2006 georgia budget and health legislative update may 25, 2006 atlanta, ga
TRANSCRIPT
2006 Georgia Budget and Health Legislative Update
May 25, 2006
Atlanta, GA
Agenda
Introduction
Legislation- What passed…What did not?
Budget Outlook- Financing our health
Open Discussion
Upcoming HealthTecdl Events
Linda Smith Lowe
Consumer Health AdvocateGeorgia Legal Services & Families First
Session Objectives
Increased understanding of:– Key health legislation affecting Georgians in
2006
Increased understanding of:– The potential impact of health legislation on
nonprofit health organizations and their clients
Health Issues for Georgia
Low health status compared to U.S. & U.S. ranks 20th in the world
8 th in number of uninsured
Costs too high & rising
Employers dropping
coverageMany
under-insured
Limited options for long-term care
Fragmentedpayment system
limits control
Crumbling rural
health infrastructure
Racial, ethnic, gender health disparities
Deficientquality control
PreventionMedicaid dental services for pregnant
women (Budget) Treatment of dental infection to prevent low birth weight & pre-term delivery
Babies Born Healthy (Budget) $500,000 more for prenatal care for immigrants not qualified for Medicaid (state now runs out of money in 6 months)
Newborn screening (HB 1066 + Budget) Expansion of genetic/metabolic screening to 40 tests
Prevention Higher payments for Health Check
screening (Budget) Affects children 0-8; left to managed care companies
Tobacco prevention funds (Budget) Ga. Smokefree Air Act (SB 90) Most public
places smoke free. Passed in 2005.
New suicide prevention program (HB 1092 + Budget)
Health Care DeliveryNurse prescriptive authority (SB 480)
Allows advanced practice registered nurses to write prescriptions for drugs, medical devices, treatments, certain tests, under protocol with physician.
Medication aide (SB 480) Allows RN/LPN tasks to be delegated to certified aides for community living arrangements (eg., non-injection drugs, including gastric tube, insulin, skin treatment, glucose test).
Medicaid waiver notice (SB 572) Administration must notify legislature before requesting major federal Medicaid waiver. Notice is joint resolution of House & Senate.
Health Care AccessHealth Shares Volunteers in Medicine (HB
166, HB 1224) Health care providers enroll with Department of Community Health to offer free care. Liability for negligence only under state tort claims act.
Unused drugs (HB 1178) Agencies to establish program to redistribute unused drugs to medically indigent people (7/1/2007)
Pharmacist refusal (HB 1178) Pharmacist may refuse to dispense drug that terminates pregnancy, but must refer to another pharmacy or return Rx. May not refuse to dispense birth control.
Health Care Access
Dept. of Community Health to design Medicaid buy-in for people with disabilities
Health Care Access Barriers
State Medicaid policy eliminating self-declaration of income (Budget)
New state & federal Medicaid citizenship verification requirements
New state policy/procedure clampdown on emergency Medicaid
Health Care Access Undocumented Immigrants
Ga. SB 529/Act 45; §9 on public benefits effective 7/1/2007
Requires verification of immigrant status for state or local public benefits (licenses, publicly funded services, etc.)
Allows affidavit with $1,000 fine and/or 1-5 years for willful falsehood; Verification through SAVE system
Exempts children under 18, prenatal care, emergency services, disaster relief, immunizations, treatment of communicable disease symptoms, higher education, and services exempted by federal law
Does not require verification unless person must be lawfully present to receive service
Health Care Access Undocumented Immigrants (continued)
3 Federal Tests for Service Exemption: Delivered in-kind (not cash) at community level,
Do not condition provision of assistance or amount of assistance on income or resources, and
Are necessary for protection of safety or life as specified by U.S. Attorney General
Health Care Access Undocumented Immigrants (continued)
Doesn’t mandate verification for health & human services if is not required by law that a person be lawfully present to receive them
Some state and local public benefits have required lawful presence since at least 1996*
Many other health and human services are exempt because they meet the 3 tests or have been otherwise exempted*
A service using a sliding scale fee system could be considered “conditioned on income” and therefore not exempt unless policies also require that persons be served regardless
* P.L. 104-193, Personal Responsibility & Work Opportunity Act of 1996
SB 529 Bottom Line:
Health Care Quality
Stem cell research (SB 596) Would create umbilical cord bank & encourage research (passed both houses, different forms, but no final approval)
Hospital acquired infection study (SR 853) (not passed, got through Senate)
Health Care Quality
Lymphdema treatment (HR 1055) Urges
treatment by nationally certified therapists.
