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Rising Medicaid Costs Strain Alabama Budget

Brandon Moseley

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By Brandon Moseley
Alabama Political Reporter

Medicaid is a shared cost state and federal program designed to assist the poorest among us with their healthcare costs. However, as the economy has deteriorated more and more Alabama citizens have turned to the program for their medical needs contributing to growing deficit spending by the federal government and straining the state of Alabama’s budget.

In remarks reported on the Alabama Medicaid website, Medicaid commissioner, R. Bob Mullins, Jr., has estimated that Alabama’s part of the Medicaid program will consume about 35.2 percent of the total 2012 general fund budget.

Representative Jim McClendon (R-Springville) and Chairman of the Alabama House of Representatives Health Committee says that early estimates show that the state likely will have a $100 million hole in the Alabama Medicaid budget for 2012. Rep. McClendon said that Alabama cannot make further cuts to the Medicaid program benefits because the state is already offering the minimum number of programs allowed by the federal government. Deeper cuts to the program could potentially result in the state losing federal matching funds which are roughly 80 percent of the actual costs of the program.

McClendon said that the state legislature was exploring other ways to find cost savings. Among those options being explored are contracting out care to a managed care company. Currently, Alabama Medicaid contracts with doctors and hospitals and pays the bills of Medicaid beneficiaries.

Commissioner Mullins does not think that private managed care will be necessary “we feel we can get the same savings with our programs that would be realized with a commercial managed care program.” Commissioner Mullins said that Alabama Medicaid has already started three pilot programs based on ideas used in the state of North Carolina.

McClendon said that educating beneficiaries to use prenatal care and regularly scheduled doctors visits instead of emergency rooms for care would also save the program money. He also said that there could be some savings found from pharmacies and from long-term-care facilities.

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McClendon said that the state was also exploring the idea of combining the general fund and the education funds. “The growth funds are in the education fund.” McClendon explained that that is why that fund is growing while the general fund is still stagnant. Medicaid is not the only problem in the general fund “the prison system is at 190 percent capacity. Very few states operate like we do with two separate funds.” Rep McClendon acknowledged that there would be “a lot of resistance.”

Long term, the issue that overshadows this year’s budget is the massive expansion of Medicaid eligibility ordered in the Affordable Care Act of 2010, popularly known better as ‘Obamacare.’ Commissioner Mullins said it “is estimated that we will require about 92 percent of the General Fund Budget by FY 2020 and that cannot happen,” he emphasized. “Second, because of our economy and the Affordable Care Act, we anticipate an increase of around 500,000 new enrollees in Medicaid by 2014.” Commissioner Mullins said that Medicaid will need another 1,000 primary-care doctors to meet that level of demand.

Rep. McClendon says that the federally-ordered Medicaid expansion in 2014 would be “a doomsday scenario. Every penny in the general fund will go to Medicaid. We can’t let that happen. We are about maxed out today. We have no way of paying for that under the current tax structure.McClendon states, “The Act, which the state of Alabama is currently suing to block in federal courts, could well be overturned by the Federal courts. That would take a lot of immediate pressure off of the legislature, but future funding will remain a challenge.”

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According to statistics in Alabama Medicaid’s 2010 report, Alabama has a total population of 4,838,236. Of those, 1,026,429 (21.2 percent) are Medicaid eligible.

Alabama has 1,356,124 children. Of those, 589,894 (43.5 percent) are Medicaid eligible.

Some 45 percent of Medicare eligible Alabama residents are Black, 45.6 percent are white, and 5.4 percent are Hispanic.

The county with the highest percentage of Medicaid eligible residents is Wilcox with 43.4 percent.

Shelby County has the lowest percentage of Medicaid eligible residents with just 7.7 percent.

Alabama Medicaid had a 2010 total budget of $5,394,338,268.

Of which, $3,957,178,091 came from the federal government and the remaining $1,437,160,177 came from the State of Alabama.

Brandon Moseley is a senior reporter with six and a half years at Alabama Political Reporter. You can email him at [email protected] or follow him on Facebook.

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Judge dismisses lawsuit, settling ownership of Alabama Democratic party

Eddie Burkhalter

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Montgomery County Circuit Judge Greg Griffin on Thursday dismissed a lawsuit over who was in control of the Alabama Democratic party, meaning the so-called reform group championed by U.S. Sen. Doug Jones has won out. 

Griffin in his order filed Thursday morning wrote that his court lacked jurisdiction “over what appears to be an intra-political-party dispute regarding the officer elections and governance of the Alabama Democratic party.” 

Griffin’s ruling means that state Rep. Chris England, who was picked to lead the state Democratic party by the reform group, is the party’s chair. 

The ruling puts an end to the lawsuit filed by former ADP chairwoman Nancy Worley, after the Democratic National Committee ruled that her re-election as chair was invalid. 

