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House lawmakers released the first draft of their 2015-17 budget proposals Thursday morning. We take a look at the health and human services highlights.

By Rose Hoban

The budget-making process in Raleigh is similar to an intricate dance. The first steps are taken when the House of Representatives presents its budget document, which happened Thursday morning.

And so far this year, there’s little drama in the Health and Human Services budget.

Medicaid

Medicaid, the program that covers health care for low-income children and some of their parents, seniors and people with disabilities, has been a frequent headache for lawmakers in recent years. But this year, Medicaid appears to be on or close to its budgeted cost, producing limited drama.

The tussle over Medicaid will come later this summer, when House representatives and members of the Senate attempt to resolve their differences over the future shape of the program. Thursday’s House budget documents only hinted at the Medicaid debate, with $5.2 million in funds allocated for the planning and reform of the program, but no details on what that reform might look like.

The annual Medicaid “rebase,” the calculation of anticipated costs that takes into account increased enrollment, inflation and predicted utilization, adds $287 million for the coming fiscal year, for a Medicaid budget of $3.77 billion for the coming fiscal year.

A special provision in the House budget also creates a new oversight committee comprised of House and Senate members to monitor the program, which spends upwards of $13 billion in state and federal dollars to cover close to 1.8 million beneficiaries.

Mental health

After years of complaints about emergency departments backed up with mental health patients, House lawmakers want the state to allocate funding for rural hospitals to make some of their vacant beds available to mental health patients without having to go through the usual state approval process.

“For a lot of the rural hospitals, it’ll be an advantage; it’ll put some vacant beds to use,” said Rep. Marilyn Avila (R-Raleigh). She admitted that one of the challenges will be attracting mental health workers to rural areas to staff the beds, but said that some of the money could be put toward creating incentives for mental health workers.

The proposed budget also would increase funding to bump up the number of community hospital beds used for mental health patients from 165 to 180.

The increase of indigent patients in state psychiatric facilities combined with the loss of Medicaid funds has contributed to what the budget refers to as “chronic budget shortfalls” at Central Regional Hospital in Butner. The budget provides an extra $8.4 million per year to cover the shortfalls.

And House lawmakers are proposing funding for several new mental health projects, including the creation of a “bed registry” to inventory, in real time, the number, location and availability of psychiatric beds in the state; creation of a program to use emergency medical services personnel to transport mental health patients directly to non-hospital psychiatric facilities; and $2 million for creation of mental health crisis facilities.

Lawmakers also proposed adding $3.3 million in funds for additional mental health services in the state’s prisons, including adding a total of 66 people to staff 72 additional mental health beds at the new Central Prison Mental Health Facility in Raleigh.

A special provision in the budget also designates $25 million from the sale of the Dorothea Dix Hospital property to the Trust Fund for Mental Health, Developmental Disabilities and Substance Abuse Services, as well as covering costs for mental health group homes.

Children’s health

During the legislative interim and early on in this session, the Joint Oversight Committee on Health and Human Services heard multiple presentations from public health researchers about what the best practices are to improve health over the lifespan. One theme that emerged from those presentations was the strong body of evidence that shows how early services for children improve their health and educational outcomes for decades.

Getting a budget through the legislative process can be a long, tortuous process. Photo courtesy dadblunders, flickr creative commons

“A perfect example is that we have Smart Start that covers zero to 5 and we’ve got PreK that starts at 4 to solve a lot of problems, when we should be solving those problems starting with good prenatal care for the mother,” Avila said. “So the issue is putting the money the earliest it will make an impact.”

So the House budget calls for funding a raft of very early-childhood services, from pregnancy care case management ($300,000) to the Perinatal and Maternal Substance Abuse Initiative ($2.7 million) to the Triple P-Positive Parenting Program ($828,000).

“It’s a horrible picture,” said Avila, who spoke of how though the state has so many health care resources, it ranks 40th in the country in infant mortality.

“It’s not that we don’t have the resources; the issue is that we haven’t planned the correct progression of how to work with our zero to 5 kids.”

Children in the foster care system have had two champions in this year’s legislative session: Avila and Sen. Tamara Barringer (R-Raleigh), who together made improved services for foster children their signature issue.

“We had the budget. It was not about getting the money – they allocated it,” said Avila about getting the nod to include these appropriations from budget chairs.

“I talked to individuals in our caucus, and they totally get it,” she said.

The House budget includes funds to cover the costs of increasing foster care caseloads. Some of the new funds would go toward helping youth aging out of the foster care system make the transition to adulthood easier, and a special provision would create a legislative oversight committee on adoption.

Finally, the House budget proposal makes changes to child-care subsidy rules to make it easier for relatives outside an immediate family, such as grandparents, to receive subsidies when they do child care.

Medical examiner

The autopsy suites in the new state lab in Raleigh at the Office of State Medical Examiner. The new facility opened in early 2013. Photo credit: Rose Hoban

In the wake of a scathing investigation by the Charlotte Observer last year, lawmakers kept their promise to appropriate funds to get the Medical examiner’s office up to national standards. The budget increases fees paid for autopsies from $1,250 to $1,750. County medical examiners will receive a $200 fee for investigation and “prompt” filing of deaths, up from the prior fee of $100, which the examiners complained barely covered their costs. County medical examiners will also be required to attend annual training, funding for which is created in the budget.

The office of the state’s Chief Medical Examiner will also see increases of more than 25 percent to cover a new computerized death certificate system, replace outdated equipment and upgrade the CME’s information systems.

Traumatic brain Injury

Representatives are proposing the creation of a new package of Medicaid services that would be aimed at treating people with traumatic brain injury, allocating an initial $4 million over the coming two years to get the services started.

Another $2.37 million would provide funding for home modification, transportation and other needs requested by TBI sufferers, as well as provide funding for some people to live in residential programs designed specifically for people with TBI.

In a few weeks, the Senate will respond with its budget, and then the real dance begins.

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