Prevention of Starvation/Dehydration of Persons with Disabilities (SR 1067) Study Committee
Health Insurance
High risk pool (HB 1359) Would create a system providing access to insurance for uninsurable persons, but funding methodology a major issue (not passed)
PeachCare for All Kids (HB 1464) Would expand Medicaid & PeachCare to cover children up to 400% of federal poverty level with federal match & offer sliding scale buy-in above that
(not passed)
Long-Term Care (Budget)
1,500 new Developmental Disability Waiver slots
152 new Independent Care Waiver Slots
1,000 new Community Care Services Program Waiver slots
NH personal needs allowance increase from $30 to $50/month
Long-Term Care (Estate Recovery)
Ga. SB 572– Effective ?– Reserves $100,000 + CPI
& exclusions (year’s support, last illness costs, $5,000 funeral)
– Person must have had written notice at application & signed acknowledgement
– No recoupment of costs before effective date
Current Ga. Rule– Effective 5/1/2006– Applies to estates over
$25,000– Applies to person over
55 in LTC not disenrolled from Medicaid by 4/15/2006
– Recoups costs back to 8/2001
Watch for
developments!
Continuing Health Issues for Georgia!
Low health status compared to U.S. & U.S. ranks 20th in the world
8 th in number of uninsured
Costs too high & rising
Employers dropping
coverageMany
under-insured
Limited options for long-term care
Fragmentedpayment system
limits control
Crumbling rural
health infrastructure
Racial, ethnic, gender health disparities
Deficientquality control
Linda Smith Lowe
Consumer Health AdvocateGeorgia Legal Services & Families First
Family & Policy Bulletin
Alan Essig, Executive Director
Session Objectives
Increased understanding of:– The 2006 Georgia budget and its implications
for nonprofit health organizations
Increased understanding of:– Available resources for further information on
health legislation and related financing
Snapshot of State SpendingFY 1991 FY 2007($7.6 B) ($17.6B)
Education 51.4% 53.8%Medicaid and PeachCare 9.0% 12.5%Health and Social Services 12.3% 8.7%Criminal Justice 9.6% 9.9%Transportation 6.6% 3.8%Debt Service 4.6% 4.9%Homeowners Tax Relief 2.5%All Other State Agencies 6.5% 4.0%
Figure 1: State Revenues as Share of Personal Income (FY 1980 - FY 2007)
4.00%
4.50%
5.00%
5.50%
6.00%
6.50%
7.00%
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
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1996
1997
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2007
Re
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as
Pe
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State Revenues
Georgia Ranked 37th or 38th in state revenues as share of income every year between FY 1990 and FY 2001.
Georgia dropped to 43rd in state revenues as share of income in FY 2004.
Georgia ranks 42nd in state taxes per capita.
Problems to Solve in Georgia
– 18.8% of children live in poverty (national average 17.7%).
– In 2004 Georgians median income had largest decline in country
– African-Americans have unemployment, underemployment, and poverty rates more than double that of white workers.
Problems to Solve in Georgia
– Kids Count Well Being of Children - 39th
– Teen Birth Rate - 43rd
– Overall Health - 43th
– High School Graduation – 49th
– Children Without Health Insurance – 41st
FY 2006 Revenue Outlook Revenue grew 7% in FY 2004 and 8% in FY 2005.
Governor projects revenue growth of 5.6% in FY 2006.
Revenue Growth 9.0% through April.
Potential surplus at end of FY 2006 of $540 million.
FY 2007 Budget Outlook
Will we really have a surplus?
– Revenue Shortfall Reserve (RSR) at $223 million.
