Issue: Health

Alabama House passes budget that could end Medicaid in state

By Carol Gundlach

Medicaid could end in Alabama under a General Fund (GF) budget that the Alabama House passed Wednesday. Medicaid would lose 23 percent of its state funding, or $156 million, next year under the plan. Lost federal matching money would increase those cuts significantly. Cuts that large could end the Medicaid program in Alabama, State Health Officer Don Williamson said Tuesday.

The House initially voted 46-45 to reject a budget amendment cutting Medicaid. But then, on a second vote, it approved the amendment 46-44. The House then passed the GF budget 53-40, sending it to the Senate. Several key senators have said they strongly oppose deep Medicaid cuts, but their solution to the GF shortfall remains unclear.

Medicaid is ‘health care infrastructure in this state’

If the Medicaid cut remains, about one in five Alabamians would lose their health coverage, including nearly half of Alabama’s children and about 60 percent of the state’s seniors in nursing homes. Those cuts likely would lead to the closure of Children’s Hospital in Birmingham, as well as dozens of other hospitals and nursing homes across the state. The results would be devastating for Alabama’s economy and quality of life.

During four hours of debate on the budget, House members decried the impact that the Medicaid cuts would have on their constituents and communities. Rep. April Weaver, R-Brierfield, said it was “shocking” to see lawmakers considering such cuts to Medicaid. “If anyone thinks that Medicaid is an entitlement, come see me,” Weaver said. “It’s the health care infrastructure in this state.”

Rep. Mike Jones, R-Andalusia, also spoke of the huge toll that a Medicaid shutdown could take on communities. Jones said the end of Medicaid could mean 600 job losses in his district and put two hospitals and several local nursing homes at risk of closing.

Without new revenue, the path forward is uncertain

The budget passed after key parts of Gov. Robert Bentley’s plan to raise new revenue to prevent massive GF cuts went nowhere in the House’s GF budget committee. The panel voted 8-7 Tuesday to reject a plan to increase the state cigarette tax by 25 cents per pack (from 42.5 cents to 67.5 cents). A bill to increase the business privilege tax on large corporations was on the agenda Tuesday but did not come up for a vote.

House and Senate committees have approved bills to transfer use tax revenues from the Education Trust Fund to the GF, but the measures face stiff opposition from many legislators. The use tax is equivalent to a sales tax on goods bought outside the state for use within Alabama. It is commonly discussed in the context of Internet or mail-order purchases.

Many lawmakers strongly oppose shifting money from education to GF services. Alabama’s education funding is still well below its 2008 level, before the Great Recession, and its K-12 cuts and higher education cuts since then are among the nation’s worst.

The GF supports vital services like health care, child care, corrections and public safety in Alabama. The budget relies on a hodgepodge of revenues, most of which grow slowly even in good economic times. That leaves the GF with a structural deficit, meaning revenue growth is not strong enough to keep pace with ordinary cost growth.

If lawmakers do not approve a substantial source of new GF revenue in the coming days, it will be impossible for them to pass a budget that avoids devastating cuts to Medicaid or other vital services during this special session. Alabama’s 2016 budget year begins Oct. 1, 2015, and the prospect of another special session before then looms ever larger by the day.

By Carol Gundlach, policy analyst, and Chris Sanders, communications director. Posted Aug. 5, 2015.

Medicaid could end under Alabama House committee’s budget

By Carol Gundlach

Medicaid could end in Alabama under devastating cuts in a proposed General Fund (GF) budget that the Alabama House’s GF budget committee approved Tuesday, State Health Officer Don Williamson said. About one in five Alabamians would lose their health coverage, including nearly half of Alabama’s children and about 60 percent of the state’s seniors in nursing homes.

Medicaid would lose 23 percent of its state funding, or $156 million, next year under the budget that the committee approved Tuesday. Lost federal matching money would increase the loss significantly.

Those cuts likely would lead to the closure of Children’s Hospital in Birmingham, as well as dozens of other hospitals and nursing homes across the state. “If Alabama chooses not to have a Medicaid program, you will see an impact on the health care system that you can only begin to imagine,” Williamson said Tuesday.

Cigarette tax increase, other revenue bills fail to gain traction

The vote came after key parts of Gov. Robert Bentley’s plan to raise new revenue to prevent massive GF cuts went nowhere during a tense day in the House’s GF budget committee. The panel voted 8-7 Tuesday to reject a plan to increase the state cigarette tax by 25 cents per pack (from 42.5 cents to 67.5 cents). A bill to increase the business privilege tax on large corporations was on the agenda but did not come up for a vote.

