First of all, this budget is formulated to cover both years of the biennium, starting with July l-June 30, 2013-14, and July l-June 30, 2014-15. Next year's short session would concentrate on necessary changes to the biennium budget. Following the Governor's presentation, both the Senate and the House debate and consider changes to the proposed budget.
- Appropriations for Department of Justice (DOJ) Settlement Agreement (in addition to the $l0M appropriated last year) FY 2014: 3.8M FY 2015: 9.7M
- Medicaid Copayment Requirements increased from $3.00 per visit for most encounters, to $3.90/visit. This is an out of pocket expense
- New Requirement for Prior Authorization of Mental Health Drugs FY 2014: $15M FY 2015: $32M
- Expansion Dollars for Broughton Hospital, to be opened in December 2014 $23M for equipment, information technology system, furniture (nonrecurring)
- Expected reduction in LME administration costs due to statewide waiver implementation : $l5M to simply go to the General Fund to help with the overall NC Budget
Analysis:
The DOJ appropriations are a good thing; they will help with individual housing, and implementation of evidenced based practices like ACT, supported employment, and peer support. It's probably not enough, but it is good to see it in the budget.
The medicaid copay increase will have an affect on those who must now pay almost a 33% increase each time they go for a service.
Including a prior authorization requirement for getting your mental health prescriptions filled is just adding another hoop to jump through, another barrier to cross to getting the treatment that people need. In states that have this requirement, there is data to show that noncompliance is on the rise, leading to bad outcomes, including more trips to the ED, and more admissions to jails and prisons. This is a very disturbing thing to see in the budget, at a time when already too many individuals are lining up in emergency departments.
Any funds saved from a conversion to a medicaid waiver statewide should be used to invest in improving community mental health services, not used to balance the overall budget. The whole nation is poised to consider serious improvements to mental health, in the post Sandy Hook weeks and months; this $15M should be used for early detection of mental illness in our schools, for hiring of additional clinical staff in schools, training of school resource officers in recognition of mental illness, and the like. The time to make these changes are now.
The Big Question: What is missing from the budget?
There are l500 people living in .5600a group homes (and another 400 with developmental disabilities) who only have funding through June 30, thanks to HB 4, to cover the losses they experienced due to eligibility changes in personal care medicaid services. There is no solution in this budget to carry these homes forward. We have been in touch with the Division, and with DMA, and we are assured that they will find a solution.
Sometimes it is the things that are missing that are the biggest things of all.
