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Jan. 21, 2021

Gold Dome Report — Budget Hearings, Day 3

The General Assembly’s Appropriations Committees resumed today on their work around the Governor’s recommendations for FY 2021 Amended and FY 2022 budgets. Today’s focal points were the state’s health and human services’ needs. Much was expressed around the additional federal funds that Georgia has received over the last few months through an enhanced FMAP rate (the state fund matching rate for services matched with federal funds — such as Medicaid). To date, the State has enjoyed a six percent increase to the FMAP which has allowed agencies to free up some of their state fund needs — however, those dollars will go away July 1, 2021. We seek to provide you a brief report on the discussions today in the Committees’ presentations from the Department of Human Services, Division of Families and Children’s Services, and Departments of Community Health and Behavioral Health and Developmental Disabilities.

In today’s Report:

  • House Appoints Committee Chairs, Members
  • IN DEPTH: Health & Human Services Agency Presentations
  • House Appropriations Subcommittees Begin Meeting

House Appoints Committee Chairs, Members

Late yesterday, House Speaker David Ralston announced the assignments of committee members and leadership for the 2021-22 Legislative Session. Committee assignments are now on the House website, and chairs are as follows:

  • Access to the Civil Justice System – Rep. Trey Kelley
  • Access to Quality Healthcare – Rep. Mark Newton
  • Agriculture & Consumer Affairs – Rep. Robert Dickey
  • Appropriations – Rep. Terry England
  • Banks & Banking – Rep. Greg Morris
  • Budget & Fiscal Affairs Oversight – Rep. Lee Hawkins
  • Code Revision – Rep. Timothy Barr
  • Creative Arts & Entertainment – Rep. Matt Dollar
  • Defense & Veterans Affairs – Rep. Heath Clark
  • Economic Development & Tourism – Rep. Ron Stephens
  • Education – Rep. Matt Dubnik
  • Election Integrity – Rep. Barry Fleming
  • Energy, Utilities & Telecommunications – Rep. Don Parsons
  • Ethics – Rep. Randy Nix
  • Game, Fish & Parks – Rep. Trey Rhodes
  • Governmental Affairs – Rep. Darlene Taylor
  • Health & Human Services – Rep. Sharon Cooper
  • Higher Education – Rep. Chuck Martin
  • Human Relations & Aging – Rep. Jesse Petrea
  • Industry & Labor – Rep. Bill Werkheiser
  • Information & Audits – Rep. Don Hogan
  • Insurance – Rep. Eddie Lumsden
  • Interstate Cooperation – Rep. Steve Tarvin
  • Intragovernmental Coordination – Rep. Jan Tankersley
  • Judiciary – Rep. Chuck Efstration
  • Judiciary (Non-Civil) – Rep. James Burchett
  • Juvenile Justice – Rep. Mandi Ballinger
  • Legislative & Congressional Reapportionment – Rep. Bonnie Rich
  • MARTOC – Rep. Mary Margaret Oliver
  • Motor Vehicles – Rep. John Corbett
  • Natural Resources & Environment – Rep. Lynn Smith
  • Public Safety & Homeland Security – Rep. J Collins
  • Regulated Industries – Rep. Alan Powell
  • Retirement – Rep. John Carson
  • Rules – Rep. Richard Smith
  • Science & Technology – Rep. Ed Setzler
  • Small Business Development – Rep. Mike Cheokas
  • Special Rules – Rep. Dave Belton
  • State Planning & Community Affairs – Rep. Karen Mathiak
  • State Properties – Rep. Gerald Greene
  • Transportation – Rep. Rick Jasperse
  • Ways & Means – Rep. Shaw Blackmon

Chairmen of the subcommittees of Appropriations are as follows:

  • Economic Development – Rep. Penny Houston
  • Education – Rep. Todd Jones
  • General Government – Rep. Sam Watson
  • Health – Rep. Butch Parrish
  • Higher Education – Rep. David Knight
  • Human Resources – Rep. Katie Dempsey
  • Public Safety – Rep. Bill Hitchens
  • Transportation & Infrastructure – Rep. Clay Pirkle

IN DEPTH: Health & Human Services Agency Presentations

Department of Human Services
Commissioner Robyn Crittenden kicked off the morning with an overview of the work of the Department of Human Services. Among the work under her Department’s oversight is providing protections and services to Georgia’s elderly. In the current proposal considered, there is the proposed combination of two program areas into one — it would fold Elderly Supports and Elderly Living Services into one program which would then continue to provide elderly with Medicare counseling and home and community-based services.