The committee recessed for several hours after the cigarette tax vote. When it returned late Tuesday afternoon, a frustrated Rep. Steve Clouse, R-Ozark, who chairs the committee, offered an amendment to concentrate GF budget cuts in the Medicaid program. Committee members approved the change 10-4 and then OK’d the budget on a voice vote. The GF budget now awaits action in the full House.

Democratic committee members strongly condemned the proposed Medicaid cuts. “To take and use Medicaid as a pawn, I think is totally unfair,” said Rep. John Knight, D-Montgomery. “Other agencies should be on the chopping block.”

Knight urged legislators to be honest with the public about the need for new GF revenue to support vital services like health care, child care and public safety. The Legislative Black Caucus will not vote for tax increases without adequate long-term GF revenues, Knight told the Montgomery Advertiser.

Clouse criticized several Democratic lawmakers’ votes against the cigarette tax bill, telling the Advertiser that Democrats had supported a tobacco tax increase during the regular session. “I came with a fair budget that level-funded Medicaid,” he said. Clouse said he does not support deep Medicaid cuts but said Alabama needs to have a debate about the program’s future.

Lawmakers OK transfer of education revenues to shore up General Fund

Both the House and Senate’s GF budget committees approved bills Tuesday to transfer use tax revenues from the Education Trust Fund (ETF) to the GF. The use tax is equivalent to a sales tax on goods bought outside the state for use within Alabama. It is commonly discussed in the context of Internet or mail-order purchases.

The House committee voted to transfer both use tax revenues and some funding obligations to the GF, resulting in a net loss of $50 million to education and a net GF gain of the same amount. The Senate bill would transfer use tax revenues but not the accompanying obligations. That would reduce education revenue (and increase GF revenue) by more than $200 million.

Alabama’s education funding is still well below pre-recession levels. The state’s per-pupil K-12 spending in 2015 was 18 percent lower than in 2008, the second worst decline in the nation, according to the Center on Budget and Policy Priorities (CBPP). Alabama’s per-student higher education cuts from 2008 to 2016 are also the nation’s second worst, the CBPP found.

Bentley has proposed to “backfill” the ETF’s revenue loss by ending the state income tax deduction for FICA taxes paid to support Social Security and Medicare. But this bill has not yet been set for a committee vote, and many press reports suggest it is unlikely to pass.

Bill to ‘un-earmark’ mental health, DHR money advances in House committee

The House’s GF budget committee also approved a bill Tuesday to “un-earmark” revenues dedicated to five state agencies and shift the revenues into the GF. Nearly 90 percent of the transfers under HB 46, sponsored by Rep. Allen Farley, R-McCalla, would come from mental health and the Department of Human Resources (DHR). Other services affected would be public health, veterans’ affairs and forestry.

Bentley’s budget plan would provide additional GF money to help the agencies cover the un-earmarked amounts. But neither the current Legislature nor future ones would be obligated to do so under HB 46. Advocates for children and for people with mental illness are deeply concerned about this idea.

By Carol Gundlach, policy analyst, and Chris Sanders, communications director. Posted Aug. 4, 2015.04

What went well in 2015 — and the challenges that remain for Alabama

By Kimble Forrister

It’s over! But it’s not over yet. After approving a wholly inadequate General Fund budget that would jeopardize our state’s future, the Alabama Legislature ended the 2015 regular session Thursday. But Gov. Robert Bentley vetoed that budget, and he will call lawmakers back for a special session on the budget later this summer.

Arise members celebrated some big victories this year, but major challenges still remain. Here’s a quick review of how Arise issues fared:

Budgets and taxes: None of Bentley’s revenue bills passed. Without new revenue, vital services like Medicaid and public safety face devastating cuts that would hurt Alabama’s quality of life for years to come. Just a few examples:

  • Thousands of Alabamians would lose community-based mental health care services.
  • Medicaid would end coverage of crucial services like outpatient dialysis and prosthetics.
  • State prisons would be even more overcrowded and at greater risk of federal takeover.

But there was some good news, too. Lawmakers overwhelmingly approved a bill to save money and give Alabamians more choices in Medicaid long-term care services. The state will have a powerful new tool – a “tax expenditure report” – to determine if tax breaks are worth the cost. And a new prison reform law will help save money and reduce overcrowding – but it only takes effect if the state funds it.

