Thread by @sclaudwhitehead

More health budget hearings happening this morning at the Georgia Capitol and by Zoom. First up, @GADCH which oversees Medicare and Medicaid and regulates LTC facilities in Georgia, which have been hit hard by the pandemic.

Stream here: bit.ly/3iAi3eg

#gapol

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@GADCH About 1/3 of all COVID deaths in the state have been among people in long-term care facilities.

Though, DCH only shares info on facilities with 25 beds or more. Not a lot of good data on deaths linked to smaller settings in the state.

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@GADCH Commissioner Berry: "We have had more children and families become eligible for Medicaid than ever before" during the pandemic.

A substantial amount of Georgia's budget goes to covering part of the costs for Medicaid, some of those costs come from the feds.

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@GADCH Update on Georgia's 1115 Medicaid waiver, which offers a limited expansion of coverage to those who can meet certain work/volunteer requirements.

DCH says implementation will happen in three phases, with all rolling by 7/1/2022.

Slide below.

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@GADCH DCH is also working on Georgia's 1332 waiver, which would cut the state's ties with bit.ly/2Klnk9u.

That plan, approved by the Trump administration, is currently the subject of a lawsuit filed last week.

More here: bit.ly/3qAlmVe

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@GADCH Ok time for numbers! First, in AFY21.

Biggest savings is from the feds making states pay less in matching contributions for Medicaid program, because of COVID.

That's saving the state $344 million for the rest of the current FY.

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@GADCH In 2022 ... lots of money being spent.

More on benefits, more when the enhanced federal match goes away.

And ...

$65.4 m for benefits for Georgia's limited Medicaid expansion program, and $2.4m to run that program.

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@GADCH Lots of red in this slide about the state health benefit plan, looking at a potential deficit of $696.5m (!) in FY23.

DCH says agency contributions to the plan aren't keeping pace with member expenditures.

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@GADCH Berry on COVID-19 vaccine administration in LTC: "I have heard we're slowly increasing the number of workers getting it. Moving to 40-50 percent. The more we can encourage the workforce to get it, the better off we'll be."

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@GADCH As for the rollout, Berry says @DCH plays more of a support role to @GaDPH and private companies like Walgreens and CVS, who are working to dole out vaccines in LTC facilities.

Says his agency is willing to adapt to meet the needs of those partners.

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@GADCH @dch @GaDPH @Pierre_ap15

Here is another one to try!

bit.ly/3iAi3eg

@GADCH @dch @GaDPH Berry on SHBP: "What is it that we want to be providing for us? What are the health outcomes that we want? What are the services we want to purchase, not what is someone trying to sell us."

More on the SHBP here: bit.ly/3o6Winj

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@GADCH @dch @GaDPH It serves a LOT of people, and with a projected deficit in the coming years, I'd think a lot of them are thinking, "How might my benefits go away/change?"

Looks like SOME savings will need to be found in the coming years to keep the plan afloat.

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@GADCH @dch @GaDPH Now to everyone's favorite topic: Certificate of Need!

The state has relaxed rules to allow facilities to add beds to meet COVID needs. Berry says that's tied to the state of public health emergency that's been in place since early-pandemic.

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@GADCH @dch @GaDPH CON is one of the stickiest, thorniest, wonkiest health issues that gets discussed under the Gold Dome.

To have rules waived for the pandemic is pretty striking based on how much fighting happens over the issue.

Waiver of rules will end when public health emergency ends.

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@GADCH @dch @GaDPH DCH has asked for 1115 waiver to extend post-partum Medicaid from 2 > 6 months. Active discussion with the feds about expanding the coverage, which is aimed at cutting Georgia's maternal mortality rate.

A bill expanding coverage passed last session bit.ly/2M5HNTr

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@GADCH @dch @GaDPH Berry: DCH continues to expect more federal support to help hospitals find additional staff to handle the pandemic, calls that help "one of the most valuable tools we've had to fight COVID."

Staffing is a MAJOR CHALLENGE, not just having enough COVID beds.

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@GADCH @dch @GaDPH Now it's time for DBHDD! A little bit on what the agency does and who they serve: people with mental illness, substance use disorders, and with intellectual and developmental disabilities.

Again, stream is here: bit.ly/3iAi3eg

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@GADCH @dch @GaDPH Here's a breakdown of what the agency does and their budget.

If you've ever wondered what a state agency does, watching budget hearings is a GREAT reminder.

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@GADCH @dch @GaDPH DBHDD "continues to work toward a successful exit" with the settlement agreement it entered with the USDOJ over its treatment of people with mental illness and i/dd, that the state was too reliant on institutional care.

Georgia entered the agreement in 2010 (!).

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@GADCH @dch @GaDPH The state re-upped its agreement with the DOJ in 2016, when it said the state still hadn't done enough to address the issue.

Here's the breakdown of what the state is still working on from Commissioner Judy Fitzgerald.

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@GADCH @dch @GaDPH With the Biden administration coming in, Fitzgerald says, Georgia should have a better sense soon how the feds think the state is doing.

It was the Obama administration that first entered into the agreement with the state in 2010 and then extended it in 2016.

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@GADCH @dch @GaDPH Now for COVID impacts:

- crisis services were hit hard; staffing hit hard, not great access to PPE for staff
- group services had to stop/adapt for COVID; staff couldn't see patients in person
- independent providers faced financial instability

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@GADCH @dch @GaDPH Now to state hospitals.

- COVID got in easily and wasn't easy to get out
- had to make "dramatic changes" to keep staff and patients safe
- "herculean effort" says Fitzgerald to get that done

Breakdown of patient/staff deaths from the agency:

bit.ly/2VSukAM

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@GADCH @dch @GaDPH Here is how the state adapted to address those issues, Fitzgerald says.

Notice, the state Medicaid match reduction also helped DBHDD. My understanding is that will eventually go away post-pandemic.

So, does the state get used to this reduction? Or prep for it to expire?

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@GADCH @dch @GaDPH Reminder that DBHDD saw some major cuts last year, with other state agencies.

The budget discussion last year for the agency was one of the most heated, as I recall. Lots of pushback on lawmakers to proposed budget cuts, some of which got restored.

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@GADCH @dch @GaDPH Here are the changes for AFY21 and asks for FY22.

Looks like some of that money the state saved in the enhanced Medicaid match went to full some holes in the budget (see line 6).

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@GADCH @dch @GaDPH Here are the 2022 asks.

Fitzgerald also asking for $5m in bonds for repairs and "major renovations and repairs" for DBHDD hospitals.

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@GADCH @dch @GaDPH Fitzgerald says there about 7k people on the state's "planning list" (a.k.a. waiting list) for i/dd services.

The agency is asking for funding for funding to take 100 new people off that list.

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@GADCH @dch @GaDPH There has been an uptick in mental health services, overdoses, addiction services in GA as in most of the country because of the pandemic.

State set up COVID support line to take pressure off state's main crisis line; state got grant money to ID people at risk of suicide.

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@GADCH @dch @GaDPH That grant money, Fitzgerald says, allowed the state to reach out to people at greatest risk to offer services.

And that's a wrap! We'll have to see how these budget requests play out!

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