Statewide adjustments to the Department for the FY 2021 Amended are more than $4.4 million which would bring this agency’s budget to a total of more than $800 million. For FY 2022, the adjustments proposed are almost $8 million with a total budget of $803.9 million.

One of the major initiatives in the Department’s budget is the standing up of the Patient’s First Act that the General Assembly passed in 2019. It requires in FY 2021 Amended more than $ 4 million and in FY 2022 more than $7.2 million.

Commissioner Crittenden was asked what her agency’s largest stress had been during the pandemic. She indicated it had been the availability of PPE for staff. The agency’s work has continued to provide adult protective services and guardianship services and is now able to do more of that work in person with the availability of PPE.

Division of Family & Children Services
Division of Family and Children’s Services Director Tom Rawlings presented his Division’s budget to lawmakers. Among issues he discussed included trends for eligibility of benefits for SNAP (food stamps), Medicaid and TANF.

Rawlings noted that there were fewer reports of children being victims of abuse or neglect as schools have been partially virtual with instruction. School teachers are mandated reporters. In particular, he noted reports of these children were 3,800 fewer than in 2018. He indicated that cost savings for these children are being used to help children safe. He noted that there were three to four times the number of children adopted through private providers than the state’s adoption process (he mentioned that the children adopted through the state was because the children typically have more needs).

In the FY 2021 Amended budget, Director Rawlings noted that adoption services are proposed to use the increase in FMAP of 6.2 percent for adoption services. This funding totals $3.5 million. Administration is proposed to have an additional $412,000 in order to address more individuals filing food stamp applications and Federal Eligibility is proposed to have an additional $750,000 with fund shifts ($500,000 for SNAP appeals and $250,000 for Medicaid appeals) to cover costs. Director Rawlings mentioned the proposed additional 50,000 individuals who will access Patients First Act services; thus, an additional $707,702 is requested for staffing for the anticipated start date of this effort in July. Director Rawlings explained that his agency is in the process of building the system for Patients First implementation at the present - delivering of the insurance benefit, determining the computer and data system, and staffing. In the Out-of-Home program, the Division indicated that it has served fewer numbers of children in foster care and therefore its costs have been less; they have also been able to use the enhanced FMAP funding to save state dollars and has proposed utilizing the savings for SNAP.

In the FY 2022 budget, Director Rawlings highlighted a need for $4.5 million in state funds as there is growth in numbers of adoptions. This would bring a total of $12.4 million with this proposed addition. The budget proposal also includes increasing funds by more than $114,000 to reflect the FMAP adjustment as the increase from the federal government is eliminated in July. This budget also has language to recognize more than $1.1 million in marriage and divorce fees collected for the Children’s Trust Fund for child abuse and neglect prevention.

Under the federal eligibility program, Director Rawlings accented the proposed increase of $750,000 for Office of State Administrative Hearings and an addition of more than $943,000 for staffing to stand up Patients’ First Act.

In the Out-of-Home program, there is an addition of $6.5 million proposed to increase state funds to reflect the loss of federal Title IV-E funds. The agency also has a proposed adjustment of more than $80,000 for the FMAP change and a proposed reduction of more than $14.3 million to reflect savings from the program’s utilization change due to a decline in the number of placements. He noted that the Division is working to keep children close to their families by placing them with family members or in kinship placements — it is more cost effective and less traumatic for the child. Title IV-E funds’ reduction is due to the fact that the funding is no longer available for expenditure on group homes with the Family First Act but the state still needs the group home services.

Overall, Rawlings noted that his agency’s budget was $7.8 million less in FY 2022 than in FY 2021. This funding is also reflecting an overall cut of 3 percent last year.

Department of Community Health
Commissioner Frank Berry, along with CFO Lisa Walker, discussed the Department of Community Health’s proposed spending plans. Berry began his presentation acknowledging all the various partners across the state who have continued to work tirelessly on addressing the needs of the pandemic.

Some of the issues accented by the Commissioner and staff included the state’s certificate of need (“CON”) rules which were suspended. This suspension allowed hospitals to bring online added beds to help with capacity issues. It was noted that the Governor’s order indicates that the CON relaxation is good for 90 days past the expiration of the public health emergency; hospitals would then revert back to prior CON-approved bed capacity. Further, the Department noted the work at the Georgia World Congress Center and its use with temporary hospital beds to treat lower acuity patients. Another area highlighted was the expanded use of telehealth so that services could be brought more easily to individuals, particularly children.

