Mike Klein Online

Thousands of Mentally Ill Patients Will Leave State Psychiatric Hospitals

Mike Klein

The changing face of Georgia health care looks something like this: Thousands of mentally ill patients will begin to leave state psychiatric hospitals as they move into community care settings. Programs that serve millions of Georgians will be scaled back even as public sector employees pay more for coverage and receive less in their state health benefit plan.

How Georgia will make decisions about health care dollars was the focus Thursday when the state’s three leading public health executives testified during Senate – House appropriations committee hearings. Next year health care expenditures will be nearly $14.7 billion. Governor Nathan Deal’s proposed budget includes $4.1 billion in state dollars. The rest are federal funds.

Two of the state’s three large public health agencies – Community Health and Human Services – expect to lose hundreds of millions of state dollars in the Governor’s Office proposed budget. Program services will be eliminated or reduced affecting young and old, infirm and able-bodied.

The third large agency — Behavioral Health and Developmental Disabilities — will receive an increase in part because the state must transfer thousands of patients with mental illness or developmental disabilities out of state psychiatric hospitals and into community settings.

This happened because the U.S. Justice Department sued Georgia after an investigation found the state was not in compliance with the Americans with Disabilities Act, or with a U.S. Supreme Court decision that Georgia had unlawfully segregated some patients who had disabilities.

Last October the Justice Department also said the investigation “found that preventable deaths, suicides and assaults occurred with alarming frequency in the hospitals.” Under the settlement agreement Georgia must transfer 9,000 patients before July 2015 and it must stop admitting developmental disabilities patients to state hospitals this summer.

It was not lost on anyone who was in the committee room Thursday morning that less than two weeks earlier a gunman shot 19 persons, including Arizona Congresswoman Gabrielle Giffords, during a Tucson event. A nine-year-old girl, a federal judge and four other persons died.

Behavioral Health Commissioner Frank Shelp acknowledged that, “People with severe mental illness who have not received proper services, if they are neglected and allowed to simply move about, bad things happen eventually, as we’ve seen recently in our country.”

He asked that legislators remember, “Mental illness is a spectrum condition. Some people with severe diagnosis still operate virtually autonomously and move about in the community and even maintain jobs and do all kinds of things whereas someone with the very same diagnosis can be virtually completely incapacitated and need complete care, and everything in-between.”

Shelp said many more than 9,000 Georgians are afflicted with schizophrenia; he estimated the number at closer to 70,000. Behavioral Health requested $10.3 million in the amended budget and $54 million next year to fund the settlement agreement changes.

Public health dollars pay for many other services including Medicaid, PeachCare, inpatient and outpatient health care, HIV testing, chemical hazard investigations, food safety inspections, assistance to unwed teenage mothers, state hospitals, infectious disease tests, adult and child care services, indigent care, the state’s vital records program, even poison and rabies control.

The largest piece of the state health budget goes to the Department of Community Health. The Governor’s Office recommended $11.936 billion for DCH next year, down from $12.1 billion.

Community Health Commissioner David Cook spent nearly an hour describing program cuts before he asked legislators to support a $10 million bond package that would enable Georgia to draw down $90 million in federal matching funds to implement health care reforms.

“This money will be used to create a revised eligibility program to determine Medicaid eligibility and it’s something that I believe we desperately need to do,” Cook said. I’ll just speak for our area; the IT infrastructure area is in need of help and I am asking for your support on that.”

Medicaid will cost more in state dollars because federal stimulus funds are going away. Cook said the state must replace more than $600 million during each of the next two years. Medicaid and PeachCare programs administered by the agency serve 1.6 million Georgians.

DCH also administers the state health benefit plan. Cook said the 2010 audit showed a $17 million reserve. “That may seem like a lot of money but that represents an average of two days of claims. We are running on a very thin margin in the state health benefit plan.”

This year 700,000 state employees, teachers and retirees will pay higher spouse and tobacco use surcharges. Basic premiums will increase, as will co-payments. Cook said the real cost to employees will be an additional 10%. DCH has been asked to identify another $37 million in new state health benefit plan savings. “We need to rebuild those reserves,” Cook insisted.

Human Services Commissioner Clyde Reese testified a proposed 4% reduction in the agency’s next budget will zero-out all state funds for child care facility licensing, family violence services and needy families’ assistance. Some state funds will be replaced with federal dollars.

“We are down now to bone. There is no more fat left,” Reese said. “There hasn’t been for quite a while. The priority is the must work phase. Things that we would like to do, things that some people feel the department should do; those have to take a back seat.” Reese said the priority at Human Resources is preservation of children’s and family services caseworkers.

Former state representative and newly elected Labor Commissioner Mark Butler returned to familiar surroundings as Thursday’s final witness. Butler said Georgia must pay $6 million to the federal government this year for interest on funds borrowed to write unemployment checks.

The state Unemployment Insurance Trust Fund ran out of money in 2009.  Weekly checks to jobless Georgians have been written primarily with hundreds of millions of dollars borrowed from the federal government. Georgia will be on the hook to Washington for principal and interest.

Mike Klein is Editor at the Georgia Public Policy Foundation.

January 22, 2011 - Posted by mikekleinonline | Uncategorized | Georgia General Assembly, Georgia Public Policy Foundation, Mental Illness, Mike Klein, U.S. Justice Department