Which health and human services items are budget targets?

Florida lawmakers spent this year's legislative session bemoaning a lack of money. But that didn't stop them from trying to bring home the bacon for health and human-service programs in their districts.

From the Panhandle to Miami, the state budget approved last month is dotted with millions of dollars in spending on senior-citizens centers, medical-education programs and health services that are targeted at specific areas. In some cases, the spending also is tailored to the districts of powerful legislative leaders.

Gov. Charlie Crist will issue budget vetoes next week, giving him final say about whether he thinks lawmakers have engaged in the old game of pork-barrel spending --- known in Tallahassee as passing budget "turkeys.''

But with state tax revenues shrinking in recent years and lawmakers making cuts to a wide range of programs, Florida TaxWatch spokesman Robert Weissert said the number of local projects in the overall budget could come as a surprise to many people.

"Given the tight budget year, I think zero ... local projects would have probably been the assumption,'' said Weissert, whose fiscal-watchdog group will issue its annual report on budget turkeys before the governor announces his vetoes. "I know we're finding more than zero.''

Lawmakers defend spending on local projects that they say address legitimate needs. Also, while state agencies propose spending priorities, lawmakers fiercely defend the power of the Legislature to decide what gets included in the budget.

Senate Health and Human Services Appropriations Chairman Durell Peaden, R-Crestview, could take home two medical-education programs, totaling $9.5 million, to his Panhandle district.

The budget calls for spending $8.5 million to help Florida A&M University offer pharmacy and other health-related programs at a new center in Crestview. The other $1 million would go toward funding primary-care residency positions in Walton County and Okaloosa County, which includes Crestview.

Peaden said the programs would help address needs in the Panhandle, such as improving minority and rural health care. Also, he said the western Panhandle lacks many of the types of medical-education programs that other parts of the state have.

"I don't know what the hell the problem is with educating them in Crestview (rather) than in Tampa or somewhere,'' said Peaden, a retired physician.

Many of the projects included in the budget would receive relatively small amounts of money but are designed to help specific groups or projects. As an example, Sen. Joe Negron, R-Stuart, got $1.2 million in the budget to help finish construction of the Charles and Rae Kane Senior Center in Martin County.

Negron, who serves on Peaden's health budget-writing committee, said he thinks funding a senior center that will serve low- and moderate-income people is important. He said the project was included in the Senate's original budget proposal, so it was open to scrutiny during the session.

"I'm proud of the senior center and the services it will provide, such as Alzheimer's day care,'' Negron said.

Lawmakers approved a $70.4 billion budget on April 30, the final day of the legislative session. By law, Crist has until next Friday (May 28) to sign the budget and issue line-item vetoes. The budget takes effect with the July 1 start of the fiscal year.

Health and human-services programs make up a huge chunk --- $28.5 billion --- of the overall budget. But much of the spending on those programs is locked into providing services for Medicaid recipients.

A lack of tax revenues and rising expenses caused lawmakers to cut funding for many programs as they drew up the budget. That ranged from saving $199 million by reducing Medicaid rates for nursing homes to cutting about $10 million from the Healthy Families program that provides services to pregnant women and mothers of newborns who are considered at risk for child abuse.

It is difficult to pinpoint a total amount of money that lawmakers plopped into the budget for local projects. As an example, budgets also often reflect state-agency requests to fund local projects, such as upgrading public-health departments.

Also, budget fine print sometimes doesn't fully explain where money is going. For instance, the new budget includes $875,000 for any rural hospital that moved in 2009 and meets certain criteria about serving Medicaid and charity patients.

The Agency for Health Care Administration says it is only aware of one hospital, Lakeside Medical Center in Belle Glade, that appears to qualify for the money. That hospital is not mentioned in the part of the budget that includes the money.

But other projects are clearly the work of lawmakers. Among others things, the budget includes $1 million to provide dental and medical services for uninsured and underinsured people in the Lake Wales area.

Lake Wales happens to be home to Senate Ways and Means Chairman JD Alexander. When Peaden was asked about whether Alexander was responsible for the budget item, he answered wryly, "I imagine. He lives in Lake Wales, doesn't he?''

Miami-Dade County, the home of House budget Chairman David Rivera, also would receive money for several projects. That includes $1.7 million for construction of the Mildred Pepper Senior Center in Southwest Miami-Dade County and $450,000 in two budget items for seniors programs in Hialeah and Little Havana.

When asked how those three projects got into the budget, House Health Care Appropriations Chairwoman Denise Grimsley, R-Lake Placid, said she thought they came out of negotiations between Rivera and Alexander.

Peaden said the Senate agreed to include $2.5 million in the budget for a health center in Miami's Liberty City area because of a request from Miami Democrat Frederica Wilson. But even Peaden said he did not know how a couple of other Miami-Dade projects got into the budget, including $100,000 that would go to the Richmond Heights Homeowners Association for "crisis-intervention and support services to low-income persons.''

"I don't even know where Richmond Heights is,'' Peaden said. "I didn't do that one.''

One of the ways to gauge whether lawmakers are trying to funnel money to local projects is to look at budget priorities of agencies such as AHCA and the Department of Health. Before each session, those agencies request funding for programs that they oversee.

But lawmakers such as Negron and Grimsley reject the notion that lawmakers should be bound by the agency requests.

"Ultimately, the test should be the efficacy of the program and not whether the agency asked for it or not,'' Grimsley said in an e-mail.

As an example, the House, at the request of Jacksonville Democrat Mia Jones, put $500,000 into the budget to pay for a mobile health unit for the AGAPE Community Health Center in Duval County.

Grimsley said that move, which was not requested by the Department of Health, stemmed from the closure of a dental clinic in Jacksonville. She said lawmakers considered keeping the clinic open but thought it would cost too much. As a replacement, they decided to provide money for the mobile unit.

Ultimately, however, Crist has the power to look at local projects and decide whether to veto them. Crist has indicated he could veto large amounts of spending in the overall budget, though spokesman Sterling Ivey said he is not aware of specific health- and human-services items that are being considered for chopping.

That leaves Peaden, a close political ally of Crist, hoping the governor will spare projects such as the Florida A&M medical-education program in Crestview. The city provided a former factory building for the program, and $7 million of the $8.5 million in the budget would be used for renovations.

"I don't know what the governor's going to do with those (Panhandle) projects,'' Peaden said. "They're good projects.''