Blake Fulenwider, Medicaid Chief, discussed the state’s implementation of the Georgia Pathways (Patients’ First Act) and the two waivers (1115 approved October 15, 2020 and 1332 approved November 30, 2020). These have been described as “transformative” waivers to permit more Georgians access to healthcare. DFCS is working on the core functions to bring this effort’s eligibility system up and running. Phase 1 of this project is July 1, 2021 with the Phase 2 for premium assistance coming online January 2022 and member and Phase 3 rounding it out in July 2022 for member rewards. Presently, the rate filing process is underway; the reinsurance piece of this effort will take effect first.

For FY 2021, highlights include:

  • Reduction of $26.8 million for growth across all programs in DCH
  • $344.7 million for state savings due to enhanced FMAP
  • Addition of more than $1.2 million for Medicare Part B premiums
  • Reduction of more than $26 million for the Medicare Part D Clawback (these are the state’s dual eligible folks)
  • COVID-19 nursing home survey (driven by federal requirements) an addition of $2.4 million
  • Nursing home survey contracts an addition of $4.8 million

For FY 2022, highlights include:

  • Addition of more than $64 million for benefits growth
  • Addition of more than $201 million for enhanced FMAP (with the expiration of federal subsidy)
  • $65 million for Patients’ First Act Benefits
  • $6.3 million for Medicare Part B premiums
  • $6.4 million for Part D clawback
  • $4.8 million for nursing home survey contracts

The State Health Benefit Plan, which is also overseen by DCH, reflected a surplus at end of FY 2020 of $228 million. However, the SHBP is forecast to have a deficit of $29.9 million for FY 2021 and a deficit of $336.5 million for FY 2022.

There were several questions raised by members. In particular, there was concern about the strike teams looking at how to help Georgia’s rural hospitals. DCH is working with the Office of Rural Health and Mercer Dean Jean Sumner on this effort; a survey of the facilities has been developed which should roll out March 2021 and be a way at helping get funding to these facilities.

Commissioner Berry also fielded questions relating to how the state could help get the vaccine shots in individuals’ arms. He indicated that his agency was willing to help and is working with long-term care facilities but this work is really being done by the Department of Public Health. He did acknowledge the difficulties of the home and community based providers and stated he welcomed additional discussions.

There was a brief mention of the psychiatric residential treatment facilities’ concerns and how therapeutic foster care could provide services to children in the community. DCH has partnered with VOICES for Georgia’s Children in an effort to look at the data on the denials of children to access care in these psychiatric residential treatment facilities. He indicated that the CMOS have also been engaged as well and is hopeful to come up with an agreed-upon approach (for medical necessity review criteria).

A member also inquired about the State Health Benefit Plan contract and renewals. There is no plan to issue a new request for proposal; there are no end dates on the contracts. The Department, however, is looking now at services and approach.

Senator David Lucas (D-Macon) inquired if any rural hospitals had asked for advance payments from their disproportionate share hospital (“DSH”) allocation. Ms. Walker indicated that none of the rural hospitals had requested such. However, each of the facilities receives interim payments in the December-January timeframe and a “true up” of funds in May-June timeframe.

Senator Nan Orrock (D-Atlanta) asked about the high maternal mortality issues which Georgia experiences. There is a move with the 1115 waiver submission made to CMS for moving coverage of women who have delivered, covered by Medicaid, to be extended coverage for six months post-delivery (presently, it is two months). Blake Fulenwider indicated that the Department is now discussing the waiver with CMS and working on budget neutrality efforts.

Representative Lee Hawkins (R-Gainesville) asked about augmented staffing. Commissioner Berry noted that there is additional funding for staffing through March 6. However, the Department has been pushing for more federal funds for added staffing.

Department of Behavioral Health and Developmental Disabilities
Commissioner Judy Fitzgerald presented her agency’s budget. She began by accenting the FY 2021 budget reductions, mentioning that the Department of Behavioral Health and Developmental Disabilities had taken a $123.4 million reduction but had enhancements of $32.1 million bringing a net change to the budget of $91.3 million. She highlighted the following goals:

  • Provide services in the community for individuals most in need
  • Maintain hospital quality and safety
  • Contract with qualified and capable community providers for service delivery
  • Strive for efficient and effective operations

For FY 2021, the agency is using its enhanced FMAP funds for services, implementing a feasibility study for an intellectual and developmental disabilities behavioral health care center (this would be the first such center in the country); and to help two of the state’s hospitals. For FY 2022, there is a request of more than $1.7 million in state funds to address the FMAP change and an additional $13.2 million to backfill budget reductions related to the enhanced FMAP. The budget for FY 2022 includes 100 new slots for NOW and COMP waivers at a projected cost of more than $1.9 million; annualized funding for the 40-bed forensic unit in Columbus of $4.6 million; and additional funds for a corrective action plan specialists at a cost of more than $355,000.

