State health budgets bring relief, some pain

Usually at the midpoint of a Georgia General Assembly session, health care industry groups are scrambling to prevent deep cuts in the budgets of Medicaid and other government programs.

Not so this year.

Hospitals, doctors and other medical providers appear fairly satisfied with the budget news so far, halfway through the legislative session.

They see no major reductions in the Medicaid or PeachCare programs, either in services, benefits or payments.

A proposed 0.5 percent cut in doctors’ pay under those two programs has been eliminated. And the administration is adding $4.6 million in state funds to raise several PeachCare payment rates for physicians and hospitals. Those funds would offset the movement of thousands of children from the state employee health plan to the PeachCare program, which pays providers less for services.

The hospital provider tax will remain unchanged this year as well.

“It’s a pretty quiet year,’’ said Tim Sweeney, senior health care analyst at the Georgia Budget and Policy Institute, in a recent interview. “There’s nothing really big and dramatic.’’

Given that the state’s economy remains weak, the budgetary situation could have been far worse for the health industry. But cuts and changes in some programs — ranging from children’s services to the state employee health plan — have raised concerns among lawmakers and advocacy groups.

State officials have said some physicians have stopped taking new Medicaid and PeachCare patients into their practices, so the bump in PeachCare rates is seen as welcome news.

Rick Ward, executive director of the Georgia chapter of the American Academy of Pediatrics, told Georgia Health News, “This is the first increase of Medicaid or PeachCare rates of any kind in over a decade. You can imagine the strain that some practices are under, [those] who see large numbers of Medicaid and PeachCare patients.’’

The budget for fiscal 2013, which begins in July, also increases state funding by $45 million for the Department of Behavioral Health and Developmental Disabilities. Most of the money goes to programs that are part of the 2010 Georgia settlement with the Department of Justice to improve the state’s mental health system.

Gov. Nathan Deal has proposed $3.7 million in additional funding to employ more school nurses. And he has built funds into his budget to pay for 400 new residency training slots in hospitals across the state for graduates of Georgia medical schools.

The idea behind the residency program is to induce many more of these young physicians to practice in Georgia. Where doctors perform their residency is a key predictor of where they ultimately practice. The state has a major doctor shortage, particularly in primary care and in rural areas.

“As Georgia’s population continues to increase, the physician numbers are not increasing as fast,’’ said Cherri Tucker, executive director of the Georgia Board for Physician Workforce.

But while residency slots may increase, medical schools face funding cuts. Mercer School of Medicine faces a $417,000 cut in the next fiscal year, and Morehouse School of Medicine $220,000. The Medical College of Georgia also is scheduled for a reduction.

Morehouse School of Medicine President John Maupin said that if required, the school will make the necessary program reductions. ”We can work with it,” he said, but acknowledged, “we would prefer to retain the funds to ensure optimal support of the residency programs.”

Maupin also noted that an additional $1.4 million is transferred from the Morehouse operating grant to the graduate medical education program within the Board for Physician Workforce budget. “This transfer, if not specifically designated to our residency programs, has the potential to significantly undermine both our residency and [graduate medical education] programs,’’ he said.

Meanwhile, Public Health funding is still lagging after years of budget cuts.

The Georgia Budget and Policy Institute points out that despite a slight increase in fiscal 2013, Georgia’s public health programs will still operate with fewer state funds than in the pre-recession budget of fiscal 2009. The budget does restore more than $400,000 in fiscal 2013 to the state health lab, along with $228,000 this year.

Georgia is one of 17 states that lost funds by Congress’s decision not to reinstate supplemental grants under the Temporary Assistance for Needy Families (TANF) block grant.

In Public Health’s budget, an adolescent and youth program aimed at preventing risky behavior among teens will lose more than $5 million in federal TANF money this year and in fiscal 2013. The state will end up closing 30 teen centers and shift to a new focus on youth development coordinators, centers of excellence, and funding through a federal grant called the Personal Responsibility Education Program.

Also taking a $2.8 million TANF hit next year –- and $2 million this year — is the Children’s 1st program, which screens children from birth to age 5 to identify and refer those at risk of poor developmental or health outcomes to appropriate services.

This reduction will mean that more than 8,000 low birthweight or very low birthweight babies will not receive nurse home visit services, and that about 30,000 children with potential medical and/or developmental concerns will not be linked to services.

The Department of Public Health’s commissioner, Dr. Brenda Fitzgerald, said the agency is working with other state departments to try to fill this children’s services gap. “We absolutely have to find this money,’’ Fitzgerald said Tuesday at an agency board meeting.

Millions more in TANF funds are scheduled to be lost from addiction recovery services provided by Community Service Boards and private organizations (Here’s a past GHN article on this cut).

Hearings involving the Department of Community Health budget have focused on state moves to fill a major shortfall in the State Health Benefit Plan.

Teachers, state employees, school personnel and retirees are already paying higher premiums for coverage. SHBP is also charging much higher co-pays for certain drugs. Bariatric surgery was eliminated as a benefit.  And school districts face a big jump in their insurance costs for bus drivers, cafeteria workers and other non-teacher personnel. (Here’s a recent AJC article about schools’ health costs.)

Two financial issues are scheduled to continue beyond the legislative session.

One involves proposed rate changes for providers of services to the developmentally disabled, which provoked an emotional state hearing recently. The state has delayed action on the changes.

The other is the recent Navigant report, calling for a revamped managed care system for Medicaid and PeachCare.

State officials are expected to recommend a plan for overhauling those programs sometime in April, but the decision probably won’t occur till after the General Assembly session closes, when lawmakers have all gone home.