Ending Alabama’s lifetime SNAP ban: Alabamians can celebrate a big win for second chances! The prison reform bill includes language ending the state’s lifetime SNAP and TANF eligibility bans for people with a past felony drug conviction. Thousands of people can regain SNAP eligibility on Jan. 30, 2016, if the prison reform law gets the money required for it to take effect.

Alabama Accountability Act: The Legislature approved major changes to the act. The new version allows more money that would have supported public education to go to private schools instead – but it also includes some of Arise’s recommendations for greater accountability and transparency.

Housing Trust Fund: A bill to fund affordable housing in Alabama encountered powerful opposition and did not emerge from committee. Supporters plan to meet with opponents to seek agreement before the 2016 session.

Payday and title lending reform: In a big win for consumers, the Alabama Supreme Court ruled the state Banking Department can create a single statewide database of payday loans. But much work remains in the drive for a 36 percent interest rate cap: No bills to regulate payday or auto title loans passed, but public pressure for reform continues to grow.

The regular session is over, but Arise’s work continues. Stay tuned for updates as we prepare for this summer’s crucial debates over our state’s future. Together, we can build a better Alabama for all!

By Kimble Forrister, executive director. Posted June 4, 2015. Updated June 12, 2015.

HIV medication redistribution bill clears Alabama Legislature

By Jim Carnes

New information: Gov. Robert Bentley will not sign the bill, his health policy adviser Dave White said Friday, June 12. White attributed the decision to a technical error in the committee amendment and said Bentley supports the bill’s intent.

Pharmacies that distribute HIV medications in or for HIV clinics could redistribute certain unopened drugs under a bill that won final approval Thursday in the Alabama Legislature and was sent to Gov. Robert Bentley.

HB 247, sponsored by Rep. Patricia Todd, D-Birmingham, passed both the House and Senate without a single “no” vote. The bill includes a Senate committee amendment protecting drug manufacturers from liability in the event of improper re-dispensing and excluding drugs that require patient registration with the drug’s manufacturer. Pharmacies serving correctional facilities and nursing homes already have the authority to redistribute unopened drugs.

Under current law, HIV clinics must destroy unopened medications if patients do not show up for treatment. Todd’s bill, if signed by Bentley, will allow pharmacies to redistribute those drugs to other patients and set controls on handling and oversight of the drugs. Arise recommended this policy change in 2013 to the governor’s Medicaid Pharmacy Study Commission, which sought ways to reduce costs in the state’s Medicaid drug assistance programs.

By Jim Carnes, policy director. Posted June 4, 2015. Updated June 12, 2015.

Alabama Legislature passes Medicaid long-term care reforms

By M.J. Ellington

Medicaid long-term care patients in Alabama would have more options about their care under a bill that passed the House 98-0 Thursday and went to Gov. Robert Bentley. SB 431, sponsored by Senate Majority Leader Greg Reed, R-Jasper, cleared the Senate 30-0 last week.

The plan would deliver comprehensive Medicaid long-term care services, including in-home and other community-based services and nursing home care, through one or more integrated care networks (ICNs). One goal is long-term cost control.

State Health Officer Don Williamson told legislators that the ICN system could lead more people to choose in-home care rather than nursing home placement. The legislation would remove caps on the number of Alabamians eligible to receive less costly at-home and community-based Medicaid services.

The plan would give patients more options for care while retaining the more costly nursing home option if needed. The bill would set up a managed-care health delivery system for seniors and for people with disabilities who have Medicaid coverage and meet the criteria for admission to a nursing home.

“As quietly as this bill passed, its historic significance is easy to miss,” ACPP policy director Jim Carnes said. “When these changes go into effect, it will be a new day in Alabama for patient choice and cost-effectiveness in long-term care.”

The ICN plan would be similar in structure to the regional care organizations (RCOs) into which other Medicaid patients will move. The state’s new RCO model is designed to keep patients healthier while cutting costs.

The long-term care plan was developed with input from the nursing home industry, health experts and advocates on the Medicaid Long-Term Care Workgroup, of which Arise is a member. The bill calls for each ICN to have a Citizens’ Advisory Committee that includes members nominated by Alabama Arise and a number of advocacy partners.

