2006 Georgia Budget and Health Legislative Update

2. 2006 Georgia Budget and Health Legislative Update May 25, 2006 Atlanta, GA

3. Agenda • Introduction • Legislation- What passed…What 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 lifeas specified by U.S. Attorney General

15. 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

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. 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 Long-Term Care (Estate Recovery) 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@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. FY 1991FY 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% Snapshot of State Spending

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 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)

41. What’s Next at Healthtecdl? • Health Literacy • Board Recruitment, Development, and Evaluation • Grantwriting for Success • Marketing 101 for Nonprofits

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