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Medicaid’s Uncertain Fate Slows Budget Talks

Widely divergent approaches to overhauling Medicaid which emerged from the House and Senate loomed Wednesday as an obstacle in talks on the proposed $69 billion state budget, with the Senate’s chief budget-writer saying the ambitious rewrite should be delayed.

Once characterized as historic, plans to revamp the state-federal Medicaid program looked more likely to become history, with Senate budget chief JD Alexander saying there was rising concern about going too far, too fast and potentially jeopardizing coverage for the 2.7 million Floridians in the $19 billion program.

Alexander said that since the Medicaid effort promised to save little money in the budget now being cobbled together, he said lawmakers should study the issue further over the next year rather than struggling to choose between the omnibus proposals advanced by the House and Senate.

“Many of those things will have limited effect on next year’s budget, so that tends to make me take a little bit slower approach to it and get it right, rather than hurry through it,” Alexander said of the overhauls.

The Lake Wales Republican added, “We’ve not ruled out either plan. Both have solid merit. But from my standpoint, I think taking a more steady approach over the next year has merit, too.”

Alexander’s call to go-slow came hours after Gov. Charlie Crist also acknowledged he was uneasy with the sweeping plans and the few signs of consensus coming from the House and Senate.

While the Senate would add about 250,000 low-income Floridians in 19 counties to a pilot effort underway since 2006, which relies heavily on managed care, the House would steer all 2.7 million Medicaid recipients into such programs over the next five years.

“I have some concerns about it,” Crist said. “I want to make sure whatever is passed doesn’t unfairly treat the most vulnerable in our society as well as our senior citizens.”

House Speaker-designate Dean Cannon, R-Winter Park, among the architects of the House Medicaid plan, said he had huddled with Senate Health Regulation Chairman Don Gaetz, R-Niceville, on the proposal, and came away with the impression there were broad areas of agreement between the sides.

“Managed care, properly expanded, is the way to go, but clearly the House and Senate have different approaches,” Cannon said. “We’ll just have to wait and see.”

He added that if its savings Alexander is seeking, he should consider setting Medicaid change in motion this year. “Medicaid is like turning a battleship. Nothing we do this year will have a dramatic effect this year. But…it charts the course over the next five years to improve access and quality of care,” Cannon said.

House and Senate conference committees concluded their work by midday Wednesday, settling small-bore budget differences but kicking bigger ticket issues to Alexander and his House counterpart, Rep. David Rivera, R-Miami, to decide.

Alexander and Rivera are scheduled to hold their first huddle at 5:30 p.m. Thursday, when they will review a host of university building projects marked for different levels of funding. School representatives are expected to be given a chance to make their case for state dollars.

Among the scores of differences remaining are $21 million the Senate would steer to public libraries around the state, compared with no funding set aside in the House proposal. Health and Human Services differences are marked by an $83 million difference between the two sides on health programs and a $59 million gap in Department of Children & Families programs.

While the House finances $13.8 million in mental health programs around Florida, most of these hometown services are eliminated in the Senate spending plan. Both sides endorsed a 7 percent cut in state funding to nursing homes, although negotiators said they would lobby Alexander and Rivera to offset the reduction in end-game discussions.

In higher education, the Senate prevailed over the House in its efforts to make it more difficult to qualify for the popular Bright Futures scholarship.

The change raises the SAT requirements from 1270 to 1290 for the top award and 970 to 1050 for the secondary award, a likely further erosion of the scholarship program covering the college tuition for about half of Florida's college students.

When established over a decade ago, the scholarship covered 75 percent to 100 percent of tuition depending on a student's high school grades. But last year, as the program expanded and the state treasury shrank, lawmakers changed the law so that it could only give students flat awards.

Budget negotiators settling public school financing expect to keep per-pupil spending close to its current level, but those numbers won't officially fall in line until the two sides work out issues in their respective budget conforming bills.

By maintaining public-school funding at the current level of $6,866-per-student, it represents a rough middle-ground between the House’s proposal to cut school dollars by $52-per-pupil and the Senate looking to boost spending by $38 for each child in a classroom.

Kathleen Haughney and Keith Laing of the News Service staff contributed to this report.

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