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House HHS Budget: Part 2 – More Mental Health Beds, Cuts to Pregnancy Prevention

State lawmakers rolled out their health and human services budget Thursday, one that provides for more beds in state psychiatric institutions, while targeting Planned Parenthood and cutting not for profit service providers, such as a statewide adolescent pregnancy prevention program.

Part 2 of 2

By Rose Hoban

The House health and human services appropriations subcommittee, and panels for other areas of the state budget, met Thursday morning to present their spending plans for the next year. State lawmakers rolled out their budget for health and human services, one that would spend about $161 million more than what the legislature originally budgeted for the upcoming fiscal year.

Republicans seem intent on softening their image as budget cutters in preparation for the election in November, beefing up mental health and presenting a plan to augment education spending. However, many smaller programs will see their funding trimmed, if not eliminated.

The full appropriations committee will take up work on the entire budget Tuesday.

Mental health funding holds the line

Budget writers have asked for more money to provide beds in state psychiatric hospitals and for mental health beds in community hospitals for the upcoming year, in an effort to address the persistent problem of long wait times for mental health beds for people waiting in emergency departments.

The state’s newly rebuilt Cherry Hospital in Goldsboro is expected to come online in April, 2013, with more beds than the old facility. House legislators also asked for an additional $18 million to pay for psychiatric beds at local hospitals around the state, bringing the number of contracted beds in community hospitals up to 232 from 141.

Broughton Hospital

Broughton Hospital, Image courtesy of polydor03, Wikimedia Creative Commons

Lawmakers also said they would allocate money to renovate an unused wing at Broughton Hospital, a state psychiatric facility in Morganton, to provide for 19 more beds to serve the western part of the state.

“For those who represent that area, we hear about wait times for beds,” said Rep. Justin Burr (R-Albemarle). “The idea is to beef up Broughton Hospital so there’s not as long a wait time for those people in that catchment area.”

The House budget made no mention of a completed U.S. Department of Justice investigation that found North Carolina in violation of the Americans with Disabilities Act for the way the state uses adult care homes to house people with mental illness. Negotiations over the case have been ongoing since last summer, and advocates and mental health officials expect a settlement will be announced soon.

House Republicans also added a special provision to the budget creating an oversight committee to monitor the state’s mental health system. For the past decade, Democratic legislators had run a similar committee to oversee the mental health reform process, that committee was disbanded when the new majority replaced Democrats after the 2010 election.

Meanwhile advocates for services to kids with developmental and intellectual disabilities were trying to figure out the meaning of a provision mandating them to raise ten percent of their budgets to match state dollars (see below).

Planned Parenthood in the crosshairs

Lawmakers added a special provision to the House HHS budget to prohibit local health departments from contracting with outside agencies to provide family planning or pregnancy prevention services, a measure aimed at Planned Parenthood. The provision would mean the loss of $343,000 to the organization.

Planned Parenthood Logo

Planned Parenthood Logo

Although Planned Parenthood was not named specifically in the provision, the organization is the only one in the state providing contracted family planning services to supplement what health departments provide.

Diane Parfitt (D-Fayetteville) proposed an amendment to repeal the provision.

“The reason the health departments go with contracting services is because they don’t have capability of providing those services in a timely fashion,” Parfitt told the subcommittee. “As of today, to get an appointment in the Wake County public health department for family planning services, you would have to wait is until August. So, they are currently referring people to Planned Parenthood for those services. These contract clinics have the ability to use a little bit of money because they are already providing the services.”

Republican Rep. Marilyn Avila (R-Raleigh) responded that her intention was to provide more services to local public health departments. “I grew up in a time when they were the center for a lot of people getting their health care, and I feel like… over time, we have sort of diminished their role in the community,” Avila said.

Planned Parenthood spokeswoman Paige Johnson said she didn’t buy that explanation.

Last year’s budget specifically targeted Planned Parenthood for defunding. The agency sued, saying the state violated federal law by singling out a single organization for defunding. A federal judge ruled against the state, agreeing it was illegal for the legislature to target a specific organization for punishment.

