TALLAHASSEE – Major changes in Florida’s Medicaid program are part of a nearly $70 billion budget bill and related legislation passed by the Senate on Wednesday.

The House also began debating its smaller $67.2 billion budget for the fiscal year beginning July 1, and will take a vote Thursday. The two chambers then will have a month to work out their differences.

The Senate budget bill (SB 2700) passed unanimously, but the chamber was divided over a provision directing state health care officials to seek a Medicaid rule waiver from the federal government that would allow for the voucher system. It would also let Florida require some Medicaid patients to pay for part of their health care costs for the first time.

Sen. Joe Negron, R-Stuart, offered the proposal as a way to cut the escalating cost of Medicaid. The state-federal program for low-income and disabled patients is expected to consume $19 billion, or about a quarter, of the next budget.

The tab is expected to escalate when the new federal health care law takes full effect at least four years from now by expanding Medicaid income eligibility from 100 percent to 133 percent of the poverty level, he said.

Instead of paying doctors, hospitals and other providers, the state would give patients vouchers to buy private coverage. That would be an improvement as many doctors now refuse to take Medicaid patients because the program pays them too little, Negron said.

His proposal passed on a near-straight party line vote, 24-12. All Democrats and one Republican, Sen. Rudy Garcia of Hialeah, voted against it.

Other Democrats questioned the rush since it’ll be several years before the state will feel the effects of the new federal law.

Negron said his proposal is just a first step. If the federal government approves the waiver the Legislature would have to work out the details and pass a final plan.

One of several budget-implementing and conforming bills the Senate also passed would add 19 more counties to five now covered by an experimental Medicaid program. It pays private companies a set amount for handling a specific number of residents similar to a health maintenance organization in the private sector.

The program has drawn widespread complaints from patients and doctors, but it has the backing of Senate President Jeff Atwater, R-North Palm Beach. The bill (SB 1484) passed 34-3.