Miami-Dade County commissioners on Tuesday took swift action to prevent themselves from doing two things they haven’t attempted in more than a decade: appropriating the profits of Jackson Health System and imposing “unfunded mandates” on the taxpayer owned healthcare provider.
Commissioners voted unanimously to change the county ordinance that governs Jackson, waiving their power to use Jackson’s budget surpluses, which reached a record $64 million in 2015. They also agreed not to add new responsibilities to the public healthcare network without the money to pay for it.
The last time Miami-Dade commissioners tried to do something similar was in 1999, when they voted to add $17.5 million in expenses for Jackson, including a health insurance program for poor children.
“It put Jackson in some financial jeopardy,” Jackson CEO Carlos Migoya told commissioners.
Tuesday’s changes will allow the hospital system’s administrators to better ensure “the long-term future and success” of Jackson, he said.
But critics called the changes premature, and they urged commissioners to wait for the mayor’s office to complete a report on Miami-Dade’s plan for providing healthcare for the county’s uninsured residents in the face of dwindling federal funds to help defray those costs.
Steven Marcus, CEO of the nonprofit Health Foundation of South Florida, which funds local healthcare efforts, told commissioners he was surprised by the urgency of the ordinance amendment, which bypassed committees and received its first public hearing on Tuesday, the same day it was approved.
Marcus said he had hoped the mayor’s report on indigent healthcare would provide guidance for Jackson to fulfill its mission of providing a single standard of care for all residents of Miami-Dade, regardless of their ability to pay.
“We can deliver care for indigents better than we do today,” he said.
Miriam Harmatz, a healthcare attorney with the nonprofit Florida Legal Services, a legal aid group, urged commissioners to work openly to find a solution to a scheduled reduction in federal funds, known as Low Income Pool or LIP, for Florida hospitals to provide indigent care.
“There’s been no public discussion,” she said.
Migoya told commissioners that he, too, was “a little uncomfortable” that the amendment had bypassed committee hearings. But he said any concerns about indigent care were unrelated.
Miami-Dade Commissioner Audrey Edmonson, who sponsored the amendment and requested it be placed on Tuesday’s agenda, concurred with Migoya.
“This has nothing to do with indigent care,” she said. “What it’s really doing is ensuring Jackson Health System has enough cash on hand for at least a year.”
Under the change, Jackson’s governing board, the Public Health Trust, will control the hospital system’s cash reserves until they are large enough to sustain operations for a year, about $1.8 billion. Any amount above that will be used to increase healthcare access throughout the county, according to the amendment.
Despite the changes, Miami-Dade commissioners will retain much of their control over Jackson, including the power to approve appointments to the governing board and to ratify the hospital system’s budget. County taxpayers also will continue to fund Jackson, which received about $389 million in local dollars in 2015, including $242.1 million in local sales taxes, and $147.2 million in county funding and other contributions.
In addition, Jackson will get another $830 million in local taxpayer money over 10 years after Miami-Dade voters in November 2013 approved a bond referendum to fund the hospital system’s expansion and renovation.
Migoya said Jackson has lost about $120 million over the past two years because of reductions in LIP. Statewide, LIP funds are scheduled to drop from $1.1 billion for the year ending June 30 to about $608 million for the coming year.
In March, Gov. Rick Scott signed into law a plan for distributing the reduced funds, which relied on a novel system of voluntary contributions among competing hospitals to generate more federal dollars for the uninsured. But federal regulators alerted state officials in a letter dated May 20 that the plan violates the terms of Florida’s agreement for receiving the funds, and they instructed state officials to develop a new plan.
Also Tuesday, Miami-Dade commissioners appointed four members to Jackson’s seven-member governing board. Current members William “Bill” Heffernan and Irene Lipof were reappointed to three-year terms while Albert Dotson and Robert Zarco, both attorneys, were appointed to two-year terms.