– $172 million for FY 2007 supplemental budget for
Education
– After next session, RSR should have a minimum
of approximately $689 million.
FY 2007 Budget Outlook
Revenue estimate based on 5.2% growth.
Other than Education Adjustment minimal surplus to spend in supplemental budget.
If revenues continue to grow at current strong pace Governor could increase revenue estimate.
FY 2008 Budget OutlookHealthcare
– Continued budget pressures on state budget as a whole.
– Increased funding for Medicaid. Increases due to national healthcare inflation, enrollment growth, and one time funding in FY 2007 budget.
– Public health, disabilities and mental health funding needs.
FY 2008 Budget Outlook
7% Revenue increase equals $1.2 Billion
Education (formula growth) $275 Million
Salary Increase (3%) $210 Million
Restore QBE Austerity Cut $170 Million
Medicaid $450 Million
$1.1 Billion
Budget Outlook Beyond FY 2008 Political pressure for tax cuts
– Property tax caps– Eliminate ad valorem tax on cars– Eliminate or further cut corporate income tax– Eliminate income tax on seniors– Cut income tax by 20 percent
TABOR – Limits on growth of state and local budgets– House and Senate Study committees as well as
campaign platforms
Budget Outlook Beyond FY 2008 Continued Federal Budget Cuts
Population Growth and Demographic Changes
– Education
– Healthcare
– Transportation
Actual and Potential Lawsuits
– School Funding
– Child Welfare
– Olmstead (long-term care for disabled and elderly)
Medicaid Modernization
Long-Term Solutions Commission for a New Georgia
Budget and Management Reform
Tax Reform and Modernization
Solidify tax base
– Raise sufficient revenues
– Withstand downturns
– Targeted tax cuts
21st Century Economic Development Policies
Long Term Solutions
Reason for a state budget is to allow state government to assist in improving quality of life (healthcare, education, public safety, environment, etc.).
The state budget and the fairness, equity and adequacy of taxes are linked
Alan Essig, Executive Director
www.gbpi.org
Important Links and References
Georgia Budget and Policy Institute (www.gbpi.org)
Voices for Georgia’s Children (www.georgiavoices.org)
Women's Policy Education Fund (www.womenspolicygroup.org)
Georgia Health Policy Center (www.gsu.edu/~wwwghp/)
Georgia Legal Services (www.glsp.org)
Atlanta Women’s Foundation (www.atlantawomen.org)
What’s Next at Healthtecdl?
Health Literacy
Board Recruitment, Development, and Evaluation
Grantwriting for Success
Marketing 101 for Nonprofits
FY 2007 Budget Outlook
Current RSR = $223 million
FY 2006 projected surplus = $632 million
Projected RSR (7/1/2006) = $855 million
Education Adjustment = $160 million
Adjusted RSR = $695 million
Minimum RSR (13 days) = $650 million
Funds available = $ 45 million
Health Care Access Undocumented Immigrants (continued)
Crisis counseling & intervention; services for child protection, adult protective services, violence & abuse prevention, victims of DV or other crimes; treatment of mental illness or substance abuse
Short-term shelter or housing assistance for homeless, DV victims or runaway, abused or abandoned children
Services or assistance for individuals during periods of heat, cold, adverse weather
Soup kitchens, food banks, senior nutrition, meals on wheels, etc. Medical & public health services (including treatment & prevention
of disease & injury), mental health, disability or substance abuse assistance to protect life or safety
Activities to protect life or safety of workers, children, youth, community residents
Any others necessary to protect life or safetyStill must meet
the other 2 tests!
66 FR 3613 (1/16/2001); See also 63 FR 41658 (8/4/1998)
U.S. A.G.: Services Necessary to Protect Safety or Life
Health Care Access Undocumented Immigrants (continued)
Services exempted by federal law:* Emergency medical services defined under
Medicaid law & not related to a transplant, Non-cash disaster relief, Immunizations & treatment of communicable
disease symptoms, and State & local benefits meeting 3 tests and
specified by U.S. Attorney General
* P.L. 104-193, Personal Responsibility & Work Opportunity Act of 1996