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Florida Grappling With Questions About Taxes For Indigent Care

Dec 06, 2011

This story is part of a reporting partnership that includes WFSUNPR and Kaiser Health News.

TALLAHASSEE - A special panel appointed by Florida Gov. Rick Scott has been meeting to figure out a way to scale back what taxpayers at the local level contribute to hospital costs in some parts of the state.

The panel is wading into sensitive territory. Taxpayer-funded "hospital districts" are counties where property owners pay a bit more tax to fund local hospitals, specifically those serving the poor. The more than 20 districts generate about five billion dollars annually, statewide, for the coffers of some medical centers.

One area where those special property taxes have created controversy is in Lake County, in the central part of the state. Republican State Rep. Larry Metz is advocating scrapping the current district rules - which send the extra funds to three of the area's hospitals - and to let voters decide in a referendum whether they want to create a new district. He's calling for sending the extra funds to any hospital to help pay for the costs of charity care.

"The taxpayers are paying all their taxes, and out of those general taxes we're paying for all these programs, general programs. Then on top of that the taxpayers of North Lake County are paying 1 mill to pay for these Medicare and Medicaid (mostly Medicaid) shortfalls. I just don't think the system is properly structured," he said.

Not everyone is on board with the idea of scrapping the special hospital districts. Florida Hospital Association President Bruce Rueben says there could be a big problem down the road if the state tinkers with that revenue source. That's because the money those districts generate goes to help the state draw matching funds from the federal government for Medicaid. The federal government pays about 55 cents of every dollar spent on care for Medicaid patients; Florida pays the rest.

Rueben cautions that the state relies on the hospital district revenues to get additional money from the federal government and adds: "If we're going to dismantle that or put it at risk, then we simply have to know where that match is coming from." He believes the governor's Hospital Review Commission is tinkering with a very delicate instrument, and, if it's not careful with its proposals, it could create a problem that it may not be able to fix.

"I don't know what they're really trying to accomplish or focus on, but I hope, before this thing is over, that they will address this issue of what really could be a gigantic unintended consequence," he says.

Meanwhile, the commission is set to make recommendations to the governor and legislature in January on how to treat the hospital taxing districts. Gov. Scott says lawmakers may not act on the recommendations until 2013.

The panel is also examing an effort by Tallahassee Memorial Hospital to cut hospital costs, so they don't need as much help government help.

The hospital invested in a program as a way to give people follow-up care once they're discharged from the hospital, in the hope that they won't come back to the emergency room - which is the most expensive kind of care - to be readmitted.

Judy Griffen, a nurse practitioner at Tallahassee Memorial Hospital’s Transition Center says it's working: "What we're finding is that when we get a patient who didn't have good follow-up care and we get them stabilized medically and we provide them out-patient services, they tend to not utilize the hospitals or community services as much, because they get what they need."

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