VACo Budget Update: Health & Human Resources

December 29, 2015

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The following is VACo’s analysis of the Health and Human Resources recommendations by Governor McAuliffe in his FY 2016–2018 biennial budget.

 

FY16 Caboose Bill (HB29/SB29) Budget Amendments

Social Services

-Adds $1.7 million in FY 2017 and $6.5 million in FY 2018 to cover the cost of providing foster care and adoption subsidy payments.

FY17/18 Budget Bill (HB30/SB30) Budget Proposal

Children’s Services Act (CSA)

-Provides $18.1 million in FY 2017 and FY 2018 for anticipated caseload and expenditure growth for services provided through the Children’s Services Act.

-No additional money is added for CSA administrative funds.

Department of Health

-Provides $179,000 in FY 2017 and FY 2018 for local health districts that are expecting significant rent increases in 2017 and 2018 due to moving to new facilities or rent increases in existing facilities.

-Increases appropriations by $100,000 in FY 2017 for the Mission of Mercy (MOM) dental project to address rising costs in patient care and broaden the foundation of support.

-Increases nongeneral fund support by $1 million in FY 2017 and FY 2018 for the Comprehensive Health Investment Project (CHIP) of Virginia. The purpose of the program is to develop, expand, and operate a network of local public‐private partnerships providing comprehensive care coordination, family support, and preventative medical and dental services to low‐income, at‐risk children.

-Increases appropriation by $100,000 in FY 2017 and FY 2018 for the Health Wagon, located in Southwest Virginia, to address the medically underserved population, which is expanding as a result of increased unemployment in coal producing areas of the state.

-Adjusts general fund support for the State Rural Health Grant Fund to reflect changes in grant funding. The adjustment increases agency appropriation by $300,000 general fund in FY 2017 and FY 2018 to meet match requirements for the grant. The appropriation level has not increased in 15 years while the match requirement has more than tripled. Funds are used to deliver programming, technical assistance, and resources to all areas of rural Virginia.

-Increases general fund support by $254,000 in FY 2017 and FY 2018 for environmental health programs. This funding is intended to help address a backlog of requests for onsite sewage and water supply services and address other programmatic inconsistencies. Current program staff have diverted resources to and address these problems, which in turn has created a delay in other services.

Medicaid

-A total of 855 new waiver slots are added to the intellectual and developmental disability waivers over the course of the biennium. These slots are mandated by the settlement agreement with the U.S. Department of Justice and include 180 slots for individuals transitioning out of facilities (90 in the first year and 90 in the second year), 50 slots to address the developmental disability waiver waitlist (25 in each year), and 625 slots to address the intellectual disability waiver waitlist (300 in the first year and 325 in the second year). Adds $14.2 million in general funds and $14.2 million in nongeneral funds in FY 2017 and $31.8 million in general funds and $31.8 million in nongeneral funds in FY 2018.

-Funds 100 reserve waiver slots across three waivers: Intellectual Disability, Developmental Disability and Day Support waivers. Reserve slots will be used for emergencies, for individuals transferring between waivers and for individuals transitioning from an Intermediate Care Facility or nursing facility to the community in compliance with requirements of the 2012 Settlement with the U.S. Department of Justice. Adds $1.9 million in general funds in FY 2017 and FY 2018 and $1.9 million in nongeneral funds in FY 2017 and FY 2018.

-Provides $13.1 million in general and nongeneral funds in FY 2017 and $23 million in general and nongeneral funds for FY 2018 for the implementation of three redesigned Medicaid waivers serving individuals with intellectual and developmental disabilities. The costs include an average rate increase of 5.4 percent for waiver services, the addition of new services to assist in increasing the number of individuals who can live in integrated settings, an increase in the developmental disability case management rate, and additional funds for more intensive services for individuals who are medically fragile or have complex co‐occurring behavioral health needs. The redesigned waivers will address the concerns raised by the U.S. Department of Justice (DOJ) and the U.S. District Court in relation to the state’s compliance with the settlement agreement reached with the DOJ in 2012.

-Reduces the budget for state training center reimbursements to account for the on‐going facility closure costs and savings resulting from compliance with the Department of Justice settlement agreement. This package reflects the estimated impact of closing Northern Virginia Training Center in March 2016, and Southwestern Virginia Training Center by the end of FY 2018.