“If they press this and give additional dollars to health departments, that won’t expand their capacity to serve these women, because we can do it more efficiently” Johnson said. “It’s pure politics. There’s no other reason to do this, there’s no savings to the state, not one dime.”

“They’re trying to shield themselves by not naming us,” she said. “Today they didn’t name us, but they did before. It’s obvious what they’re trying to do.”

Parfitt’s amendment to repeal the budget provision was defeated on a party-line vote.

Cuts to teen pregnancy prevention

Many health and social service programs are funded via the mechanism of federal block grants. Block grants are given to states with the instruction the money be used for specific areas, but the block grant program also give states leeway to distribute funds as local leaders see fit.

Teen pregnancy prevention campaign image. Image courtesy Polina Sergeeva, Flickr Creative Commons

Teen pregnancy prevention campaign image. Image courtesy Polina Sergeeva, Flickr Creative Commons

As a result of the Congressional debt ceiling deal last summer, many federal social service block grants will see deep cuts that aren’t immediately evident in the state’s budget proposals. Those documents only detail how much money is going to specific programs, not the difference in funding between last year and this year.

One area taking a hit is teen pregnancy prevention, which will see a funding cut of about $450,000, down from about $1.1 million last year.

According to Kay Phillips, head of the Adolescent Pregnancy Prevention Campaign of North Carolina, the cuts would be to community organizations running programs for pregnancy prevention, and to help pregnant and parenting teens. Phillips’ organization provides advice and support to most of the state’s programs.

“There was a time when North Carolina had 71 teen pregnancy prevention programs,” Phillips said. “If this $450,000 is not funded, we will lose about nine of them, bringing us down to about 50 projects.”

North Carolina’s teen pregnancy rate hit a low of 49.7 pregnancies per thousand girls in 2010, down from a high of 105.4 pregnancies per thousand in 1990.

One Greensboro-based program Phillips described as being under threat supports teenaged girls who are pregnant or parenting.

“The idea is to give the girls life skills,” Phillips said, “keep them in school, help them get jobs, and help them become self-sufficient. A lot of the girls in this program go on to college.”

But she said the program depends on foundation money that won’t be forthcoming if there are not state dollars to match.

Public Private Partnerships

A number of not for profit providers of health, mental health and social services would also see cuts across the board in the upcoming year in this budget. A range of organizations, from the North Carolina Senior Games to the ARC of North Carolina, will see a requirement to raise funds to match ten percent of total state allocations each year.

Representatives from many of the organizations were present at Thursday’s meeting and the requirement had them scratching their heads.

“We don’t know exactly what it will mean for us, it’s such a vague provision,” said Jennifer Mahan from the Autism Society of North Carolina. “Is it a rate cut? Or do we have to show that we raise money for those services?”

Mahan said that private fundraising for her organization fluctuates greatly from year to year.

“Some years, we get lots of dollars from private foundations and donations, some years no,” she said. “Everyone’s been under stress with the economy, and the foundations are no different, and they’ve got more people asking them for help.”

A similar provision also affects the North Carolina Partnership for Children, the not for profit entity that manages the state’s Smart Start early childhood program.

“It’s supposed to be a public private partnership,” said Rep. Burr, “but it’s been more public than private.”

Burr said the budget includes some money for the NCPC to hire someone to write grants and do fundraising.

“Obviously the state is tapped out in a lot of regards,” Burr said. “This is to give them tools to raise more dollars, which they’re doing in some counties.”

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    -Monitor health status to identify community health problems.
    -Diagnose and investigate health problems and health hazards in the community.
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    -Develop policies and plans that support individual and community health efforts.
    -Enforce laws and regulations that protect health and ensure safety.
    -Link people to needed personal health services and assure the provision of health care when otherwise unavailable.
    -Assure a competent public health and personal healthcare workforce.
    -Evaluate effectiveness, accessibility, and quality of personal and population-based health services.
    -Research for new insights and innovative solutions to health problems.

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