Budget News

On Tuesday, December 4, 2001, the House Appropriations Committee’s Subcommittee on Human Resources held a meeting to hear from consumers, providers, advocates, and others about the needs for the FY 2002 (Supplemental) Budget and FY 2003 Budget. The meeting was held in the Appropriations Room before a full house. More than 40 persons testified as to their issues and needs for funding.

Rep. Georganna Sinkfield, Chair of the Subcommittee, presided. Other House members present included: Rep. Michele Henson; Rep. Keith Heard; Rep. Nan Orrock; Rep. Gail Buckner; Rep. Judy Manning; and Rep. Buddy Childers. Matthew McElroy, a new Budget Analyst from the Legislative Budget Office, will be assisting this Subcommittee this year. In order to be eligible for consideration for funding through the Subcommittee process, a form must be submitted to the Subcommittee. Attached to this report is a copy of the form for your use. The forms must be submitted to Matthew McElroy on or before December 18, 2001 at the Room 142 of the State Capitol, Atlanta, GA 30334.

Department of Human Resources Commissioner Jim Martin was present and made some brief remarks concerning the difficult times for the State due to the nation’s economy. Commissioner Martin has met with Governor Barnes and is attempting to deal with the economic downturn in a responsible way. The Child Protective Services portion of the budget was not impacted by the Governor’s decreases of 2.5% and 5.0%, respectively to the FY 2002 and FY 2003 Budgets.

Commissioner Martin addressed the issues relating to the group homes which have been reported in the Atlanta Journal-Constitution. Presently, the Department is evaluating each group home for safety and determining what, if any, corrective action needs to be taken in order to protect the children within those homes. The issue relating to privacy is of major concern and the concern is the privacy for the consumer rather than the Department.

Rep. Nan Orrock asked questions concerning the closure of Brook Run and whether those dollars have been provided to the State from the sale to DeKalb County of the facility.

Also present at this hearing was Child Advocate Dee Sims. Ms. Sims stressed the need for both intervention and prevention. Treatment programs, placements and investigations all need proper funding. She reported that her office had conducted 611 investigations this year; not all of those investigations required the same depth of investigation. In the FY 2003 Budget, she will be requesting three new investigators for the Macon area as well as some clerical help. Additionally, the Atlanta office also needs some additional staff – an attorney and some clerical help. She is also asking for two vehicles; she explained that her office had obtained two, very used returned vehicles, from the Dept. of Administrative Services and one has since had to be junked as it had more than 170,000 miles. There is a great need for mental health services for children and the State is not meeting those needs. Further, there are services lacking in many communities.

Nellie Dukes testified about the need for more monies for the Osteoporosis Initiative which the Commission on Women is extremely committed to supporting. The Division of Public Health has been using the monies for osteoporosis and has parlayed those funds for $2,500 and $5,000 community grants. There will be two events to raise interest in the issue: Heart of Georgia Railroad ride in March; and Georgia Walks for Better Bones.

Representatives from the Georgia Council for the Hearing Impaired also stressed the need for additional funding in order that it may continue to provide employment information to the hearing impaired as well as offer information on employment issues, the rights and responsibilities, etc. Additionally, this group provides assistance with legal services.

Martin Miller, with Southern Home Care Services and the Georgia Council on Aging, asked that more funding be provided for home and community based services. In the Community Care Services Program, there were more than 16,000 persons served.

Lisa Barnes with Joblink, which provides employment assistance for transplant recipients, testified about what assistance Joblinks provides. Referrals to Joblinks increased in 2001 by 80%. She asked for $120,000 funding for the FY 2003 Budget.

Will Crosley with the Barton Clinic (Emory University) spoke in favor of dollars for prevention, intervention, and treatment. He asked that mental health services for children be strengthened and also for additional monies for the Division of Family and Children’s Services ("DFACS"). He also asked that a special Assistant Attorney General be added to the Attorney General’s staff just to address children’s issues. During his testimony, it was noted that there is a need in Georgia for 588 case workers within DFACS. The cases workers were to be funded over a three-year period with 196 being added each year. Due to budgeting issues, only 100 were funded in FY 2002 (thus, the State is already behind 96 slots).

