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March 28--TALLAHASSEE -- Tampa General Hospital stands to lose $43 million under a new funding system lawmakers passed three years ago as part of a statewide medical assistance overhaul, according to a hospital advocacy group.
Overall, teaching hospitals, stand-alone children's hospitals and a regional perinatal hospital in Pensacola could lose about $293 million, the Safety Net Hospital Alliance of Florida says.
Those kinds of deep cuts will likely result in reduced staffing, decreased training and the elimination of specialty treatments like burn units, advocates say.
The Legislature, when it went to a Medicaid managed-care system, instituted a new funding formula that becomes effective on July 1, placing hospitals in "tiers."
Medicaid is the joint state-federal health care program for the poor.
Hillsborough County also collects money to go toward health care for the indigent through a local tax. Under tiering, the county has to put that money into a statewide pool, as part of the state's match for federal Medicaid dollars.
That has Hillsborough County Commissioner Sandra Murman seeing red.
"Those are local dollars," said Murman, a state representative from 1996-2004. "It's an issue of fairness."
Locally-raised money, she said, "shouldn't be used to assist other communities that didn't have the political foresight to provide for the care of their most needy residents."
Because Hillsborough's share is "diluted," it won't get as much federal money as it would have, said Tony Carvalho, the hospital alliance's president and a former budget director under Gov. Jeb Bush. "It's like forcing them to share their money with everybody in the state," Carvalho said.
The eventual shares also will depend on what the state gets for its low income pool, or LIP, which pays for hospitals' charity care. Gov. Rick Scott is asking the feds for an extra $4.5 billion.
The low income pool has been limited at $1 billion for eight years; the U.S. Department of Health and Human Services must rule on Scott's request.
Tampa General spokesman John Dunn called the funding formula "arbitrary and not based on any underlying public policy rationale."
"The goal of the formula is to take local public health funds provided by certain communities, and the federal match they earn, and share those benefits with communities that provide no local health funds to Medicaid, and to hospitals that provide little care to Medicaid patients," Dunn said.
Safety net hospitals usually need all the help they can get.
The U.S. Department of Health and Human Services has defined them as providing "a disproportionate amount of care to vulnerable populations," including "a high proportion of low-income patients."
People without health insurance often forgo treatment until they're quite ill and then visit emergency rooms for care they can't afford.
The Florida alliance counts Tampa General as a member, as well as Orlando Regional and Jackson Memorial in Miami.
A legislative fix likely won't happen this session -- mostly because leaders in Tallahassee think there's nothing necessarily broken.
Senate President Don Gaetz, R-Niceville, suggested there will never be a funding system that satisfies everyone.
Particularly, he added, since big-city hospitals got used to benefiting from the sway of their elected officials.
"I'm aware that the action that the Legislature took in the past ... is one that some hospitals find troublesome," he said. "Because when the money follows the patient, instead of the money following the politics, it creates problems for people who have gotten extra money in the past.
"I think we're far from settling that issue," Gaetz said. "I'm not aware of any formula that settles the matter."
In 2011, the Legislature passed a plan to enroll roughly 3 million Medicaid patients in managed-care programs. Here, managed care means private insurers will pay for services through set payments on a monthly per-patient basis.
The deal, backed by Gov, Rick Scott, was designed to contain the state's Medicaid costs.
Almost a third of the overall state budget goes to Medicaid. More specifically, out of the 2013-14 budget, more than $23 billion was marked for Medicaid long-term care and "Medicaid services to individuals."
House Speaker Will Weatherford, R-Wesley Chapel, said that every year, "everybody thinks they don't get their fair share ... I would just tell people to be patient."
In Florida, local communities can choose to put in money toward Medicaid thorough an agreement with state officials, according to Carvalho.
But, critics say, tiering provides a disincentive to do so because it comes across as a redistribution of wealth, penalizing areas that chose to pass a tax to pay for charity care.
"You can call it foresight, you can call it political will, but it's always a tough decision when you decide whether to tax yourself to pay for something," Carvalho said.
Lawmakers are working now on the state budget for 2014-15, the only bill they are required to pass every year.
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