Commissioner Fitzgerald assured the Committees that there would be no reductions in peer services.

There was also interest raised by Representative Carolyn Hugley (D-Columbus) in regards to the mental health services in her area, particularly those provided by The Bradley Center.

Senator Butch Miller (R-Gainesville) inquired about the rollout of the “988 program” which will be a tool to help with suicide prevention and will have a FCC-designated number of 988; the number should become functional in FY 2022. Georgia is fortunate in that it already has the Georgia Crisis and Access Line; many states do not have that infrastructure in place.

House Appropriations Subcommittees Begin Meeting

Education Subcommittee
The Education Subcommittee of the House Appropriations Committee met today to hear testimony on the Amended FY21 State Budget. Outgoing Chairman Robert Dickey (R-Musella) opened the meeting by congratulating Representative Todd Jones (R-South Forsyth) on being named incoming chair of the subcommittee and thanked Sara Arroyo, budget analyst for the Subcommittee, for her support of the members.

Amy Jacobs, Commissioner of the Department of Early Care and Learning (“DECAL”), opened testimony by noting that there are no recommended changes in the Amended FY21 spending plan for her agency. Instead, she used her time to provide an overview of the Department’s response in light of COVID. Commissioner Jacobs emphasized that it is business as usual for the Department, which regulates 4,500 licensed childcare programs across the state. DECAL continued to provide access to CAPS funds to families who need them and ramped up efforts to ensure children have access to food. Commissioner Jacobs noted that 97% of childcare in Georgia is open, but enrollment is down by approximately 25%. DECAL has received CARES Act funding, which has been deployed in a number of ways, including 1,000 scholarships for children of essential workers and 4,300 scholarships for children who cannot attend schools due to closures but need a safe and supported environment while parents work. There were no questions for the Commissioner from the Subcommittee.

Joy Hawkins, Executive Director of the Governor’s Office of Student Achievement (“GOSA”), also testified on GOSA’s work during the pandemic since there are no recommended changes to its Amended FY21 Budget. Director Hawkins highlighted GOSA’s Growing Readers program and the Governor’s School Leadership Academy. The Academy has had to scale back its training programs to only principals and assistant principals due to budget cuts. GOSA also had to cancel the Governor’s Honors Program in 2020. Students selected to participate in 2020 have been invited to participate in the 2021 program, and 75 have elected to do so. There is currently a private fundraising effort underway to secure funds to pay for these extra slots. In response to a question from Chairman Dickey, Director Hawkins noted that GOSA will make a decision by mid-April as to whether GHP will be held in-person or virtually this year. Representative Randy Nix (R-LaGrange) asked if additional money for GHP is needed in the Amended FY21 or FY22 budget, to which GOSA responded that an addition to either budget would be workable.

Rusk Roam, CFO for the Department of Education, discussed the recommendations for his Department in the Amended FY21 Budget. The Governor’s proposal recommends restoration of $577 million to the Quality Basic Education program, amounting to an approximately 60% restoration. The proposal also includes partial restoration of austerity cuts to other Department programs, including Agricultural Education, GNETS, RESAs, and Technology/Career Education. The proposal also includes additional funds for enrollment growth and testing that was not waived by the U.S. Department of Education. The Governor has also recommended additional testing funding for realigning assessments to the expected updates to math and ELA standards and increased demand for AP and PSAT exams. Representative Nix asked about the funding level of QBE, to which Mr. Roam agreed that austerity has been reduced to just over 4% in the proposed budget. Chairman Dickey asked how the Department and school districts will use the restored funds in the remainder of FY21, to which Mr. Roam provided examples like offsetting COVID-related expenses, replenishing reserves, updating technology, and professional development for online teaching and learning. Chairman Dickey also expressed concern about the dispersal of funds earmarked for biology training for teachers that “needs to be fixed”, and the Department committed to investigating. Speaker Pro Tem Jan Jones (R-Milton) asked about the restoration of austerity to feminine hygiene grants, to which Matt Jones with the Department reported that the original allocation was $1M, and the proposed restoration would bring the allocation to $740,000. Speaker Jones noted that her original intent with the grant was to help low-income and low-wealth school districts and expressed concern that grants went to all districts.

