Budget paints grim picture for services

More expectant mothers could go without prenatal health care; more children could wind up abused. More seniors could wind up in nursing homes instead of aging peacefully at home.

Those are just some of the bleak prospects that appear in proposals that state Senate and House committees finalized on Tuesday, in response to the state's $3.2 billion budget hole next fiscal year.

Most of those cuts appear in the Senate's budget proposal which, so far, contains about $1 billion less for health care and human services. Among the proposed cuts:

•Eliminating prenatal care through Medicaid for pregnant women living between 150 percent and 185 percent of the federal poverty line.

•Halving a home-care program for seniors and eliminating other local services for seniors seeking to avoid institutionalization.

•Eliminating Healthy Families.

The $27 million Healthy Families program teaches parenting skills and nurtures parent-child relationships in families identified as high-risk for abuse.

Research shows that 98 percent of children in participating families remain free of abuse and neglect a year after. Healthy Families costs about $1,700 a child annually, compared with $64,000 to care for an abused or neglected child.

The proposed elimination "was a complete surprise," said Barbara Macelli, program manager for the Healthy Start Coalition of Hillsborough County, which provides Healthy Families services.

"Healthy Families has been around for 12 years; it's the only evidence-based, proven child abuse and prevention program that's statewide in Florida," she said.

The House plan would leave Healthy Families untouched, but the proposed elimination by the Senate drew a personal plea on Tuesday by conservative former Senate President Dan Webster. "Does this program lower taxes? Yes it does. Does it empower the family? Absolutely."

Committee chairman Durell Peaden said he agreed, renewing his call on families and providers to lobby Senate leaders for more health care money.

"We work within the constraints of our allocations," said Peaden, R-Crestview.

Developmental disabilities

The Senate plan also makes tougher cuts to services for people with developmental disabilities.

Florida assigns about 30,000 such people receiving state-paid services to spending "tiers" depending on the severity of their disability. Those with the greatest needs have no spending limit.

That would change under both the House and Senate plans, which would cap spending for that group at $120,000. According to the Agency for Persons with Disabilities, about 338 Florida residents had spent more than $120,000 on services and treatments in 2008-2009.

The Senate would go a step further by reducing spending in lower tiers and cutting payment rates for providers.

That worries Grace-Anne Alfiero, executive director of Creative Clay, a program in St. Petersburg that provides art therapy and art-related job training for people with disabilities. Already, she said, state payments for her nonprofit organization have dropped since 1996 from $86 a person to $29 for providing the same services.

"Another 10 percent starts to get devastating," she said. "Every year, we try to find a way to make it work, but we just can't keep on doing it."

More money?

Congress may soon award more than $1 billion to Florida for its Medicaid program. Peaden and Democrats on his committee have asked Senate leaders to spend all of those prospective dollars on health care - not other budget needs.

Technically, the money would have to support Medicaid, the cost of which has expanded dramatically due to increased public need in tough economic times, but that wouldn't stop lawmakers from using the federal aid to supplant state dollars in the health budget.