DeSantis aims to slice state budget by $4.6 billion. Here’s how he would do it. [Orlando Sentinel]

TALLAHASSEE — Gov. Ron DeSantis is proposing more than $4.6 billion in cuts from the state’s $119 billion budget while continuing to provide billions in popular tax cuts and putting more into the state’s rainy day fund.

The slashing starts with more than $1 billion to healthcare services, largely because of federal Medicaid money that has gone away with the end of the pandemic state of emergency.

And the cuts continue as other one-time funds dry up, usually projects backed by federal grant programs that have been discontinued. Those deep cuts include education, commerce, environmental protection and agriculture and consumer services.

Most of the reductions involve one-time funds for member projects and federal money the state won’t be getting in the coming year, Jeremy Redfern, the governor’s press secretary, said in an email.

DeSantis’ proposed budget also falls $4.4 billion short of what state agencies and the Legislature have requested, setting up a potentially bruising round of budget negotiations.

Sen. Linda Stewart, D-Orlando, vowed the Senate would hold the line on “protecting teachers, public schools and Florida’s uninsured” from any budget reductions.

“We’ve never adopted his budget,” Stewart said.

The two biggest priorities of Senate President Kathleen Passidomo, R-Naples, are an education deregulation package and two bills to train more doctors and other healthcare professionals and provide more access to care.

“We have to make sure they don’t take it out,” Stewart said. “The Senate is not going to go along with [doing that]. You don’t go against the Senate president.”

The main health care bill, SB 7016, includes $807 million to help pay for the Live Healthy plan, in addition to $258 million in state and federal funds to raise the reimbursement rates for nurses and other health workers.

The plan would offer new opportunities for training and retention of healthcare workers, provide tuition reimbursements for physicians, nurses and other professionals, create a statewide medical screening portal, and expand rural care and free and charity clinics to keep people from having to use expensive emergency room care.

Longtime healthcare advocate Sen. Gayle Harrell, R-Stuart, said she’s confident the Senate will find the money.

“This is a significant investment. It will change things dramatically,” Harrell said. “The needs are going to be huge.”

The money is included in the bill, Harrell said, so if it passes and is signed into law, those items will be funded, unless the governor vetoes it.

Proposed DeSantis cuts

The governor’s proposed budget is considered the start of the negotiating process that will consume much of the 60-day legislative session that began early this month.

The governor’s Focus on Florida website shows where DeSantis is recommending cuts, which include eliminating more than 1,000 jobs, many of them unfilled.

The largest of DeSantis’ proposed cuts is to an agency within his own office: $1.5 billion or just more than 50% of the budget the Legislature gave the Division of Emergency Management this year, Redfern said.

It includes federal funds for disaster mitigation and other operational expenses related to hurricane recovery for Ian and Nicole, as well as statewide emergency alert systems and disaster preparation and protection.

Also, the DeSantis budget recommends $500 million in Department of Education cuts, including $315 million for early learning that was from the federal American Rescue Plan.

Health, human services

Health and Human Services took the second deepest hit at $1.136 billion. But Redfern said those reductions largely represent a change in the mixture of general revenue, trust funds and federal dollars.

The biggest cut is to the Agency for Health Care Administration. It would receive $816 million less than the current spending level, due mainly to the elimination of $2 billion related to the iBudget Medicaid Waiver, which helps provide services for people with disabilities, Redfern said.

These reductions were offset by various increases, including more than $300 million for Medicaid provider rate hikes, he said.

A proposed transfer of oversight of the Children’s Medical Services managed care contract to ACHA from the Department of Children and Families would result in $184 million and 26 full-time positions cut, Redfern said.

The Department of Health also will cut 307 full-time positions that had been vacant for more than one year, he said. “Most of these were already being held in reserve and not filled due to changes in local county health department needs,” he said.

Harrell agreed that the governor’s budget moves money around so that decreases are not as significant as they look. “The healthcare numbers are really not cuts in that we’re cutting services, but a reallocation of dollars,” she said.

But there is reduced spending in DeSantis’ budget because of the hundreds of thousands of people who qualified for Medicaid during a special waiver during COVID-19 and are now being kicked off because the pandemic emergency has ended.

Not expanding Medicaid

State Democrats have said it made more sense to meet the healthcare needs of the public by expanding Medicaid rather than shuffling money around to pay for the Live Healthy program.

Sen. Geraldine Thompson, D-Orlando, asked during a committee hearing last week why the state didn’t just expand Medicaid for the $14.3 billion it would bring in over the next five years, noting that 41 other states have already expanded Medicaid to their advantage.

“The program we’re discussing is not that,” Sen. Colleen Burton, R-Lakeland and chair of the Senate’s health policy committee, echoing Passidomo’s comments at the start of the legislative session that she would not be considering Medicaid expansion.

“This is to help every Floridian regardless of their insurance status,” Burton said.

Democrats nonetheless supported the Live Healthy Act because it could go a long way to increasing the number of healthcare workers in Florida and increasing access to free and low-cost clinics.

The $14.3 billion Florida is not availing itself of is federal tax money sent to Washington by Florida residents, Thompson said.

“Florida Republicans continue to deny millions of women, children and workers access to affordable health care by refusing to expand Medicaid, contributing to higher enrollment in the Affordable Care Act,” Florida Democratic Party Chair Nikki Fried said.

But Harrell said, “Medicaid expansion isn’t the answer. It comes with too big a price tag in future years.”

She said she hadn’t seen studies from the Florida Policy Institute that show overall savings for the state of $200 million under expanded Medicaid but also hasn’t seen any study by Senate staff analyzing the costs and benefits of expanding it.

“I want to see insurers offer health insurance to those with lower incomes,” Harrell said. “Private investment in health care is key.”

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