Gold Dome Report — Legislative Day 17
February 17, 2021: Freezing temperatures and the threat of icy roads couldn’t keep legislators away from the Gold Dome as they kicked off yet another week of the Session. Both chambers OK’d a small slate of bills followed by a packed afternoon (and cafeteria). As the clock ticks closer toward Crossover Day, lawmakers continue to fill the hoppers with new legislation — including a revamp to the state’s citizen arrest law, announced by Governor Kemp and a bipartisan group of legislators during an afternoon press conference. All this, and more in today’s #GoldDomeReport.
In today’s Report:
- Committee Reports
- New Legislation
- Rules Calendars for Legislative Day 18
House Appropriations — Human Resources Subcommittee
Chairman Katie Dempsey (R-Rome) and her Human Resources Subcommittee spent a part of President’s Day hearing more specifics regarding the FY 2022 Budget needs, particularly around the areas of the Departments of Behavioral Health and Developmental Disabilities, Human Resources (including Division of Family and Children’s Services), Veterans Services, Georgia Council on Developmental Disabilities and Georgia Vocational Rehabilitation Agency. The full tracking document for HB 81, the proposed spending plan for FY 2022, is here.
The Subcommittee heard presentations from the Departments and agencies, but the real discussions were the testimonies provided by the public. A few highlights of the agencies presentations included:
Department of Human Services — Commissioner Robyn Crittenden outlined that her budget for FY 2022 is projected to be $803.9 million which is an increase of $7.9 million over its budget for FY 2021. She accented the combining of programs, Elder Support and Elder Community Living Services, which deliver home and community based services. Commissioner Crittenden also mentioned the Safe Harbor and Sexually Exploited Children Fund and the use of $351,000.
Division of Family and Children's Services — Director Tom Rawlings explained his agency’s changes in out-of-home care ( a reduction of $14.3 million but with added funding is a net decrease of $3.5 million) and funding increases for adoptions. He also mentioned the funding proposed for implementing the Patient’s First Act which is projected to add 50,000 individuals in the Medicaid program. He also mentioned that passage of the Medicaid Express Lane Eligibility bill would add 50,000 children. Representative Mary Margaret Oliver (D-Decatur) inquired about what would be the impact on Patient’s First Act given the action last week by the federal government on the work requirement and overall expanding Medicaid. Director Rawlings indicated they do not know all the effects yet. He was also asked about the pending lawsuit involving the Safe Harbor Commission and its funding; he indicated that expenditure of the funds would be permitted and did not pose a threat for a “clawback” of the approximate expenditure of $350,000. Chairman Dempsey asked about the adoption rate increase. Rawlings stated that there was a year-over-year increase in the numbers of children being adopted from foster care and that many of those children have special needs. Further, the median age of the child adopted is 6 years old. Rawlings closed by stated he was grateful for the assistance for the $1000 supplement for his staff; there are about 7,000 individuals who will benefit from the supplement.
Department of Behavioral Health and Developmental Disabilities — Commissioner Judy Fitzgerald spoke to her agency’s budget for the upcoming fiscal year outlining the four priorities for DBHDD: 1) 100 new NOW/COMP waiver slots an addition of $1.94 million; 2) annualizing the funding for the 40-bed forensic unit at West Central Georgia Regional in the amount of $4.65 million; 3) using GHVP funds to implement housing supports; and 4) funding for four corrective action plan specialists at a cost of $355,000. Fitzgerald also mentioned the capital funding necessary for upkeep of DBHDD’s 470 buildings across its five campuses (a total of $5 million in bonds). She also mentioned these items:
- Continued enhancement of crisis services (including the new 988 line for suicide)
- Ongoing ADA settlement
- Multi-year plan to address intellectual and developmental disabilities planning list
- Investment in community behavioral health — core outpatient funds
- Addictive diseases capacity
- Forensic services improvement and
- Workforce retention of direct care staff.
Rep. Oliver asked what amount was cut from FY 2021 budget which was not restored in FY 2022. CARES Act funds helped with funding needs. Fitzgerald indicated that the agency looked at areas where reductions could be taken but preserving crisis and residential services. Fitzgerald also noted that the staff augmentation by Jackson Healthcare which was paid for by the CARES Act. DBHDD’s total budget is $1.3 billion. There were some other questions around the 188 individuals who are impacted by the 1915c waiver renewals and their changes for NOW/COMP Medicaid waivers. Fitzgerald indicated that they are presently in discussions with CMS; Department of Community Health submitted the proposal on December 31. Every five years these waivers are required to be renewed. She indicated that CMS may have a decision between 90 days to 6 months. There are adjustments in settings and delivery of services to this population who would otherwise be in nursing homes. There are proposed exceptions written into the waivers; DBHDD also asked for a transition period for these 188 individuals (24 months). Once the waivers are approved, DBHDD will work with the families of the 188. Fitzgerald could offer no insight on the changes to Patients’ First based on recent federal comments.
Department of Veterans Services — Commission Mike Roby noted that his agency supplies services to 700,000 veterans in the state — the Department assists with benefit claims, providing nursing home care to veterans (in Milledgeville and Augusta facilities), and memorial benefits. Georgia ranked 9th in the nation in numbers of veterans in 2019; he also mentioned that the state was 5th nationally in the non-taxable VA benefit dollars (approximately $3.5 billion in 2019). Currently, there are 261 veterans in the Department’s two nursing homes. His agency’s budget for the FY 2022 year is proposed at $23 million.
