BUDGETING 101

1
(No Transcript)
2
2006 Georgia Budget and Health Legislative Update

• May 25, 2006
• Atlanta, GA

3
Agenda

• Introduction
• Legislation- What passedWhat did not?
• Budget Outlook- Financing our health
• Open Discussion
• Upcoming HealthTecdl Events

4
Linda Smith Lowe
Consumer Health Advocate Georgia Legal Services
Families First
5
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

6
Health Issues for Georgia
Deficient quality control
Low health status compared to U.S. U.S. ranks
20th in the world
8th in number of uninsured
Crumbling rural health infrastructure
Costs too high rising
Employers dropping coverage
Many under- insured
Fragmented payment system limits control
Racial, ethnic, gender health disparities
Limited options for long-term care
7
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

8
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)

9
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.

10
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.

11
Health Care Access

• Dept. of Community Health to design Medicaid
  buy-in for people with disabilities

12
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

13
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

14
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

15
Health Care Access Undocumented Immigrants
(continued)
SB 529 Bottom Line

• Doesnt 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
16
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)

17
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

18
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)

19
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

20
Long-Term Care (Estate Recovery)

• Ga. SB 572
• Effective ?
• Reserves 100,000 CPI exclusions (years
  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!
21
Continuing Health Issues for Georgia!
Deficient quality control
Low health status compared to U.S. U.S. ranks
20th in the world
8th in number of uninsured
Crumbling rural health infrastructure
Costs too high rising
Employers dropping coverage
Many under- insured
Fragmented payment system limits control
Racial, ethnic, gender health disparities
Limited options for long-term care
22
Linda Smith Lowe
Consumer Health Advocate Georgia Legal Services
Families First Family Policy
Bulletin smithlowe_at_earthlink.net
23

• Alan Essig, Executive Director

24
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

25
Snapshot of State Spending

• FY 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

26
(No Transcript)
27
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.

28
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.

29
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

30
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.

31
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.

32
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.

33
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.

34
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

35
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

36
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

37
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

38
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

39

• Alan Essig, Executive Director
• www.gbpi.org

40
Important Links and References

• Georgia Budget and Policy Institute
  (www.gbpi.org)
• Voices for Georgias 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 Womens Foundation (www.atlantawomen.or
  g)

41
Whats Next at Healthtecdl?

• Health Literacy
• Board Recruitment, Development, and Evaluation
• Grantwriting for Success
• Marketing 101 for Nonprofits

42
(No Transcript)
43
(No Transcript)
44
(No Transcript)
45
(No Transcript)
46
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

47
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
• Any others necessary to protect life or safety

Still must meet the other 2 tests!
66 FR 3613 (1/16/2001) See also 63 FR 41658
(8/4/1998)
48
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