Pharmacy ‘privilege tax’ to help Medicaid budget approved by House committee

Most pharmacies in Alabama would pay an additional 15 cents in privilege tax on each prescription they fill or refill under HB 698, which won the approval of the House’s General Fund (GF) budget committee Thursday. Just four legislative days remain for the bill to clear the House and Senate.

Medicaid would gain about $8 million under the proposal. Rep. Elaine Beech, D-Chatom, the bill’s sponsor, said retail pharmacists agreed to pay the supplemental privilege tax as a way to help Medicaid avoid drastic service cuts. Beech’s bill excludes prescriptions for hospital patients and pharmacies operated by the state or state agencies.

Without more revenue, Williamson said, Medicaid will have little choice but to use a pharmacy benefits manager and mail-order prescription drugs to help cut costs. Many pharmacies, especially those in rural areas, depend on Medicaid prescription drug business. Pharmacies will continue to pay an existing privilege tax of 10 cents, bringing the total pharmacy tax to 25 cents per prescription if the legislation becomes law.

A similar bill sponsored by Sen. Rodger Smitherman, D-Birmingham, cleared the Senate’s GF budget committee Tuesday. SB 507 also would impose an additional privilege tax of 15 cents per prescription, but it would not exclude hospital pharmacies and state-owned pharmacies.

By M.J. Ellington, health policy analyst. Posted May 28, 2015.

Medicaid long-term care options would expand under bill that clears Alabama House committee

By M.J. Ellington

More Alabamians with Medicaid coverage would have more options for long-term home and community care under a bill that the House Health Committee approved unanimously Thursday. The bill, which the Senate passed 30-0 Tuesday, now goes to the full House for consideration.

SB 431, sponsored by Senate Majority Leader Greg Reed, R-Jasper, would deliver comprehensive Medicaid long-term care services, including in-home and other community-based services and nursing home care, through one or more integrated care networks (ICNs). A House version of the plan – HB 585, sponsored by Rep. April Weaver, R-Brierfield – won committee approval earlier this month.

The legislation would set up a cost-effective, managed-care health delivery system for seniors and for people with disabilities who have Medicaid coverage and meet the criteria for admission to a nursing home. The bill would remove caps on the number of Alabamians eligible to receive less costly at-home and community-based Medicaid services. The plan would give patients more options in care while retaining the more costly nursing home option if needed.

The ICN plan would be similar in structure to the regional care organizations (RCOs) into which other Medicaid patients will move. The state’s new RCO model is designed to keep patients healthier while cutting costs.

The ICN plan was developed with input from the nursing home industry, health experts and advocates on the Medicaid Long-Term Care Workgroup, of which Arise is a member. The bill calls for each ICN to have a Citizens’ Advisory Committee that includes members nominated by Alabama Arise and a number of advocacy partners.

By M.J. Ellington, health policy analyst. Posted May 21, 2015.

Medicaid, mental health, child care would be slashed under Alabama House’s General Fund budget

By Carol Gundlach

Alabamians’ quality of life would suffer for years to come if the no-new-revenue General Fund (GF) budget that the state House passed 66-36 Tuesday becomes reality. The barebones budget would slash vital services like health care, child care and public safety. Alabama’s promising new reforms of Medicaid and prisons would end, and services for low-income children could face devastating cuts. The budget now goes to the Senate.

“Alabama simply can’t afford the cuts in the no-new-revenue General Fund budget,” Arise’s Kimble Forrister said Tuesday. “It’s time to stop cutting the services that make our state a better, healthier place to live and to start investing in Alabama’s future.”

At no point during floor debate did a House member mention Gov. Robert Bentley’s plan to raise $541 million in GF revenue. The bills, including proposals to increase the state cigarette tax and the state sales tax on automobiles, still await a House vote.

‘We were elected to govern, not to pander’

Opponents of the budget cuts repeatedly raised concerns about their impact on children, seniors, low-income Alabamians, and people with disabilities. Rep. Thomas Jackson, D-Thomasville, argued that the budget would take food from low-income families. Rep. Laura Hall, D-Huntsville, said the cuts would prevent the state’s promising new prison reforms from being implemented. “I don’t know how anyone can be proud to pass prison reform and then not fund it,” Hall said.

Rep. Patricia Todd, D-Birmingham, emphasized the budget’s proposed cuts to AIDS drug assistance and put the GF debate in stark terms. “People are going to die because of this budget,” Todd said. “We were elected to govern, not to pander.”

