General Assembly meets for joint budget hearings

Last week the Georgia General Assembly met for the joint budget hearings during which Senate and House legislators heard from agency leaders and Governor Brian Kemp about the proposed current and upcoming state budgets. This year’s budgetary considerations consist of requested changes to the current FY 2019 state budget which will run through June 30th and proposals for the FY 2020 general state budget, which will begin on July 1st.

The House will now craft the budget requests into legislation and continue its funding considerations. Both chambers reconvened yesterday, January 28th, for the fifth day of legislative session.

2019 joint session budget hearings

Budget requests presented to the General Assembly

Last week, the General Assembly heard from department commissioners and other leaders regarding their budget requests for the amended FY 2019 budget (sometimes called the “little budget”) and the upcoming FY 2020 budget (called the “big budget”). Here we highlight some of the primary asks made by the state agencies that most impact consumer health. For more detailed budget analysis, please see the Georgia Budget and Policy Institute’s Overview of Georgia’s 2020 Fiscal Year Budget document.

Department of Community Health 

The Department of Community Health (DCH) oversees Medicaid, PeachCare, and other state health care programs. Commissioner Berry requested an increase of $71 million in the amended FY 2019 budget to include $33.7 million for growth in Medicaid expense and $18.7 million for the Indigent Care Trust Fund, which draws down additional federal money for Disproportionate Share Hospital payments.

Commissioner Berry’s most significant request in the FY 2020 budget was an increase of $92 million to offset a reduction in the federal cost-sharing payments for Medicaid and PeachCare for Kids. Georgia’s Federal Medical Assistance Percentage (FMAP) rate will drop from 67.62% to 67.30% for Medicaid and from 100% to 88.61% for PeachCare for Kids, prompting the funding request.

Department of Behavioral Health and Developmental Disabilities 

The Department of Behavioral Health and Developmental Disabilities (DBHDD) provides treatment, support services, and assistance to Georgians with disabilities, behavioral health challenges, and substance use disorders. Commissioner Fitzgerald’s request for the little budget mirrored the Governor’s recommendations to add $8.4 million for the Georgia Apex Program to provide support counselors for mental health services in high schools.

Commissioner Fitzgerald requested that the big budget include an increase of $78.6 million for the Department. The additional funds would be partially compromised of an additional $10.2 million for behavioral health crisis beds, $2.5 million for supported housing, and 125 new slots for NOW and COMP waivers to reduce the current waiting list.

Department of Human Services

The Department of Human Services (DHS) delivers a wide range of human services designed to promote self-sufficiency, safety and well-being for all Georgians. Commissioner Crittenden requested that the big budget include $849,951 to increase funds for 50 additional Medicaid eligibility caseworkers.

The Department of Public Health did not present during the joint budget hearings last week and the Department of Insurance did not have any budgetary requests that were specifically health related. We will include summaries from both departments as we learn more.

GHF has you covered

Stay up-to-date with the legislative session

GHF will be monitoring legislative activity on a number of critical consumer health care topics. Along with our weekly legislative updates and timely analysis of bills, we have the tools you need to stay in touch with health policy under the Gold Dome.

• Sign up for the Georgia Health Action Network (GHAN) to receive action alerts that let you know when there are opportunities for advocacy and action
• Track health-related legislation
• Look out for the 2019 Consumer Health Advocates Guide coming soon!

The 2019 legislative session has begun

The Georgia General Assembly convened last Monday through Thursday, completing four days of the constitutionally capped 40-day session. The first week of the 2019 legislative session was mostly taken up with committee appointments, inauguration-related celebrations, and Governor Kemp’s first State of the State address.

This week will be dedicated primarily to budget hearings for the current (FY 2019 Amended) and next year’s (FY 2020 General) state budgets. The General Assembly will reconvene next Monday, January 28th for the fifth day of legislative session.

State budget outlines Governor’s top priorities

Governor Kemp submits his first budget recommendations

On Thursday, Governor Kemp addressed the General Assembly in his first annual State of the State address and, per tradition, used the opportunity to introduce his proposed budget. Governor Kemp laid out his priorities for his first year in office, including education and health care. The amended budget (an update to the current state budget) includes $1 million for the Department of Community Health to draft an 1115 Medicaid waiver plan that will attempt to lower costs and improve access to health care. This waiver could include a pathway to health coverage for low-income Georgians. Tell Gov. Kemp and your state legislators that you support closing Georgia’s coverage gap so all Georgians can have health insurance card in their pockets.

The FY 2020 budget, which will begin on July 1, 2019, includes $8.4 million to fund a school-based mental health initiative called Project Apex, which aims to increase access to mental health services for children and youth. Because of a reduction in how the federal and state governments share costs for the program, an additional $27.4 million is included for the PeachCare for Kids program. The House will now take up and consider the budget before passing it to the Senate later in the session.