England was elected ADP chair after the DNC ordered new elections and the adoption of new bylaws.

 

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Bill would make owning pre-1960 slot machines legal for personal use

Eddie Burkhalter

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Vintage slot machines are highly sought-after by collectors, but owning one for personal use is a crime in Alabama. That could change this year. 

Rep. Chip Brown, R-Mobile, told APR by phone on Wednesday that he was approached by a group of antiques collectors who asked that he write a bill that would allow a person to own the vintage slot machines for personal use. 

Mention of legislation around gaming machines of any kind raises caution in Montgomery, where legislators and special interests have for decades fought over gambling and whether to establish a state lottery. Brown said he was well aware of the sensitivity of the subject matter when crafting the bill, which makes clear it won’t allow any of the old machines to be used for commercial purposes. 

“All this does is it just allows individuals to collect pre-1960 slot machines for their own home collection,” Brown said.  “I was very careful when we drafted the bill to make sure that it wouldn’t open the door to any bigger issues.” 

House Bill 260 reads that “The crime of possession of a gambling device does not apply to a slot machine manufactured before 1960, with the intention that the slot machine be used only for the personal and private use of the owner or for public display as a historical artifact in a manner that the slot machine is not accessible to the public.”

Alabama is one of eight states that do not allow ownership of slot machines made in any year. Other state laws vary, allowing residents to own machines made before certain years. 

Pre-electric slot machines are highly sought-after, and can fetch many thousands of dollars. Brown said those who want to own one for personal use ought to be be able to do so. 

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“I’m hoping I can get it in debate in committee next week,” Brown said of his bill.

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Bill strengthening foster parents’ rights in child custody cases clears senate committee

Brandon Moseley

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Wednesday, a bill that would require a juvenile court to consider a child’s relationship with his or her current foster parents and the child’s best interests when making a determination of whether to terminate parental rights received a favorable report in the Senate Committee on Children and Senior Advocacy.

House Bill 157 is sponsored by State Representative Paul Lee, R-Dothan.

Lee said that when we talk about our education system, nothing is more destructive than a lack of home life. A lot of these children are in foster care for two or three years. Then when parental rights are about to be terminated relatives show up at court even though they have been AWOL in the life of the child. Presently the judge can not take into account the role that the foster parents have played. This bill allows him to use the three years weight in making his decision.

HB157 passed the full House on Tuesday where it passed 94 to 1.

24 hours later the Senate Committee on Children and Senior Advocacy, chaired by State Senator Larry Stutts, R-Sheffield, gave the bill a favorable report. There was no opposition to the bill thus there was no public hearing.

The bill was cosponsored by Rep. Terri Collins, R-Decatur.

Collins said, “Some of these children, these babies, have been in foster care for years. This gives foster care families some say in permanent decisions with the child.”

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Collins said that she met with a group of foster parents from her district and this bill was a priority for them.

According to the synopsis: “Existing law provides factors for a juvenile court to consider in making a determination of whether to terminate parental rights. This bill would require a juvenile court to consider a child’s relationship with his or her current foster parents and the child’s best interests when making a determination of whether to terminate parental rights. This bill would provide that a juvenile court is not required to consider a relative for candidacy to be a child’s legal guardian if the relative has not met certain requirements. This bill would also provide that service on an individual whose parental rights have been terminated are not entitled to receive notice of pendency regarding an adoption proceeding involving a child for whom the individual’s parental rights have been terminated.”

The bill states that: “If the juvenile court finds from clear and convincing evidence, competent, material, and relevant in nature, that the parents of a child are unable or unwilling to discharge their responsibilities to and for the child, or that the conduct or condition of the parents renders them unable to properly care for the child and that the conduct or condition is unlikely to change in the foreseeable future, it may terminate the parental rights of the parents. In a hearing on a petition for termination of parental rights, the court shall consider the best interests of the child.”

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According to the bill the judge should award custody to the foster parents over a relative, “In a proceeding for termination of parental rights if both of the following circumstances exist: “(1) The relative did not attempt to care for the child or obtain custody of the child within four months of the child being removed from the custody of the parents or placed in foster care, if the removal was known to the relative. “(2) The goal of the current permanency plan formulated by the Department of Human Resources is adoption by the current foster parents.”

The bill now goes to the full Senate for their consideration.

 

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State leaders unveil a major mental health legislative initiative

Brandon Moseley

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Wednesday, House Majority Leader Nathaniel Ledbetter, R – Rainsville, Lt. Gov. Will Ainsworth (R), Speaker of the House Mac McCutcheon, R – Monrovia, Senate President Pro Tem Del Marsh, R – Anniston, Alabama Department of Mental Health Commissioner Lynn Beshear, State Education Superintendent Eric Mackey, House Minority Leader Anthony Daniels, D-Huntsville, as well as the legislators carrying the bills held a press conference to announce a major mental health legislative initiative at a State House news conference.