Health Subcommittee
The Health Subcommittee of the House Appropriations Committee met today to hear testimony on the Amended FY21 State Budget. Chairman Butch Parrish (R-Swainsboro) opened the meeting by welcoming Rep. Debbie Buckner (D-Junction City) to the committee and thanking former Rep. Pat Gardner (D-Atlanta) for her many years of service to the committee. Chairman Parrish then called on Commissioner Kathleen Toomey to provide testimony for the Department of Public Health.

Dr. Toomey began with a quick rundown of the Department’s budget request which includes a transfer of $289,000 to the Grady Trauma Coordinating Center. This money came from savings due to the increased FMAP due to the COVID-19 pandemic. Additionally, DPH is requesting $144,026 to fund positions in the infectious disease program. This funding was inadvertently cut from the budget but the positions were not eliminated.

DPH has also received over $1.03 billion from the federal government for their COVID-19 response. DPH is in the process of finalizing the budget for the money allocated by the CARES ACT III with plans to improve its surveillance system and update the vaccine tracking software.

Rep. Carolyn Hugley (D-Columbus) asked how her elderly constituents can make vaccine appointments if they are unable to access or navigate the online portal. Dr. Toomey explained that the department is working to further develop vaccine appointment systems with statewide guidelines but currently the individual county health departments are responsible for their appointments. Dr. Toomey further explained the state’s vaccine allocation system. The federal government is currently responsible for 100% of vaccine supply and logistics and therefore the state finds it difficult to prepare long term plans as the weekly dose allocation is not a standardized number. DPH is beginning to work with partners such as Visiting Nurse Health System to provide vaccinations to individuals that are unable to leave their homes.

Rep. Lee Hawkins (R-Gainesville) asked about the limited hours for vaccinations he encountered at his local board of health. Dr. Toomey assured him she is working on expanding access across the state to maximum vaccinations. She noted the limiting factor is currently the number of doses. She is also hoping for an executive order to allow LPNs and PAs to provide supervision at vaccine sites.

Rep. Debbie Buckner asked about the legality of drive-through vaccinations. Megan Andrews, Director of Government Relations for DPH, explained that the current statute allows for an exemption to drive-through restrictions for vaccines related to a state of emergency. Additionally, DPH is planning on introducing legislation to further ease possible statutory burdens.

The committee then heard from DCH Commissioner Frank Berry. Commissioner Berry thanked the committee for its long-time partnership with the department along with the other state agencies that have been working hard during the COVID-19 emergency. He then asked DCH CFO Lisa Walker to provide the committee with an overview of the budget. Ms. Walker discussed a few specific line items including $1.8 million for implementation of the Patients First Act, $750,000 for implementation of the All Payers Claim Database, and $4.8 million for nursing home surveys. The department also saw a $35.7 million reduction in state funds resulting in the increased FMAP due to COVID-19. The committee members had no questions for Ms. Walker or Commissioner Berry.

Lastly, Liz Atkins with the Georgia Trauma Care Network walked the committee through her agency’s amended budget request. The total request totals just over $9 million and is being used to shore up distribution amounts to previous fiscal year funding levels. The system has seen unprecedented trauma utilization in the past fiscal year and returning to previous funding levels will be vital. The remainder of the funding will be used for outcome management to better aid the system in understanding the effectiveness of trauma care across the state. The committee members had no questions for Ms. Atkins.

Human Services Subcommittee
Representative Katie Dempsey (R-Rome) and her Subcommittee had some minor technology issues but welcomed its newest member Representative Teri Anulewicz (D-Smyrna). This Subcommittee heard additional presentations from the Department of Human Services, Division of Families and Children’s Services and Vocational Rehabilitation. Representative Mary Margaret Oliver (D-Decatur) attempted to drill down on what funds were cut in the FY 2021 budget from the budget adopted in FY 2020 which had not been backfilled in the Governor’s amended proposal for FY 2021 or somehow did not otherwise get additional federal funds. This question posed some need for added research.

There was only one public comment raised and that was from the Alzheimer’s Association - Georgia Chapter for added funds for home and community services. The Association noted that Georgia caregivers, in 2019, were 540,000 strong and provided a total of more than 615 million hours of care which cost $8 billion plus. The use of caregivers permits these individuals with dementia to remain in the community and out of more costly areas of care.

This Subcommittee will continue its work on Friday with discussions on behavioral health and developmental disabilities needs of citizens.