Foster kids, frail seniors among losers in budget plan

By STEVE BOUSQUET, Tallahassee Bureau Chief
In print: Friday, March 28, 2008

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TALLAHASSEE — As Florida lawmakers slash spending, their proposed cuts will hit people who need help the most, including foster children, frail seniors, organ transplant recipients and victims of catastrophic illnesses.

A House budget proposal set for formal release Sunday provides a first glance at the depth and scope of the cuts the Legislature will consider for human services, the second largest area of the state's operating budget behind education.

The plan calls for stripping $1-billion from the human services budget for 2008-09, as part of the House plan to cope with a $2.5-billion drop in state revenue. Also lost will be significant federal matching dollars.

Among the House's key targets are optional programs under Medicaid, the health care program for poor residents under 65, including children and the disabled who cannot otherwise afford coverage.

Lawmakers are considering eliminating all hospice care for 8,000 terminally ill Medicaid patients; hospitalization costs for 20,000 transplant recipients; and diagnosis and care for 2,300 children with cleft lips or cleft palates.

Other controversial House changes awaiting votes and budget negotiations include:

• Eliminating higher staffing requirements at nursing homes. Lawmakers said that because they are cutting nursing home funding by $278-million, homes need more spending flexibility. The AARP accused the Legislature of abdicating its responsibility to the frail elderly.

• Cutting $170-million from the Medically Needy program, which pays medical bills for people in need of transplants or who suffer catastrophic illness and whose income is too high to be eligible for Medicaid.

• Closing the A.J. Holley Hospital in Lantana, the state's only tuberculosis hospital, and moving its 40 patients at a savings of $6-million.

• Ending vision, hearing and dental care as optional benefits for about 146,000 seniors who are covered by Medicaid, saving $32-million.

"If you don't have teeth, it's a big deal that you do have teeth," said the chairman of the House Health Care Council, Rep. Aaron Bean, R-Fernandina Beach. "I'm bummed out about that."

Bean said the proposal cuts optional Medicaid benefits to avoid the other option for cutting the state's basic Medicaid program — raising the income eligibility requirements.

Rep. Rene Garcia, R-Hialeah, questioned the wisdom of eliminating dental care for poor seniors but leaving meals programs untouched.

The House plan is far from a done deal. The Senate will also have a plan and negotiations will follow.

The Senate's lead negotiator, Republican Durell Peaden of Crestview, opposes easing nursing home patient/staffing ratios: "They're kind of sacred," he said. "You can't substitute for that nurse standing at someone's bedside when they are 90 or 95 years old."

But with a $2.5-billion shortfall in state revenue and no will among the Legislature's Republican leadership to raise taxes, cuts are a given.

Democrats argue that the state should raise revenue. They have proposed a $1-a-pack cigarette tax increase and borrowing from a $1.3-billion fund set aside for emergencies, such as hurricanes.

"These are not things a civilized society does," said Rep. Dan Gelber, D-Miami Beach, the House Democratic leader, referring to proposed cuts. "It isn't fair, it isn't right, it isn't moral."

Republican leaders say it's fiscally imprudent to spend reserves with another hurricane season on the horizon.

Also on the House's cut list: $7-million, or about one-fourth, of the total of a statewide program that helps foster children adjust to independent living as adults. Advocates said some young people will falter as they try to live on their own.

"Even the thought of a cut is traumatic," said Andrea Moore, executive director of Florida's Children First, a program based in Coral Springs.

Critics questioned the logic of some House cuts, such as providing prescription drugs for transplant patients but not helping to defray costs of inpatient hospital treatment.

"It's almost like we're saying 'We're giving you a liver, now go to Georgia to get it transplanted,' " said Rep. Kelly Skidmore, D-Boca Raton.

Also in the House plan is the elimination next year of a $1.3-million Department of Health program that treats up to 2,300 children with cleft lip or cleft palate. But Bean said he was unaware until Thursday that the program provided direct services and would seek to preserve it.

The Department of Children and Families would lose about 700 full-time jobs. Proposed cuts include a 5 percent reduction to sheriffs in seven counties who handle child abuse investigations, including Pinellas, Pasco and Hillsborough. Critics predicted caseloads will rise and take longer to complete.

"They're carrying 35 cases per investigator and we just whacked them," said Rep. Ed Hooper, R-Clearwater.

The House proposal includes cutting funding for the Johnnie Byrd Alzheimer's Center and Research Institute to $3.8-million and giving control of the center, and responsibility for future funding, to the University of South Florida.

Steve Bousquet can be reached at bousquet@sptimes.com or (850) 224-7263.