Rep. Steve Clouse, R-Ozark, who chairs the House’s GF budget committee, said the budget wasn’t what he wanted to present. But “we’re having problems with our colleagues in the Senate and want to give them motivation to come to the table” and identify new revenue, Clouse said.

With the Legislature’s regular session nearing an end, talk of one or more special sessions is running rampant, and the threat of deep cuts to services that make our state a better place to live and work is real. Here is a look at a few of the ways Alabamians would feel the cuts in their everyday lives:

Proposed budget cuts would end new Medicaid reforms and impose severe cuts to other health care programs. The proposed GF budget would reduce Medicaid funding by 5 percent. State Health Officer Don Williamson has said the cut would force Medicaid to abandon its new regional care organization model, designed to keep patients healthier while cutting costs.

Williamson said last month that a smaller 3 percent cut would force the agency to end coverage of outpatient dialysis, forcing kidney patients to be admitted to the hospital to receive routine dialysis. Medicaid also would have to stop paying for adult eyeglasses and prosthetics.

In addition, Medicaid would reduce reimbursement payments to doctors, which could mean fewer physicians treating Medicaid patients. Medicaid also would contract with a single provider of prescription services, likely forcing many local, independent pharmacies to close.

The committee’s budget would also cut home health services for the elderly and disabled. Patients losing these services could be forced to enter much more expensive nursing homes, reducing patients’ independence and increasing costs to the struggling Medicaid program. Funding for life-saving HIV and AIDS medications would be cut by 50 percent.

Proposed budget cuts would reduce community mental health services. In recent years, the Department of Mental Health responded to budget cuts by closing nearly every public mental health hospital. Many advocates applauded the new focus on less restrictive (and less expensive) community-based services.

But the 2016 GF budget proposal would reduce funding for those very services by 5 percent. Patients unable to receive mental health treatment may be forced into private hospitals, or they may end up incarcerated in local jails without access to needed counseling and medications.

Proposed budget cuts would devastate social services for low-income families and children. Together, the House’s GF budget and the education budget awaiting House approval would reduce Department of Human Resources (DHR) funding by 14 percent. Clouse said Tuesday that the addition of revenues already earmarked, or set aside, for DHR would reduce the total cut to 5 percent.

Because much state DHR funding is matched by federal money, the agency’s total cuts would be much larger than the lost state dollars alone. DHR last week outlined severe service reductions in response to the cuts. They would include:

  • Reductions in child care assistance for thousands of working families,
  • Elimination of adult day care services for 300 elderly and disabled adults, and
  • Reductions in protective services for abused and neglected children.

Alabama’s network of Community Action Agencies provides nutrition, housing, Head Start and energy assistance services to low-income people. The proposed GF budget would cut state funding for these services by 50 percent.

Proposed budget cuts would end prison reform and could risk a federal takeover of the state prison system. The House approved GF budget would make devastating cuts to Alabama’s civil and criminal justice system, ensuring that the recently passed (and highly praised) prison reform legislation could not be implemented.

Alabama’s prison system, already operating at nearly twice its designed capacity, would absorb a 5 percent cut under the proposed budget, increasing the risk of federal intervention. The budget also includes major cuts for the very programs needed for prison reform to succeed: drug courts; community corrections; and parole services, essential for reducing recidivism.

Bentley has signed the prison reform bill into law. But before any of those reforms can be implemented, the governor’s office must certify that the Department of Corrections and the Board of Pardons and Paroles have enough money to move ahead with the changes. The proposed GF budget would derail prison reform by making this certification impossible.

Our state needs new revenue to avoid these cuts. Overall, the GF budget falls more than $200 million short of the amount needed to prevent deep service cuts and invest in reforms. Lawmakers thus far have not considered Bentley’s proposals to raise revenue and avoid those cuts, including increasing the state cigarette tax and automobile sales tax. Other tax bills that won House committee approval last week also have stalled.

Alabama faces an important choice that will help determine what kind of state our children and grandchildren will inherit. Do we raise new revenue to protect vital services like health care and public safety? Or do we erode our state’s quality of life with devastating cuts to those services? The House budget would side with the latter option, and Alabama would suffer the consequences of that choice for years to come.

By Carol Gundlach, policy analyst. Posted May 19, 2015.

