A piece of legislation moving through the state legislature could prove an existential threat to hospital districts, local officials are warning.

The Special District Accountability Act would require a performance audit every five years on independent taxing districts like the Hospital District. The proposed audit, taking effect in October, would cost hospital districts between $20,000 and $50,000, depending on their size. The audit would come on top of the district’s existing annual financial audits.

The bill appears to be aimed at eliminating replication of existing county services, among other things. But district officials – and advocates for special taxing districts – believe the bill’s true intention may be to shut down hospital districts altogether.

The bill states results of the performance audit would be sent to Florida’s auditor general and leaders of the House and Senate.

In an email sent to the 16 agencies the Hospital District funds, including Cleveland Clinic Indian River Hospital, Hospital District executive director Ann Marie Suriano warned that aspects of the bill could have “great impact” on the district.

“In the event the legislature finds through these performance audits that the District is no longer relevant, it can disband or sunset the District from its existence.”

“What would these agencies do without our funding?” Suriano asked the board last week.

There are 27 active county hospital districts in the state, out of 67 counties. In her email, Suriano urged the agencies to contact local legislators to let them know the value of the Hospital District.

The Hospital District’s millage rate in the current fiscal year is .8 percent, which amounted to $15.6 million in tax dollars going into the Hospital District annual budget. After administrative costs, around $14 million goes toward healthcare for the indigent, spread out over 16 agencies and programs approved by the District Board.

Board members, who are unpaid volunteers, put in voluminous hours, but the Hospital District is rarely credited in public with its contributions to the community, said board chairwoman Marybeth Cunningham.

“It sticks in my craw,” said Cunningham at last week’s public meeting. “I listen to other agencies that we fund give talks and they never mention that they get funding from the Hospital District. United Way, the hospital? Hello?”

“Well, I say shame on the agencies that don’t mention you,” said Treasure Coast Community Health’s CEO Vicki Soule, whose low-cost clinic system is one of four district-funded agencies that are leading the COVID-19 vaccine delivery effort.

“We have you in our annual report, we dedicated a piece of our pie chart to you, and we are very appreciative,” said Soule.