Judge Hickson from Fulton County Superior Court spoke on behalf of the Court Appointed Special Advocates program which needs funding. Judge Hickson asked that all counties in Georgia be afforded such CASA programs which assist greatly with the caseload of children’s–related actions.

Sandra Alexander with Prevent Child Abuse Georgia and the Georgia Council on Child Abuse asked for monies such as $500,000 for Healthy Families Georgia. Additionally, she noted that Governor Barnes had frozen the TANF funding which would have funded the program. The FY 2003 request is $2 million. Currently, there are 23 program sites around Georgia.

The Child Fatality Review Panel also asked for funding in order to review the reasons behind the deaths of children. There have been 573 deaths reviewed. The Panel asked for additional funding for more program consultants and some administrative help. Additionally, the Panel would like for counties to be reimbursed for the costs of the reviews which they are mandated to pay.

The Children’s Advocacy Centers of Georgia also had a Floyd County Superior Court Judge, Colsten, submit testimony on the need for a $200,000 enhancement for reviews and prosecution of child molestation cases.

Normer Adams with the Georiga Homes and Services for Children asked for $12 million. He explained that 10,000 children are taken each year from their homes and placed in foster care. Only 56% of the costs of the care is being reimbursed by the State. There is money coming from the federal government as well as through community charitable dollars. However, since September 11, there have been fewer community donations. Last year, there was a small amount for a daily allowance increase for such care but it was not enough. Further, some agencies did not even receive the increase. He explained that if there was no increase then more children would be on the streets.

The National Alliance for the Mentally Ill also asked for assistance with mental health services. Additionally, it asked that there be monies for Medicaid prescriptions which were vital to persons being able to stay in their communities.

AIDS’ treatment was also a topic for funding requests. The AIDS Survival Project asked for more money in order to pay for medications to lengthen the lives of those persons with AIDS. As of October, 500 persons were on a waiting list for the drugs. Currently, there are 3,600 persons enrolled in the program.

Unlock the Waiting List advocates also turned out in force asking for help. Beth Tumlin was the coordinator of the effort. The Georgia ARC Network also asked for funding for those with developmental disabilities and for restoration of the frozen slots. ARC stressed that there be no cuts to mental retardation services. Georgians with Disabilities asked for more community-based services and Eric Jacobs asked that more direct-care staff be provided. Mr. Jacobs cited the Olmstead decision and the plans being developed by the State and advocates for carrying out such decision.

Rape Crisis Centers and Domestic Violence Shelters also asked for funds. The Coalition for Domestic Violence and Partnership Against Domestic Violence were both represented. Cathy Spraetz provided an overview of the shelters operated by the Partnership which had consistently been operating at full capacity the entire year. She was also asked if the economic situation had any relationship to the increase of incidents in domestic violence. Julie Koob explained that anytime an economic downturn occurs there are more incidents of domestic violence as well as more pregnancies – primarily due to the fact that men and women are at home together more due to lost jobs. There have been 7,000 more incidents in 2001 of domestic violence than in 1999. Any cuts to the domestic violence shelters have an exponential effect – additionally, the TANF dollars targeted for domestic violence victims needs to be "thawed" as such funds were frozen – this amounts to $5,000 per shelter for FY 2002.

Georgians for Children and the March of Dimes also asked for monies. In the March of Dimes request, the money would be targeted for use with funding metabolic screenings of infants which are mandated. Last year, the General Assembly provided money for an automated voice response system for these screenings. The screenings are conducted on newborns in the hospital and cost approximately $25 per test. Currently, such tests are paid for by the State.

There were also requests for monies for assistance with programs to help those who are addicted. The money from the "rainy day" fund – surplus – should be used to help fund such efforts. Becky Vaughn stressed that persons with addictions were probably going to be falling on harder times with more unemployment.