Medicaid long-term care reforms sail through Alabama Senate

By Jim Carnes

Medicaid patients in Alabama would have more options to receive long-term care in their community under a bill that the state Senate passed 27-0 Tuesday.

SB 431, sponsored by Senate Majority Leader Greg Reed, R-Jasper, would create one or more integrated care networks (ICNs) to deliver a broad range of Medicaid long-term care services, ranging from home- and community-based supports to nursing home care. A House version of the plan – HB 585, sponsored by Rep. April Weaver, R-Brierfield – won committee approval earlier this month.

The new system would operate in coordination with the Medicaid regional care organizations (RCOs) set to take effect Oct. 1, 2016. The new RCO model is designed to keep patients healthier while cutting costs, but Medicaid could have to abandon it if the severe cuts under the House’s no-new-revenue General Fund budget become law.

SB 431 effectively would lift long-standing participation caps on home- and community-based waivers, enhancing patient choice and expanding care options that are less costly than institutionalized care. The plan represents a significant breakthrough with the nursing home industry and was developed by the Medicaid Long-Term Care Workgroup, of which Arise is a member. The bill calls for each ICN to have a Citizens’ Advisory Committee that includes members nominated by Alabama Arise and a number of advocacy partners.

By Jim Carnes, policy director. Posted May 19, 2015.

Alabama would suffer for years to come under no-new-revenue General Fund budget

By Carol Gundlach

Alabamians’ quality of life would suffer for years to come if the no-new-revenue General Fund (GF) budget that the House’s GF budget committee approved Thursday becomes reality. The House is expected to vote Tuesday on the budget, which would slash vital services like health care, child care and public safety. The state’s promising new reforms of Medicaid and prisons would end, and services for low-income children could face devastating cuts.

With the Legislature’s regular session nearing an end, talk of one or more special sessions is running rampant, and the threat of deep cuts to services that make our state a better place to live and work is real. Here is a look at a few of the ways Alabamians would feel the cuts in their everyday lives:

Proposed budget cuts would end new Medicaid reforms and impose severe cuts to other health care programs. The proposed GF budget would reduce Medicaid funding by 5 percent. While the Medicaid agency has not specified what services would be reduced or eliminated, State Health Officer Don Williamson has said the cut would force Medicaid to abandon its new regional care organization model, designed to keep patients healthier while cutting costs.

Williamson said last month that a smaller 3 percent cut would force the agency to end coverage of outpatient dialysis, forcing kidney patients to be admitted to the hospital to receive routine dialysis. Medicaid also would have to eliminate hospice care coverage and stop paying for adult eyeglasses and prosthetics.

In addition, Medicaid would reduce reimbursement payments to doctors, which could mean fewer physicians treating Medicaid patients. Medicaid also would contract with a single provider of prescription services, likely forcing many local, independent pharmacies to close.

The committee’s budget would cut home health services for the elderly and disabled by more than 9 percent. Patients losing these services could be forced to enter much more expensive nursing homes, reducing patients’ independence and increasing costs to the struggling Medicaid program. Funding for life-saving HIV and AIDS medications also would be cut by 50 percent.

Proposed budget cuts would reduce community mental health services. In recent years, the Department of Mental Health responded to budget cuts by closing nearly every public mental health hospital. Many advocates applauded the new focus on less restrictive (and less expensive) community-based services.

But the 2016 GF budget proposal would reduce funding for those very services by 5 percent. Patients unable to receive mental health treatment may be forced into private hospitals, or they may end up incarcerated in local jails without access to needed counseling and medications.

Proposed budget cuts would devastate social services for low-income families and children. Together, the committee’s GF budget and the education budget awaiting House committee approval would reduce Department of Human Resources (DHR) funding by 14 percent.

DHR commissioner Nancy Buckner last month outlined draconian service reductions in the event of major budget cuts. These could include the elimination of the Temporary Assistance for Needy Families (TANF) program, which provides cash assistance and services for extremely low-income families, including more than 30,000 children.

Other cuts could include major reductions in child care assistance for thousands of working families, the elimination of adult day care services, and the elimination of child support collection services for more than 200,000 Alabama families. Because much state DHR funding is matched by federal money, the agency’s total cuts would be much larger than the lost state dollars alone.

The House committee budget would eliminate GF support for the Department of Youth Services (DYS), which provides supervision and services for youthful offenders and their families. The total reduction would be 12 percent, accounting for DYS funds in the education budget.