“47,000 Americans lost their lives to suicide last year,” Rep. Ledbetter said. “It is the second leading cause of deaths for teenagers.”

“We are failing with mental health,” Ledbetter said. “I told the Governor that we are failing mental health. She asked us to lead an initiative to address mental health.”

Alabama Gov. Kay Ivey (R) tasked Ledbetter with leading an effort to improve and expand the mental health services that state government offers the citizens of Alabama. Ivey discussed the importance of the issue during her 2020 State of the State Address.

“The Speaker and the Pro Tem, either them or their staff, have been at every meeting we had,” Ledbetter added. “A member of the Governor’s staff also attended

Ledbetter proposed five pieces of legislation:

A School Service Coordinator Bill sponsored by Ledbetter and Sen. Rodger Smitherman, D – Birmingham, requires each school system within the state to employ a mental health service coordinator subject to legislative appropriation.

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A 72-Hour Hold Bill sponsored by Rep. Wes Allen, R – Troy, and Sen. Donnie Chesteen, R – Geneva, authorizes law enforcement officers to place individuals who are believed to have mental illness and pose a threat to themselves or others under 72-hour protective custody, which includes transportation to a hospital for evaluation and treatment.

A CIT Training Bill sponsored by Rep. Rex Reynolds, R – Huntsville, and Sen. Andrew Jones, R – Centre, requires the Alabama Peace Officers Standards and Training Commission to provide mandatory crisis intervention training and continuing education to law enforcement officers.

A Crisis Care Center joint resolution by Rep. Randall Shedd, R – Fairview, and Sen. Garlan Gudger, R – Cullman, calls for the immediate creation and funding of three 24-hour crisis care centers, which serve as an alternative to costly hospital and emergency room visits by providing suicide prevention and other mental health services on an immediate, walk-in basis.

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A Stepping Up joint resolution by Rep. Anthony Daniels, D – Huntsville, and Sen. Steve Livingston, R – Scottsboro, encourages Alabama’s 67 counties to implement and embrace the Stepping Up initiative, which seeks to reduce the number of individuals in jail with mental illness.

Ledbetter said that several of these items come with a price tag. The three crisis centers will costs $18 million. This is, “One of the major priorities of our 2020 legislative session.”

“Thank you for you and your committee’s work,” You have put a lot of time and effort in it.” Lt. Gov. Will Ainsworth said. “Alabama, we hear you. We can do a better job. We will do a better job in addressing mental health.”

“This has been an ongoing experience for our legislature to stop and take a look at what we do with mental health in our state,” Speaker McCutcheon said. It is time that we step up. The last time Alabama stepped up on mental health without a court order was in the 1960s with Lurleen Wallace’s $47 million bond issue.”

“It is time to quit kicking the can down the road,” McCutcheon said. “The House will commit a full day to these bills’ passage.”

“What I have found in my time in Montgomery is if somebody does not take a lead on a particular topic nothing gets done we just keep talking about it,” Marsh said thanking Ledbetter and the task force.

“You either have a family member, a friend, or a community member who is affected by mental illness,” Marsh said. “Mental health is not a Republican issue or a Democrat issue. It’s a simple issue of providing needed services that will help reduce recidivism in our prisons, improve performance in our schools, and enhance the quality of life for all Alabamians.”

Sept. Mackey said that, “This is an ongoing effort. Everybody has been wanting to work together to address mental health in this state.”

Mackey said that they “Are hearing from teachers that there are students coming into their classrooms with mental health issues as early as kindergarten and even as early as Pre-K.”

“We want to see that families have the mental health support that they need so that those kids come to school capable of learning,” Mackey said.

Alabama Department of Mental Health Commissioner Lynn Beshear expressed thanks that the legislative and executive branches of government are uniting their powers to address a growing problem.

“The fact that the governor and the Legislature are working so closely and cooperatively on this issues demonstrates its importance to Alabama and its citizens,” Beshear said. “The Alabama Department of Mental Health works hard to provide the best services possible with the dollars we are given, but this legislative initiative and intense emphasis will help us to literally save lives and provide hope where it does not currently exist.”

“The stepping up initiative is the foundational piece,” Beshear said. “This is an initiative that began in 2015 in the White House.” “The goal is to reduce the number of individuals with mental illness in jail.”

“The Montgoemry area was one of the first fifty to sign on to this,” Beshear explained. “They sent teams to receive training. At this time we have 21 county commissions that have signed the stepping up resolution.”

“When a person is discharged from the hospital, the hospital sends them home with a care plan,” Beshear added. “When a person is discharged from jail they need a care plan. If we can reach people early or at a crisis point in their disease process we can prevent it from progressing further.”

Commissioner Beshear said that, “Law enforcement, healthcare, government and the business community come together to create a plan at the regional level.”

The mental health reform bills could be in House and Senate bills as early as next week.

 

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