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Social Services Consortium,
The House Subcommittee's released their budgets on Friday. The HHS subcommittee also released their block grant report and special provisions in the budget. The subcommittees met for several hours first reviewing the budget and then voting on numerous amendments. No doubt that additional amendments will be taken up when the budget goes to the Full Appropriations Committee, which will probably be Tuesday or Wednesday. The day is not definite because House members are still wrangling over how much the cigarette tax should be on their budget. Once it goes to the House floor and passes third reading it will then go to the Senate where they will reject the House budget. Then the fun really begins when the Senate and House selects conferee committee members to work out a compromise for a final budget. This will take some time as there is a significant difference between the House and Senate budget – not only in what they did or did not fund but it the target amount of money they deemed available depending on which taxes they agreed to create or keep and, of course, the lottery.
I have outlined below highlights from the budget that the Senate presented and compared it to the House Budget that was just released. I will be sending out another e-mail that gives an overview of the special provisions. The special provisions document is 141 pages long and there are some items that will be of significant interest to you.
SENATE - Freeze Medicaid Rates – for SFY 2005-2006 and 2006-2007. Rate freeze applies to all Medicaid private and public providers with a few exceptions. This could make it more difficult to find Medicaid providers and if costs exceed 06-05 rate it would be a cost shift to counties.
HOUSE – Freeze Medicaid Rates - they did something similar to what was recommended by the Senate but was modified so that the 04-05 rates only apply to 05-06. They also had some different exceptions to whom the freeze applied.
SENATE - Medicaid Reserve Fund – takes $50 million from the reserve on FY 05-06 and )6 -07 . According to HHS, this money is not available as they are required to maintain a certain level in the fund and this would deplete it to a lower level than is allowed.
House - Medicaid Reserve Fund - SAME
SENATE -Medicare Part D Claw Back – this is expected to save the state money when Medicare Part D program begins paying for prescription drugs for people who have dual eligibility (Medicare/Medicaid). Save FY 05-06 $11 M, FY 06-07 $22 million.
House Medicare Part D Claw Back - SAME
SENATE - Increase Co - Payments for Medicaid – Is a $3.00 co-payment for chiropractic, optical, podiatry, hospital outpatient, non-emergency ER visit, generic prescription drug and a $ 50.00 co-pay for hospital inpatient.
House - Increase Co - Payments for Medicaid – The same EXCEPT that the removed the $50 co-pay for hospital inpatient.
SENATE - Medicaid Coverage for Aged, Blind and Disabled – This recommendation adjusts Medicaid coverage for Aged, Blind, and Disabled clients with incomes exceeding the SSI income limit. Some of these folks will still receive prescription drugs through Medicare Part D and could receive long term care services under the Medically Needy optional coverage group. However, 57,000 people will lose services and besides hurting our most vulnerable citizens, it also creates a cost shift to the counties. For example, the Personal Care Services that some of the currently eligible clients receive would be lost. For many older and disabled adults, it is PCS that allows them to stay in their homes. Without this service they would need to go into a facility which would cost a great deal more than the PCS. Saves FY 05-06 $53 million, FY 06-07 $115 Million.
HOUSE - Medicaid Coverage for Aged, Blind and Disabled – The House REMOVED this cut.
SENATE – Pharmacy Reimbursement – Reduced reimbursement by reducing the payment for prescription drugs from Average Wholesale Price (AWP) minus 10% to AWP minus 11% plus the dispensing fee.
HOUSE – Removed Pharmacy Reimbursement – replaced with Prescription Drug Coverage – The House changes prescription drug coverage for Medicaid recipients from a maximum of six prescriptions with an override policy to a limit of three name brand prescriptions and unlimited generic prescription.
SENATE -Reduction to Personal Care Services – Reduces the funding for PCS by reducing the monthly limit to 50 hrs from 60 hrs for regular PCS and the monthly limit for PCS Plus to 70 hrs from 80 hrs. Reduces the daily limit from 3.5hrs to 3 hrs per day. Saves FY 05-06 $6 M, FY 06-07 $8 M.
HOUSE - Reduction to Personal Care Services – The House wanted to see some savings in the PCS but not through enforced reduction of hours. Instead they reduced PCS funding by directing DMA to develop a utilization management system for PCS. Savings reduced to $6M 05-06 and $8M 06-07.
Senate – Health Choice – Originally the Senate plan called for moving the 0-5 from Health Choice to Medicaid but the final version took that language out and kept all ages on the Health Choice. Funding for this program was $14,670M 05-06 and $35,475M 06-07.
HOUSE - Health Choice - SAME .
SENATE - MRS FUNDS – YEAAAA!!! This money is for additional CPS workers in counties to reduce the worker/client ratio to 1:10 to assist in the expansion of MRS. It provides FY 05-06 $2 Million and 06-07 $2 Million. We want to reach $5.6 million increase but this is a great start!