Early legislation introduced

HB 37: Medicaid Expansion

House Minority Leader Bob Trammell introduced HB 37 which would expand Medicaid to low-income adults in Georgia. Closing Georgia’s coverage gap by expanding Medicaid (or through a Georgia-specific 1115 Medicaid waiver) would be the most significant step Georgia’s law makers can take to strengthen the state’s weakening rural health care system, address the opioid and substance use epidemic, and put an insurance card in the pocket of all Georgians regardless of income.  Contact your legislators and let them know that you support closing Georgia’s coverage gap and they should too.

Legislation to combat “period poverty”

HB 8 would create an exemption from the state sales and use tax for certain menstrual products. The legislation is sponsored by Rep. Buckner, who has spoken about the impacts of the costs of menstrual products on young women’s ability to be successful students and workers. The bill has been referred to the House Ways & Means Committee.

The legislative calendar begins to take shape

The General Assembly set its calendar for the first eleven days of the 2019 legislative session in SR 14. After this week’s budget hearings, the session will pick up again according to the following schedule:

January 28: Day 5

January 29: Day 6

January 30: Day 7

February 5: Day 8

February 6: Day 9

February 7: Day 10

February 8: Day 11

GHF has covered

Stay up-to-date with the legislative session

GHF will be monitoring legislative activity on a number of critical consumer health care topics. Along with our weekly legislative updates and timely analysis of bills, we have the tools you need to stay in touch with health policy under the Gold Dome.

Sign up for the Georgia Health Action Network (GHAN) to receive action alerts that let you know when there are opportunities for advocacy and action

Track health-related legislation

Look out for the 2019 Consumer Health Advocates Guide coming soon!

Georgians for a Healthy Future’s ninth annual Health Care Unscrambled breakfast built on previous years’ successes with another standing room-only crowd.

This year’s program began with a personal story from consumer Lori Murdock, who bravely shared her experience struggling to manage a chronic disease without health insurance because she was caught in Georgia’s coverage gap. Lori’s experience illustrates the pressing need to provide health insurance to all Georgians regardless of income.

Following Lori was our bipartisan legislative panel. This year’s legislative panelists were:

• Senator Kay Kirkpatrick
• Representative Debbie Buckner
• Representative Lee Hawkins

Each panelist provided updates on emerging health care trends impacting Georgia and took questions from the audience about what health issues are likely to be taken up in the 2019 legislative session. Topics included Medicaid expansion, surprise out of network medical billing, access to mental health,  network adequacy, Certificate of Need reform, social determinants of health, rural health care access, federal health care reform, and affordability of health care. All three panelists shared an optimistic vision for health care in this years legislative session.

This year’s key note speaker was Dr. David Blumenthal, President of the Commonwealth Fund. Dr. Blumenthal brought a wealth of knowledge and insight to our conversation about how innovations in health care and coverage can help us achieve better health outcomes for all Georgians. He led the discussion by comparing Georgia’s health outcomes to those of our neighboring states, and then provided an agenda for improvement. He emphasized that Georgia is unlikely to overcome poor health outcomes unless state leadership improves insurance coverage, as demonstrated by the Commonwealth Fund’s own research on Medicaid expansion’s impacts on population health. Dr. Blumenthal also shared the importance of investments in the social determinants of health for improving health outcomes and ultimately saving money. Dr. Blumenthal’s presentation can be accessed here and the Georgia scorecard from the Commonwealth Fund can be found here.

To see photos, review materials, and get more information about this year’s Health Care Unscrambled event, please visit the event page.

For more event pictures visit our Facebook photo album. 

Georgians for a Healthy Future released its 2019 policy priorities at this morning’s ninth annual Health Care Unscrambled legislative breakfast. These annual priorities outline the issues that GHF believes are most pressing for Georgia consumers and are best addressed by the state legislature. GHF will work to move all of these issues forward by engaging state policy makers, consumers, and coalition partners throughout the legislative session and the remainder of the year.

1. Increase the number of Georgians with health insurance.

Georgia’s uninsured rate hit a historic low of 12.9% in 2016, but remains one of the highest uninsured rates in the country because Georgia has not accepted federal funds to cover low-income Georgians. Approximately 240,000 Georgians remain stuck in the resulting coverage gap. These Georgians do not qualify for Medicaid under current rules and do not earn enough money to qualify for financial help through the Marketplace. Georgians for a Healthy Future supports closing this gap by extending health insurance to all Georgians with incomes up to 138 percent of the federal poverty level.

2. Stabilize Georgia’s health insurance Marketplace

Almost half a million Georgians are enrolled in health care coverage through the health insurance Marketplace. While Georgia’s Marketplace has proven robust, the last two years have brought declines in enrollments, as federal policy changes have undercut its stability. Other states have taken steps to shore up their markets by implementing state reinsurance programs, instituting state-level consumer protections and enforcement mechanisms, limiting the sale of short-term junk plans, and investing in outreach & enrollment. Georgians for a Healthy Future supports policies that promote affordable, comprehensive coverage and a competitive, stable Marketplace.

