Transcript BUDGETING 101 - Healthcare Georgia Foundation

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 Advocate
Georgia 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
Deficient
quality
control
Low health status compared to U.S.
& U.S. ranks 20th in the world
Crumbling
rural
health
infrastructure
Costs too high
& rising
Many
underinsured
Racial, ethnic, gender
health disparities
Limited options for
long-term care
Fragmented
payment system
limits control
Prevention
Medicaid 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 Delivery
Nurse 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 Access
Health 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 selfdeclaration 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)
SB 529 Bottom Line:
 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
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)
 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
 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
Continuing Health Issues
for Georgia!
Deficient
quality
control
Low health status compared to U.S.
& U.S. ranks 20th in the world
Crumbling
rural
health
infrastructure
Costs too high
& rising
Many
underinsured
Racial, ethnic, gender
health disparities
Limited options for
long-term care
Fragmented
payment system
limits control
Linda Smith Lowe
Consumer Health Advocate
Georgia Legal Services & Families First
Family & Policy Bulletin
[email protected]
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 Spending
Education
Medicaid and PeachCare
Health and Social Services
Criminal Justice
Transportation
Debt Service
Homeowners Tax Relief
All Other State Agencies
FY 1991
FY 2007
($7.6 B)
($17.6B)
51.4%
9.0%
12.3%
9.6%
6.6%
4.6%
53.8%
12.5%
8.7%
9.9%
3.8%
4.9%
2.5%
4.0%
6.5%
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Revenues as Percent of Income
Figure 1: State Revenues as Share of Personal Income (FY 1980 - FY 2007)
7.00%
6.50%
6.00%
5.50%
5.00%
4.50%
4.00%
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 Outlook
Healthcare
– 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)
Salary Increase (3%)
Restore QBE Austerity Cut
Medicaid
$275 Million
$210 Million
$170 Million
$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

Voices for Georgia’s Children (www.georgiavoices.org)

Women's Policy Education Fund

Georgia Health Policy Center (www.gsu.edu/~wwwghp/)

Georgia Legal Services

Atlanta Women’s Foundation (www.atlantawomen.org)
(www.gbpi.org)
(www.womenspolicygroup.org)
(www.glsp.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)
U.S. A.G.: Services Necessary to Protect Safety or Life
 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
Still must meet
 Any others necessary to protect life or safety
the other 2 tests!
66 FR 3613 (1/16/2001); See also 63 FR 41658 (8/4/1998)
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