Vocational Rehabilitation Agency — Director Chris Wells spoke about his budget. He began by explaining that his agency will soon be making masks available for sale. His budget is “flat.” He accented some bond funds for Georgia Hall and other properties. The agency also works with 60 vendors employing 1,600 employees. The Agency is also still serving students and is in the process of reviewing new CDC guidance and how their schools may be re-opened. As of January, the Agency has 136 counselors and 35 pre-employment specialists; they are serving 22,288 individuals. Counselors have an average caseload of 110. A new website is under development. He mentioned the three priority employment category areas and noted that 3,400 individuals are on a waiting list. His agency is focused on investing in technology (including a call center); ensuring appropriate staffing and establishing an appropriate resource allocation.
Georgia Council on Developmental Disabilities — Eric Jacobson spoke to his COuncil’s needs. Among the highlights were the IPSE education programs, including one to commence at Georgia College and State University.
Public Testimony — Much of the testimony focused on the needs of the 188 individuals who are impacted by the NOW/COMP waiver changes and the impact on 24-hour nursing care and staffing.
Sashi Omogiate, with the Imani Within Foundation, discussed the need for using PBIS and “mindfulness” to address mental health needs of school-aged children.
John Zoeller spoke about his daughter’s needs for 24/7 care for the waiver, noting that his daughter was assessed for her needs. He argued that the changes to the waivers were being used to save a few dollars in order to address individuals who are the state’s planning list (approximately 7,000). He mentioned that states of Minnesota, Oregon and Hawaii have 24 hour nursing care and that South Carolina permits 23.5 hours of nursing care. Mr. Zoeller noted that he and his family purchased a home for his daughter to live in so as to plan for her care later in life. They use Georgia Options for nursing care. His daughter did not succeed previously in a group home due to her emotional and behavior issues. Representative Dunahoo inquired about costs of the care; Mr. Zoeller indicated that this care will vary by individual depending on the level of care needed. Several other parents of these 188 individuals also spoke about their concerns trying to move individuals to congregate settings when they had been assessed for services, required 24/7 care.
Maureen Kelly, with the Georgia Council on Aging, spoke on the need for an addition of $10 million in home and community based services, particularly due to pandemic issues. The Georgia Alzheimer’s Association also supports this request.
Michael Halligan spoke on behalf of Pack 4U, an in-home medication delivery and remote patient monitoring system. He indicated that it would be a cost of $313,268 for assistive technology and could be used for the NOW/COMP waiver population, benefitting 1250 individuals. The system, known as “Spencer,” is managed by pharmacists and helps with medication adherence, patient engagement, is Bluetooth capable, and has telehealth functionality.
Brittany Luther-Jones, with The Bradley Center in Columbus (St. Francis-Emory), spoke to the need for crisis funding in the Muscogee County area, including 30 counties in that catchment area. Her request was for $1.5 million for new crisis services beds and $750,000 in one-time funding for the capital needs. This facility operates the crisis stabilization unit for the state.
Diane Wilush, with SPADD, spoke to the waiver changes and in particular an increase in funding for direct support professionals (which has seen turnover of 39.1 percent annually) and is a cost of $3,500 per turnover. The average wage paid is $10.35 per hour or about $21.500 annually.
John McCain, with Easterseals Southern Georgia, spoke about the 40 percent reduction to the family support program within DBHDD and asked that this funding be restored to the FY 2020 level of $13.3 million. He provided compelling examples of how this funding keeps individuals at home rather than placing individuals in nursing homes (e.g. medical supplies and respite for caregivers). He also asked that the Subcommittee fund travel reimbursement costs within Vocational Rehabilitation as there is no funding now and it is a hardship for rural providers.
Heather Rowles, with Multi-Agency Alliance for Children, spoke to requested funding for LEADS, an educational support program for foster youth. In 2020, the program had an 80 percent graduation rate and of those 58 percent went on to further their education. Many of the foster care youth are behind educationally due to their being in the foster care system.
Kent Woerner, with Avita Community Partners, also spoke to the NOW/COMP changes and the need to better pay direct support professionals.
Jen King, with Georgia CASA, asked for an additional $100,000 in funding to bring online the remaining 3 counties (Lowndes, Echols and Henry).
Jeff Breedlove, with the Georgia Council on Substance Abuse, spoke about the need for funding substance abuse services — particularly now as it is an “epidemic within the pandemic.” He noted the use of Narcan which saves lives and the peer-led recovery programs.
Shelly Simmons, with the Statewide Independent Living Council, spoke about the cuts in funding for centers for independent living — in some instances all funding was cut. They have only funding of $286,000 left to help individuals with disabilities; she asked for a full restoration of funds. These individuals with disabilities are even more isolated now with the pandemic.
A number of individuals with GATES spoke about the changes to the NOW/COMP waivers as well as community services, including rehabilitation services providers who are able to work with individuals but do not get referrals from the Vocational Rehabilitation Agency. Many of these providers are CARF accredited. Included in these remarks were individuals from Easterseals East Georgia and Easterseals Middle Georgia as well as the Bobby Dodd Institute, Goodwill, Creative Enterprises and others.
Teresa Heard, a parent, spoke about frustrations with Georgia Vocational Rehabilitation Agency and her son’s desire to have a job. She noted it is a “confusing and broken system.”
There were more than 40 speakers signed up to speak to the proposed budgets impacting human services provided to Georgians.
This article was originally published on The Gold Dome Report on 2/17/2021.