HOUSE – MRS FUNDS – SAME!!!! When the HOUSE and SENATE agree on something in their budget then it is no longer in contention. We WILL receive $2 Million for more CPS workers!!
SENATE - DFS Mental Health Licensure and Inspections – expands 13 new positions in 05-06 and 23 in 06-07 to provide annual inspections of 24 hour residential facilities for the mentally ill, developmentally disabled, and SA population.
House DFS Mental Health Licensure and Inspections – does the same as the Senate the first year but reduces the number of new staff from 23 that the Senate had to 13.
SENATE - DFS Adult Care Licensure Section – Provides funding for 14 positions in 05-06 and an additional 17 positions in 06-07 to allow annual inspections of adult care homes. DHHS believes that an annual inspection of ACHs by DFS will significantly improve the safety and security of residents. The Association does not agree.
HOUSE - DFS Adult Care Licensure Section – Does the same as the Senate for the first year by adding 14 new positions but doesn't increase that number the second year thus keeping the total number of positions at 14.
SENATE - Complaint Intake – Expands DFS Complaint Intake unit by 4.5 positions.
HOUSE - Complaint Intake – House REMOVES the funding for an increase of the complaint intake unit.
SENATE - NC FAST Funding – Originally the Senate reduced NC Fast by $5.4 million which was money being carried forward from this fiscal year. In the final budget they put the $5.4 million back but reduced the block grant funding for NCFAST by about $800,000.
HOUSE – NCFAST FUNDING – The House reduced the funding to NCFAST by $5.4 million in FY 05-06 and 06-07. This is the reserve money that DHHS was carrying forward for the project. They then funded NCFAST $4.9 million in 05-06 but did not include funding for FY 06-07.
SENATE - No Additional Funds for Child Care Subsidies – The Senate did not include any new money for Child Care Subsidies.
HOUSE – Child Care Subsidies . – The House include $1.231 Million in recurring funds for FY 05-06 and 06-07. This funding was included to help maintain the current level of services although the House budget describes it as addressing the waitlist. In talking with DCD they have said they will be about $700,000 short this year in meeting the current level of services. HOWEVER, next year we are looking at a $7 million dollar deficit. This increase is because DCD up until now has been absorbing the inflationary increase in subsidies but they no longer have funds available to cover this cost.
SENATE – More at Four -The Governor's budget included $16.6 M in FY 05-06 and $29 M in FY 06-07 for More at Four. Originally the Senate budget did not include any funding for More at Four and recommended that the program be transferred from the Office of the Secretary to the Division of Child Development with a reduction of 5 people from the More at Four staff. In the final Senate budget More at Four was funded for an additional 6,400 slots. Cost - $16.540 M FY 05-06 and $29,103 FY 06-07. They also took out the recommendation to transfer the program to DCD.
HOUSE – More at Four – The House expanded the program at half of what the Senate recommended. The House expansion is for 3,200 more slots at a cost of $16,640 FY 05-06 and $16,640 FY 06-07.
BOTH the HOUSE and Senate provided small increases in funding for Crisis Intervention Services ($2M ) System of Care for Child Mental Health ($2 M), Intensive Substance Abuse Services for children ($1.5M), and Adult Substance Abuse Services ($750,000).
HOUSE ONLY BUDGET ITEMS
ACH Personal Care Services for Residents of Special Care Units – Provides funding to increase the number of hours ACH PCS for residents of Special Care Units from 1.1 hrs per day to 4.07 hrs per day. $1.7 M FY 05-06 and $2.3 M FY 06-07
Adult Care Home Income Disregard
Provides funding to support increased enrollment of Medicaid recipients receiving State/County Special Assistance due to the implementation of an income disregard for the State/County SA program.
Increase Rates for Dental Services
Provides funding to increase Medicaid rates for dental. $2M recurring
******* COUNTY SHARE OF MEDICAID *********
Funds a grant-in-aid program to offset the county share of Medicaid expenditures for medical assistance payments. 50% of the funding will be used to provide targeted assistance to counties where the number of Medicaid eligibles is equal to or greater than 20% of the county's population. 50% of the funding will be used to provide assistance to all 100 counties including the counties receiving targeted assistance. $15 Million in 05-06 ONLY.
Care Coordinators for School-based Child and Family Support Teams
Facilitators for School-Based Child and Family Support Teams
School Nurses for Child and Family Support Teams
The House put funding in for each of these which supports what was in the Governor's recommendation. Funding for the Facilitators at County DSS is $1.4 Million recurring.
Increase SA Rate for Residents of Special Care Units
Increase the rate from $1,084 to $1,515.
State/County Special Assistance Rate Adjustment
Increases the monthly rate from $1084 to $1124 per month. The total requirement for the increase is $6.8 in FY 05-06 and $8.2 in FY 06-07 with state funding 50% and counties funding 50%.