Like mental health, DYS has moved in recent years toward less expensive and more appropriate community services and has closed expensive residential beds for low-risk offenders. These community services would be cut under the proposed GF budget. With fewer residential beds, juvenile offenders would be left unsupervised or incarcerated in county facilities instead.

Alabama’s network of Community Action Agencies provides nutrition, housing, Head Start and energy assistance services to low-income people. The proposed GF budget would cut state funding for these services by 50 percent.

Proposed budget cuts would end prison reform and could risk a federal takeover of the state prison system. The committee’s GF budget would make devastating cuts to Alabama’s civil and criminal justice system, ensuring that the recently passed (and highly praised) prison reform legislation could not be implemented.

The state’s already reeling trial courts would face a 16 percent cut under the budget, leading to hundreds of layoffs. The budget also would cut juvenile probation services by nearly 40 percent and forensic sciences by 22 percent. These cuts could force courts to close at least two days a week, delay trials and hearings, and delay criminal cases that require DNA and other forensic evidence. The deep cuts also would result in more unsupervised juvenile offenders even as youth services are slashed.

Alabama’s prison system, already operating at nearly twice its designed capacity, would absorb a 5 percent cut under the proposed budget, increasing the risk of federal intervention. The budget also includes major cuts for the very programs needed for prison reform to succeed. The state’s drug court program would be cut nearly 40 percent. Community corrections, the alternative to imprisonment, would be cut by half. And parole services, essential for reducing recidivism, would be reduced by 14 percent.

Bentley has said he plans to sign the prison reforms that the Legislature passed last week into law. But before any of those reforms can be implemented, the governor’s office must certify that the Department of Corrections and the Board of Pardons and Paroles have enough money to move ahead with the changes. The proposed GF budget would derail prison reform by making this certification impossible.

Our state needs new revenue to avoid these cuts. Overall, the committee’s $1.64 billion GF budget falls more than $200 million short of the amount needed to prevent deep service cuts and invest in reforms. Lawmakers thus far have not considered Gov. Robert Bentley’s proposals to raise revenue and avoid those cuts, including increasing the state cigarette tax and automobile sales tax. Other tax bills that won House committee approval last week have stalled.

Alabama faces an important choice that will help determine what kind of state our children and grandchildren will inherit. Do we raise new revenue to protect vital services like health care and public safety? Or do we erode our state’s quality of life with devastating cuts to those services? The House committee’s budget would side with the latter option, and Alabama would suffer the consequences of that choice for years to come.

By Carol Gundlach, policy analyst. Posted May 15, 2015.

Alabama Medicaid long-term care bills head for full House, Senate votes

By M.J. Ellington

Alabama would deliver Medicaid long-term care services in a new way under two identical bills that won legislative committee approval Wednesday. House and Senate committees approved the respective bills – HB 585, sponsored by Rep. April Weaver, R-Brierfield, and SB 431, sponsored by Senate Majority Leader Greg Reed, R-Jasper – without opposition.

State Health Officer Don Williamson said the plan’s goal is two-fold: to enable more people receiving long-term care to remain in the community instead of going to nursing homes, and to slow the growth of health spending for people who need long-term care. At-home care costs $10,000 per year, compared to $60,000 for nursing home care, he said.

The legislation would remove the current state cap on participation in Medicaid home- and community-based services. When fully operational, the plan could save between $700 million and more than $1 billion per year, Williamson said.

The bills would bring Medicaid long-term care services under a provider-led managed care system similar to (and coordinated with) the new Medicaid regional care organizations (RCOs), Williamson told the Senate Health and Human Services Committee. The RCO model, set to take effect in October 2016, is designed to keep patients healthier while cutting costs.

Alabama’s Medicaid Long-Term Care Workgroup recommended the plan to set up integrated care networks. The group has been meeting since February and includes Arise policy director Jim Carnes.

The plan would create citizens’ advisory committees for the integrated care networks that include representatives of Alabama Arise member groups and other health advocates. Committees amended both bills Wednesday to help ensure the membership of those committees and the networks’ governing boards reflects the diversity of the population served. Arise requested the diversity changes.

“Arise and our advocacy partners have been working for years to expand Medicaid home- and community-based service options for long-term care,” Carnes said. “The integrated care network plan is a historic breakthrough that will help Alabama meet looming health care challenges as our senior population grows.”

By M.J. Ellington, health policy analyst. Posted May 6, 2015.