During the 2001 Session, there were two bills introduced concerning the delivery of mental health, mental retardation, and substance abuse services to clients. These bills were Rep. Carl Von Epps’ HB 332 and Speaker Murphy’s HB 498. As neither bill passed, Speaker Murphy created a House Study Committee to look at the issues relating to the Community Service Boards ("CSBs") and Regional Service Boards created under HB 100.

On the morning of December 5, 2001, a second hearing was held in Macon at River Edge Behavioral Health Center. The room was filled to capacity with interested parties from Middle Georgia. House Study Committee members present included Rep. Roger Byrd (Chair), Rep. Carl Von Epps, and Rep. Larry Walker. Later that same day, a third hearing was held in Newnan. Below will summarize some of the testimony from the Macon hearing:

Lanette Bragg, a mother with a son who has developmental disabilities, spoke out concerning the mental retardation waiver supports. Ms. Bragg is also the current Chair of the Governor’s Council on Developmental Disabilities. Ms. Bragg stressed that she was not for or against Community Service Boards and/or Regional Service Boards. Rather, there was a need in the overriding principles and values. She encouraged the Committee members to keep the principles of HB 100 intact and stated that critical principles included the single point of entry and the client-centered delivery system. She did agree that more effective Board membership was needed and that it might be wise to re-examine the appointment process. Additionally, any inconsistent plans should be addressed. In the 2000 Session, legislation was created for an Ombudsman to oversee the services. However, such Ombudsman has yet to be funded by the General Assembly. Hasty change will not be good; thus, she encouraged that the Committee review the numerous studies which have produced good recommendations. Georgia must do something as it is unacceptable to be 49^th in the nation in the provision of services in the community.

Jim Sanders, an attorney from Atlanta who also has a child with Downs Syndrome, also spoke. Mr. Sanders apparently has a number of issues – including the fact that the Department of Human Resources is not financially supporting the Governor’s MHMRSA Advisory Council as there have a number of public forums held where members did not get any travel reimbursement for attending such. Additionally, this Council cannot produce a report as many persons associated with it are either State employees or parents with children in the system. Thus, many feel that there is too much opportunity for retribution. Mr. Sanders seems to be fully frustrated with the delivery system and in favor of disbanding the Regional Service Boards.

There were a number of consumers who testified. One Macon-area consumer who formerly taught school is equally frustrated and concerned. Her issues are more personal in dealing with her mental illness. She cited an article published on November 30, 2001 on the shortfall in funding of the State’s Medicaid program in the Atlanta Journal-Constitution which had quotes from Rep. Mickey Channell (Chair of the House Appropriations Committee’s Subcommittee on the Department of Community Health), Sen. George Hooks, and Renay Blumenthal with the Governor’s Office. Her concern is that the Medicaid program may not opt to fund a prescription drug program in order to help eliminate the huge $560 million deficit. She takes a myriad of medications which would cost approximately $1,461 per month; she lives on $551 per month. She claimed to have no other income except Medicaid and no family to help support her. She is also a patient of the Phoenix Center, which has tremendous staffing turnovers. In the last four years, she has had eight case managers. Rep. Walker asked her specifically why she thought her drugs would be cut and she cited the Atlanta Journal-Constitution article. This woman also complained about the numbers of attempts made to get calls through to Medicaid when questions needed to be answered. She claimed that it took weeks and that many times staffers were rude to her.

A former dentist from Dublin, Z. W. Zittrouer, testified as he previously served on the Mental Health Department Advisory Board for Dublin/Laurens County. In the last five to six years, since passage of HB 100, he has seen "all hell" broken loose. He was against HB 100 and it now has proved ineffective in helping sick people. Paperwork seems to be one of the biggest issues and thus, reports are problematic. Rep. Walker asked if there was some way of identifying which took more time – the federal or State paperwork. Dr. Zittrouer stated it was State paperwork. Additionally, he has found that the Regional Boards are doing nothing and basically "okay" what is coming out of Atlanta.