2017                               2018

General Fund           ($9.8) million                      ($10.9) million

Nongeneral Fund    ($9.8) million                      ($10.9) million

-Authorizes the expansion of Medicaid on January 1, 2017, to non‐elderly adults with incomes up to 133 percent of the federal poverty level. This action would result in approximately 350,000 Virginians gaining access to health care. The net general fund savings to the Commonwealth would be approximately $59.2 million in FY 2017 and $97.7 in FY 2018. Provides $707 million in FY 2017 and $2.3 billion in FY 2018 in nongeneral funds captured from the Affordable Care Act.

Behavioral Health

-Adds $1.3 million in FY 2017 and FY 2018 for Developmental Disability Health Supports Networks (DDHSNs) in the Southwestern Virginia region. Current base funding for DDHSNs in FY 2016 is $2.6 million, which funds networks that replace services that were previously being provided by Southside Virginia Training Center and Northern Virginia Training Center. The services provided include health education, dental services and equipment repair.

Grants to Localities

-Provides $1.7 million in FY 2017 and $2.5 million in FY 2018 for the Early Intervention Part‐C program. The average caseload growth over the last four years was 4.9 percent. The federal Individuals with Disabilities Education Act requires that the state must identify and enroll all eligible children.

-Increase funds for the crisis stabilization programs required by the settlement agreement with the federal Department of Justice (DOJ) by $4.3 million in FY 2017 and $5.3 million in FY 2018. This amendment includes funds to build two, eight‐bed therapeutic homes, in addition to funds for mobile crisis services, respite services for children, and crisis coordinators in each region. Funds are included for three crisis specialists to work in state mental health facilities to reduce unnecessary institutionalization

-Provides $636,000 in FY 2017 and $480,000 in FY 2018 for transitional needs for an estimated 180 individuals leaving the training centers during the biennium. There is currently no base funding dedicated to this need. All transitional needs have been supported through carry forward requests in FY 2015 and FY 2016. The requested funding will support needs that are not covered by Medicaid, including assistive technology, home and vehicle modifications, and specialized durable medical equipment.

-Provides $1.9 million in FY 2017 and $3.7 million in FY 2018 for 300 rental vouchers, and funding for two state positions to manage the rental subsidy program. This request will phase in the new rental subsidies by adding 150 in FY 2017, and an additional 150 in FY 2018.

-Provides $600,000 in FY 2017 and FY 2018 for up to three additional post‐booking diversion programs. These programs enhance identification, diversion, and connection of persons with mental illness or co‐occurring substance abuse disorders involved in the criminal justice system by providing pre‐trial mental health and substance abuse services.

-Provides $1.5 million in FY 2017 and $3 million in FY 2018 to establish one therapeutic group home and one intensive community residential treatment program in the Eastern State Hospital catchment area. In addition, discharge assistance planning funds (DAP) are provided to address extraordinary barriers to discharge so that individuals who are ready for placement in the community have the supports necessary to succeed outside of a state hospital. This amendment also includes funds for one position to monitor, evaluate, and prioritize individuals waiting for transfer to a state facility from local jails.

Aging

-Provides $425,804 in FY 2017 and $1 million in FY 2018 for public appointed guardians for individuals with mental illness who are being discharged from state hospitals. Based on the current discharge plan, it is assumed that funding is needed to provide services to 50 individuals in FY 2017 and a total of 98 individuals in FY 2018. Funding is also provided in the second year to serve approximately 50 additional at‐risk adults who are on the unrestricted waitlist for services. The Public Guardian and Conservator Program, operated by the Department of Aging, protects the Commonwealth’s most vulnerable citizens who are indigent, have been adjudicated as incapacitated, and have no one who is willing or able to serve as their guardian.

-Provides $50,000 in FY 2017 and $440,000 in FY 2018 to cover the on‐going operating costs associated with a replacing the current case management system being used by adult services and adult protective services (APS) workers.

-Provides $500,000 in FY 2017 and $975,000 in FY 2018 for public appointed guardians for individuals with an intellectual disability, who have been determined to be incapacitated.

-Provides $87,338 in FY 2017 and FY 2018 for a position to improve state monitoring of the Auxiliary Grant (AG) Program. In FY 2014 AG program expenditures were over $27 million and payments were provided to over 5,300 adults; however, there is currently limited program oversight. This position will be dedicated to investigating program irregularities and improving accountability.

Social Services

-Provides funds to expand foster care and adoption subsidies to age 21 under Virginia’s Fostering Futures program.

2017                              2018

General Fund           $1 million                 $2.9 million

Nongeneral Fund    $1 million                 $2.9 million

-Provides additional funds for local workers to handle a portion of the increased volume of applications associated with an expansion of Medicaid.

2017                              2018

General Fund           $1.4 million              $2.2 million

Nongeneral Fund    $4.1 million              $6.3 million

VACo Contact: Beau Blevins

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