By Jim Saunders, The News Service of Florida: TALLAHASSEE - With Medicaid facing more budget cuts, the state Agency for Health Care Administration floated the possibility Wednesday of limiting patient visits to emergency rooms and doctors' offices. Acting Medicaid director Justin Senior told a House health-care panel that the state also could reduce home health visits for Medicaid beneficiaries and slash the amount of inpatient hospital care the program covers.

"None of the cuts we're proposing here are particularly palatable,'' Senior said.

But at least some members of the House Health Care Appropriations Subcommittee appeared receptive to AHCA's suggestion that the state should only pay for a maximum of 12 emergency room visits a year for each Medicaid beneficiary. Such a move could save $12.2 million.

Chairman Matt Hudson, R-Naples, said such a move could drive people to get treatment from primary-care doctors instead of emergency rooms, which could improve their health care. 

Rep. John Wood, R-Winter Haven, appeared miffed that some Medicaid beneficiaries might go to the emergency room more than once a month, calling it "unacceptable.''

"If we're allowing that type of behavior, shame on us,'' Wood said.

But Rep. Janet Cruz, D-Tampa, said severely ill people might need to go to emergency rooms more than 12 times a year. She also expressed concerns about who would get stuck paying for the care if a low-income Medicaid patient went to the ER more than 12 times --- and couldn’t afford to cover the bill.

"I'm truly concerned about limiting the emergency room visits for those who are chronically ill or those who are terminally ill,'' Cruz said.

The AHCA proposals came on the same day state analysts posted a report indicating lawmakers would have to set aside nearly $933 million in additional general revenue next year to continue covering current Medicaid budget needs.

With the struggling economy limiting tax collections, House and Senate leaders have already warned of cuts in the Medicaid budget.

AHCA offered budget-cutting proposals earlier this month that Hudson flatly rejected. Those proposals included cuts in the high-dollar Medically Needy and Meds-AD programs, which serve sick and old people who don't qualify for typical Medicaid coverage.

That rejection spurred Senior to come back Wednesday with a new list. Some of the ideas on the list have been proposed in past years, such as eliminating services such as adult dental, hearing and vision care.

But Senior offered other ideas that have received little attention in the past, including placing a limit on ER visits and only paying for adults to visit general-practice physicians twice a month.

Currently, Medicaid does not have limits on ER visits and has few limits on doctor visits. Also, Senior's proposal would reduce the number of Medicaid-funded home-health visits from four a day to three.

The biggest savings, about $156 million in state, local and federal money, would come from reducing the inpatient hospital care that Medicaid would fund for each adult beneficiary, from 45 days a year to 23 days. 

It is far too early to know whether lawmakers will move forward with any of the ideas when the 2012 legislative session starts in January. Along with having to measure the impact on patients, lawmakers also could face opposition from groups such as hospitals, which might get stuck with more of the cost of caring for low-income patients.

But Hudson said lawmakers will have to look at a wide range of options to balance the health and human-services budget. Also during the meeting, the Department of Children and Families offered a series of budget-cutting proposals that included slicing funding for substance-abuse and mental-health treatment.

Some Senate leaders have targeted adult mental-health and substance-abuse programs in the past, describing them as "soft" services, but the House has resisted such cuts.

Bob Sharpe, president and chief executive of the Florida Council for Community Mental Health, said DCF did not want to propose the cuts. But he said reducing the services could have spin-off effects, such as leading to child abuse by adults who have untreated mental-health or substance-abuse problems.

"It's counterintuitive to cut the very services that are going to protect children,'' said Sharpe, a former state Medicaid director.

But as Senior made clear, the agencies are grappling with trying to offer proposed cuts to the Legislature.

When a lawmaker asked Senior why AHCA had not proposed limiting physician visits in the past, he replied that "necessity is the mother of invention.''