Legislative tug-of-war likely over health care spending, regulations
TALLAHASSEE — Battles over health care spending and regulation of Florida’s vast healt h c are indust r y are likely to command a great deal of time and attention when the Florida Legislature convenes in January for its annual session.
L a w ma k e r s a r e a g a i n exp e c t e d t o e n g a ge i n a tug-of-war about what type of regulations should be in place for health-care facilities, but a main focus will be on Florida’s strained safety-net health program at a time of tight state fifinances.
Florida’s Medicaid program already costs $26 billion and covers an estimated 4 million people.
A July snapshot by the Kaiser Family Foundation estimated that Medicaid along wi t h a maj o r c h i l d r e n’s health-insurance program provide coverage to two out of ever y five low-income people in the state, half the state’s children and more than three- fififths of all nursing home residents.
The bulk of money for Medicaid comes from the federal government, but this year more than $6 billion comes from general revenue, the state’s main budget account funded primarily by sales taxes.
House Health Care Appropriations Chairman Jason Brodeur, R-Sanford, said hurricanes Irma and Maria put “a bit of a strain” on the budget he oversees, and as a result that could hamper any requests for new social-services spending.
“From the explicit costs of providing more health and human services to a larger than anticipated population, to the implicit costs of things like the overtime paid to our (state employees) who are in charge of registering and providing (benefifits) to all those new enrollees, all of those costs must be paid for before we can start looking at new programs,” he said.
Nevertheless, Brodeur said members have filed more than 200 requests to fund local projects, “which is the exact opposite of ‘small government.’ ”
During the 2017 session, legislators agreed to change how the state pays nursing homes to provide care for the poor and seniors who rely on Medicaid. Lawmakers decided to scrap a longstanding system where nursing homes have been paid based on audited cost reports and agreed to implement a prospective payment system where payments are determined in advance, regard- less of the intensity of the services provided.
While lawmakers agreed to change the payment methodology, they delayed implementation of the new system until 2018. Brodeur said the conversion “is our next step in effifficiency.”
S e n a t e P r e s i d e n t J o e Negron, though, wants the Legislature to do more than pull the trigger on the prospective-payment system. He wants to increase the amount of money the state directs to paying nursing homes.
“That’s a very strong priority of mine,” said Negron who, quoting Sen. Lizbeth Benacquisto, notes that the average Medicaid-funded nursing home resident in Fl or i da i s an 85-ye ar- ol d woman.
“These are the women who shaped our communities. We have a responsibility to give them the highest level of care,” Negron said.
The St u ar t Republic an also said he would like to help the industry offffffffffffset the costs of generators that Gov. Rick Scott has mandated for nursing homes after deaths at a Broward County nursing home following Hurricane Irma. Negron predicted that the generators “will ultimately be a shared endeavor between the state and the industry.”
B u t N e g r o n ’s p u s h t o increase reimbursement for nursing homes and offset the costs of generators also comes at a time when two state agencies are requesting funding to help plug defificits.
The Agency for Persons with Disabilities is asking for $34 million in general revenue to help cover a $89 million defificit in a Medicaid waiver program that enables developmentally disabled people to live in communities instead of institutions. Also, the Department of Health is requesting $25 million to plug a shortfall in the Children’s Medical Services program, which pays the health care costs for medically com- plex children covered by Medicaid.
Negron downplayed the defificits in the programs and the effffffffffffects they could have on new funding requests during the 60-day session, which starts Jan. 9.
“You have to make diffifficult decisions,” Negron said of crafting the state budget. “That’s why I think the budget process is fascinating.”
While the annual budget is the only bill the Legislature is required to pass when it meets, it isn’t the only piece of health- c are legi slation that members will focus on.
Monday is New Year’s Day.
Federal, state and county offiffices, courts, banks and post offiffices are closed Monday. Most municipal offiffices are closed Monday. Municipal offiffices in South Palm Beach are closed Friday and Monday. Offiffices in Cloud Lake, Palm Beach and Tequesta are closed Monday and Tuesday.
Palm Beach, Martin and St. Lucie counties are closed Monday.
There is no Palm Tran bus service Monday, and Tri-Rail will operate on a weekend schedule.
Most pickups are on a regular schedule. Exceptions include: Boca Raton, Boynton Beach, where Monday pickups are Tuesday and Tuesday’s are Wednesday; Lake Park and Manalapan, where Monday pickups are Tuesday; North Palm Beach and West Palm Beach, where Monday customers will have their garbage picked up on their next regularly scheduled day. There is no garbage pickup Monday in Palm Beach. In Martin County, there are no pickups Monday. Garbage pickup will run one day late. In St. Lucie County, pickups are on a regular schedule.
Question: My brother is trustee of our late father’s living trust. Dad passed away four months ago. The four children all agreed with our father that our brother was the best choice, because he is a Certifified Public Accountant. We now think that might not have been a wise choice. We are beginning not to trust him because he rarely communicates with any of us about what’s going on. We are still waiting for our money. We’ve been told probate is not necessary for his estate. Since all four of us are benefificiaries, and three of us want him removed as trustee, can we remove him?
Answer: Not automatically, unless there is a provision in the trust that allows that. There are certain rules under the law. The fact that it is three against one is not suffifficient to remove him as trustee. You can’t just “vote him offff the island.”
There may be several issues delaying the process that you are not aware of, that your brother has failed to communicate. As the trustee, he has duties to ensure all your father’s debts and other fifinancial obligations, including fifinal tax returns, are taken care of. Besides those obligations, if your father owned his own home and it has not been sold yet, your brother may be keeping cash reserves on hand to maintain the home until it is sold.
Have you actually seen a copy of your father’s trust? Ask your brother for a copy, read it carefully, and if you need help understanding it, get advice from a qualifified estate planning attorney.
From the information you have provided, I do not know if you have yet reached out to your brother. At this point I would call him or write him a letter, all in a nonthreatening manner, asking for clarifification. Do whatever you can to avoid taking legal action, which can be costly and certainly will be emotionally trying. If your brother does not respond or is not cooperative, or if you suspect he is mishandling funds, you will then need to take legal action. If it comes to that, consult a qualifified estate planning attorney for assistance.
Joseph Karp, a member of the Florida and New York Bars, is a Nationally and Florida Bar Certifified Elder Law Attorney and founder of The Karp Law Firm, located in Palm Beach and St. Lucie counties. The fifirm assists clients with wills, trusts, Medicaid and VA benefifits planning, special needs planning, asset preservation, probate/trust administration and estate litigation.