is that the Legislature has slashed taxes by billions of dollars over the past decade. And lawmakers' refusal to consider additional taxes in order to balance the budget is finally reaching the point that human lives are being put at risk.
It is, of course, precisely in hard economic times that the services of charity care hospitals like Shands are most needed. It is unconscionable for legislators to seek to balance the budget on the backs of the very Floridians who have nowhere else to turn for help.
We hope Gov. Crist can indeed come up with an affordable health care insurance plan; certainly other states are finding that goal difficult and expensive. But in the meantime, it makes no sense to perform radical fiscal surgery on the very hospitals that are "valiantly carrying the load" by providing life-sustaining care to the poor, the needy and the disabled.
Legislators show their true colors Letter to the editor
The Tallahassee Democrat
April 14, 2008 — Tony Carvalho's My View regarding the contemplated cuts in Medicaid by the Legislature is spot on. It's really a shame that it should even have been necessary to write. But maybe, just maybe, some day the common man will catch on.
Throughout history it has been shown that those who have money, or those who have spent a greater portion of their lives pursuing it, really couldn't care less about the well-being of those less fortunate.
Part of that carelessness comes from a belief that the suffering of the afflicted is their own fault. Another is that those who pursue money generally will not let anything stand in their way. It wasn't too long ago, with the enactment of the child-labor laws, that they were forced to stop abusing children in their pursuit of wealth. Because of their disregard of those weaker than themselves, they would never have done this on their own.
Which brings us to the Legislature. Just look at it: 160 people, 60 of whom are millionaires, people whose health care is paid for by the state even though they could pay for it themselves, deciding to cut needy elderly people and children off from badly needed medical care.
The people of Florida need to remember this moment, and remember that the majority of these legislators are Republicans. You know, the party of money and the pursuit thereof. If you didn't know what they stood for before, you certainly do now.
A deadly choice: Deciding between rhetoric and lives Daytona Beach News-Journal
April 14, 2008 — The lack of health insurance kills six Floridians a day, according to a recent report by Families USA. People die because they don't get the preventative health care that would catch serious conditions such as cancer while they're still treatable, or because progressive illnesses like heart disease and diabetes aren't controlled with medication and oversight. The group estimates that 2400 Floridians between the ages of 25 and 64 died in 2006 because they lacked insurance.
Despite health programs targeted at them, many of Florida's children also go without the care they need. A separate report, published by the Florida Agency for Healthcare Administration, All Children's Hospital and Nemours, estimates that one in every 10 Florida children don't get the basic health-care services they need to grow up healthy. Many of those children lack insurance, but some have nominal coverage that doesn't meet their needs, the report concluded.
After the current legislative session, those grim statistics could grow worse.
The Legislature clearly faces tough choices. But lawmakers are aiming cuts at people who can least afford to bear them, and institutions that are already stretched to the limit.
House and Senate leaders are proposing cuts of around $600 million in Medicaid money that would otherwise go to hospitals. About half of those cuts would fall on "safety net" hospitals such as Halifax Medical Center, Shands Hospital in Gainesville and Orlando Regional Medical Center.
Those cuts couldn't come at a worse time. These publicly owned hospitals are already seeing an increasing number of people in their emergency rooms who lack insurance and need treatment. Hospitals have become expert at juggling revenue sources, including local taxes, Medicaid and private insurance, to help pay for care to those who have no insurance at all — but they can only stretch a dollar so far.
A cruel cut being contemplated by the Legislature could literally mean a death sentence for some of the 19,500 adults enrolled in Florida's Medically Needy program. Medically Needy helps to cover drugs and hospitalization for working-age adults who have no insurance and are diagnosed with life-threatening illnesses. Without this program, hospital officials may have to face a young mother diagnosed with breast cancer and tell her there's nothing to be done.
Meanwhile, the Senate has proposed eliminating supplemental Medicaid for 24,000 seniors and disabled people living well below the poverty line.
There are alternatives, but thus far, lawmakers refuse to consider them. They are particularly resistant to the notion of an additional tax on tobacco. It's a position they should reconsider.
Florida's cigarette tax is lower than 45 other states. And raising it by $1 per pack, as proposed by Democratic lawmakers, would have a dual benefit.
First, the Legislature would reap $1 billion, enough to avoid life-threatening budget cuts and even expand health programs. The research on uninsured Floridians bears out the need for more state investment in health care. Additionally, increased tobacco taxes have a proven impact on reducing teen smoking: If packs and tins of smokeless tobacco are more expensive, teens and young adults are less likely to ever start smoking, dipping or chewing — meaning they'll never become addicted.
The alternative — pulling funding from essential programs, and turning a blind eye toward the suffering that will ensue — should be unthinkable for lawmakers of conscience. Taxes may be politically unpopular, but lives depend on lawmakers' willingness to do the right thing.
Our view: Without a conscience
Replace cuts to poor, sick and elderly with sensible ways to boost state revenue Florida Today.Com
April 14, 2008 — Lawmakers wrangling in Tallahassee this week over how to close a $3 billion budget gap caused by the faltering economy are aiming a blunt hammer at the state's poor, sick, newborns and frail elderly.
They claim to have no other choices, but that's not true.
And make no mistake, the cuts to programs that aid Florida's most defenseless citizens are brutal.
Here's what we're talking about:
• Dumping services for babies and pregnant women.
Leaders in the House would cut $5 million from Healthy Start, the state's prenatal and infant healthcare program, which has greatly reduced infant mortality rates in the state since its start in 1990.
Healthy Start Coalition of Brevard County helped 2,364 pregnant women and 1,746 infants locally last year, but hundreds would have to be turned away next year under the proposal, says director Jennifer Floyd.
That's dangerous, because Brevard's infant mortality rate remains far too high. At eight deaths per 1,000 births in 2006, it's above the state average of 7.2.
• Eliminating up to 700 jobs at the already understaffed Department of Children and Families, charged with investigating child abuse, and slashing aid to young adults moving out of foster care.
The Brevard CARES program, which helps stabilize families in crisis so children can remain in the home, would also be deeply cut.
The result?
The local system of care for abused, neglected and abandoned children on the Space Coast will be devastated, says Patricia Nellius-Guthrie, who directs Community Based Care of Brevard.
• Whacking dollars for Medicaid payments to nursing homes — which would have to reduce staffing levels — and hospitals.
Also gutting the state's Medically Needy program, which covers transplant and