3. Ensure access to care and financial protections for consumers purchasing private health insurance.

When consumers enroll in a health insurance plan, they should have reasonable access to all covered services in the plan. As narrow provider networks become more common, health care consumers are at increased risk of not being able to access the medical services and providers they need without going out-of-network and receiving surprise out-of-network medical bills. In 2015, the National Association of Insurance Commissioners adopted a network adequacy model act for states. Georgians for a Healthy Future supports using this act as a foundation to develop quantitative standards for Georgia. Georgians for a Healthy Future further supports legislation that will hold consumers harmless when consumers end up with out-of-network bills despite making appropriate efforts to stay in network or because inadequate provider networks require them to go out of network to receive the services that they need.

4. Set and enforce standards that provide for equitable coverage of mental health and substance use treatment services by health plans.

The 2008 passage of the Mental Health Parity and Addiction Equity Act (Parity Act) required that health plans cover behavioral health services as they would physical health services. The Parity Act is only meaningful if health plans are implementing it well, consumers and providers understand how it works, and there is appropriate oversight. GHF supports legislation that sets standards and oversight procedures to ensure that Georgia consumers receive the coverage for mental health and substance use disorder benefits to which they are entitled by law and for which they have paid.

5. Prevent nicotine use and addiction by young Georgians

Georgia has one of the lowest tobacco taxes in the country at just 37 cents per pack, which makes tobacco much more accessible to youth in Georgia than in many other states. Moreover, Georgia does not apply an excise tax on the nicotine-delivery devices (e.g. e-cigarettes, vaping pens) that are preferred by young people today. For price-sensitive young people, increasing the price of tobacco and nicotine products decreases use and addiction, and the burden of chronic disease in Georgia. Georgians for a Healthy Future supports legislation to increase Georgia’s tobacco tax by at least $1 and to add an equitable excise tax on all nicotine delivery devices.

6. Support partners in integrating health and equity in the policies across every sector to address social determinants of health that prevent equitable access to care and equitable health status.

Factors outside the health system such as adequate housing, education, and economic opportunity impact the health of individuals, families, and communities. Left unaddressed, these and other complicating factors can inhibit the effectiveness of approaches that are strictly within the health system. Georgians for a Healthy Future supports policies that aim to advance health and health equity by addressing the social determinants of health.

To download GHF’s 2019 policy priorities, click here.

Georgia consistently ranks poorly among states in children’s mental health services, this year ranking 51st in a report from the Commonwealth Fund.  However, state leadership has been adamant about improving Georgia’s system of care through the infusion of additional dollars for children’s mental health services in the state budget and through innovative programs like Project Advancing Wellness and Resilience Education (AWARE).

Georgia Project AWARE is a youth mental health initiative focused on improving the experiences of school-aged youth in Georgia, and is funded by a grant from the Substance Abuse and Mental Health Services Agency (SAMHSA) to the Georgia Department of Education (GaDOE).

The purpose of Georgia’s Project AWARE is “to increase awareness of mental health issues among school-aged youth; provide training in Youth Mental Health First Aid; and connect children, youth, and families who may have behavioral health issues with appropriate services.”

The four main goals of Georgia Project AWARE are:

1. Increase participation of families, youth, and communities and mental health providers in efforts to identify the mental health resources available to meet the needs of students and families;
2. Increase awareness and identification of mental health and behavior concerns, and student and family access to mental health providers through the PBIS framework in Georgia Project AWARE (GPA) schools; 
3. Increase the percentage of Georgia youth and families receiving needed mental health services through collaboration between school systems and community mental health providers; and
4. Train educators, first responders, parents and youth group leaders to respond to mental health needs of youth by providing free training in Youth Mental Health First Aid (YMHFA).

Georgia’s Project AWARE grant supports the participation of three Georgia school systems: Griffin-Spalding County School System, Muscogee County School District, and Newton County Schools. The GaDOE has partnered with these school districts to provide training in Youth Mental Health First Aid and to develop innovative ways to connect youth and families to community-based mental health services.

Through Project AWARE, elementary and middle school teachers conduct universal screenings of their students and the screening results are used in two ways. School-, grade-, and classroom-level data is used to guide decisions about what universal supports or programs may be needed to better support the social and emotional needs of students. For example, if the results of the screening show high rates of anxiety for an entire grade of students, school leaders and teachers may make changes to school practices that may contribute to student anxiety or implement a program to help reduce or address the anxiety students are feeling.

Individual level screening results are used to identify those students who could benefit from extra social and emotional supports. These students are then connected to the appropriate behavioral services through partnerships the schools have developed with community-based providers.

Georgia Project AWARE has already screened a total of 18,713 students in 29 schools. Georgia State University’s Center for Leadership in Disability and the Center for Research on School Safety, School Climate and Classroom Management provide support for the program through analysis of the screening results and trainings for school leadership and staff.

In Getting to know Project AWARE: Part II, we’ll learn more about Youth Mental Health First Aid and how it helps educators meet the social and emotional needs of their students.

To learn more about Georgia Project AWARE:

• Visit the Georgia Department of Education (GaDOE)
• Read more from the Substance Abuse and Mental Health Services Agency (SAMHSA)
• Read the latest issue of the Georgia Project AWARE Digest