Dr. David Harvey with the Phoenix Community Service Board said that there was a lack of effective leadership at the Mental Health/Mental Retardation/Substance Abuse Division within the Department of Human Resources. Additionally, there has been a lack of coordination. Community Service Boards are also not represented on the Regional Boards. There has been a lack of funding in certain areas – such as Region 8 – which received no money from the $42 million redistribution.

Don Blair, the Warner Robbins Community Service Board Director, claimed that there was responsibility without any control. The "days" formula is extremely problematic. He pointed to the fines incurred by the CSBs if persons were hospitalized for more than the time allowed. For instance, he cited a $232 fine per day per adult bed (there is a different rate for children). He suggested that this formula was flawed. In Middle Georgia, there has been a reduction of bed days of 47%. However, for the CSB to pay the fine is the real issue as it is not the entity making the decision on releasing the patient from the hospital. That decision is being made by either the hospital or the physician treating the patient.

A representative from Phoebe Putney Hospital in Albany also made the trek to Macon to testify. Denial of services is a true problem but waiting times for services are also an issue. A single point of entry into the system could be a solution – but is that the acute care facility? She believes that admitting a person in the emergency room may only increase the waiting time before getting the person transferred to a State facility. Appropriate level of care is also of concern. She stressed that the health planning needs should be addressed and the certificate of need process could handle such. Additionally, she suggested that providers (both private and public) be trained on the new reimbursement system and to also stress accountability in the system.

Bibb County Sheriff Modena also spoke out at the hearing explaining the problems associated with having a jail acting as a hospital for inmates. He explained that when HB 100 went into effect, his office began taking mental health patients and acting as a "shadow" hospital. Additionally, his office spends a great deal of financial resources on transporting patients to Central State Hospital. This is not a problem local to Macon and Bibb County – this is a statewide issue. Sheriff Modena stressed that many persons in jail were there as a result of not taking medications – thus, they committed petty crimes. Rep. Walker asked if Sheriff Modena was at cross purposes of what was transpiring in Houston County with Phoenix Community Service Board. Rep. Walker explained that certain Sheriffs liked HB 100. Another problem is the financial situation is now placed on the backs of the counties rather than the State.

Rep. Byrd asked if there was a probate judge in the audience as he wanted to hear the court’s perspective on the issues relating to the CSBs and Regional Service Boards. Judge Bill Self spoke out and expalined that he saw a large problem in the lack of rendering services to persons who were in need. The community pocket is being hit for the dollars to address mental health needs by having jails serve as a treatment facility. Jails are not equipped for such. Additionally, before a Middle Georgia person can get help within the hospital, he or she must have a judge, doctor, or someone at River Edge make that commitment to Central State Hospital.

Others testified about the lack of local input which has caused problems. Others testified that there was still a need for hospitals – that not all services could be rendered within community-based services. Many voted to eliminate the Regional Service Boards. (In response to such comment, Rep. Larry Walker reminded the audience that when HB 100 was being considered, there were a number of constituents from Middle Georgia which contacted their Legislators about the need for the bill – this included a vast number of professionals.) There were some suggestions:

• Look at "Goals for the ‘90s"
• Fund more student loans through the Georgia Student Finance Commission (service cancelable loans) for persons getting Master’s Degrees in Social Work
• Provide for provisional licensure while Clinical Social Workers await taking their Boards
• Determine if paperwork required by State is duplicative of federal paperwork and if so, try and use federal forms and eliminate the need for State forms
• More adequate funding for jail diversion
• Educate judges and others on changes in the laws
• Require funds to flow to CSBs
• Monitor patients better once they leave facilities
• Provide for adequate planning before patients are discharged from facilities
• Fund adequate numbers of case managers
• Get mental health treatment to children prior to the time that they end up in Youth Detention Centers