Senate’s New 2016 Proposed Supplemental Budget
In the late hours of March 10, as it became clear that the Legislature would not be able to agree upon a 2016 supplemental operating budget before the end of regular session, Governor Inslee called for an immediate 30 day special session. On the morning of March 11, the Senate responded by releasing a new 2016 supplemental budget proposal. While this budget brings the Senate closer to the House position, it was not enough to result in a final budget.
We continue to be gravely distressed that the Senate remains focused on the bind, disabled, and COPES population. In this budget, this population would stay in managed care if HCA is able to establish actuarially sound rates that reflect a 7.3% cost savings as compared to the current rates. If the rates exceed this savings requirement, cost savings measures may be imposed across other managed care populations! If HCA is not able to establish actuarially sound rates that achieve this savings, the blind, disabled, and COPES population would be moved to fee-for-service, effective January 1, 2017. The new Senate proposal also fails to add funding to the loan repayment program to build mental health capacity. But unlike the Senate’s earlier version, this proposal does not cut funding from the original amount appropriated last year. Funding to incentivize regions to become fully integrated managed care “middle adopters” continues to be excluded in the Senate’s latest proposal. Again, the Senate misses the opportunity for valuable learning before statewide integration in 2020.
House 2016 Proposed Supplemental Budget
The House budget proposal includes additional spending ($414 million) and assumed savings ($167 million), resulting in a modest net increase in spending of $248 million. This includes $49 million in additional funding for mental health programs and services; $47 million for long term care and developmentally disabled programs and services; and uses $318 million from the Budget Stabilization Account for fire related costs, local levy effort assistance, and homeless services and programs.
The House budget adds $1 million to the Health Professional Loan Repayment Program, which will be dedicated to behavioral health specialists such as marriage and family therapists, licensed social workers, and psychologists. This is significantly less than the $3 million the community health centers and our coalition partners have been advocating for during this session. Unfortunately, the budget did not allocate additional funding to assist those regions that would be ready to integrate behavioral health into primary care (“middle adopters”) well before 2020.
The press release on the House budget can be found here.
Senate 2016 Proposed Supplemental Budget
The Senate budget proposal increases net spending by $49 million from the 2015-2017 biennium budget. This net increase results from a combination of higher than expected marijuana funds, one time account transfers, and spending changes. To achieve a balanced 4-year budget, the Senate leaves $5 million in unrestricted reserves with $1.3 billion in the Budget Stabilization Account at the end of the 2017-2019 biennium.
A concerning item is the Senate’s proposal to transfer the categorically needy blind disabled and COPES population from managed care to fee-for-service, effective July 1, 2016. This vulnerable population receives important services by being part of managed care, including care coordination, linkages to primary care, and utilization management. Taking these away could be considered a significant cut to their services.
Unlike the House, the Senate doesn’t invest in loan repayment for behavioral health specialists. In fact, the Senate takes away $500,000 out of the Health Professional Loan Repayment program in fiscal year 2016 and another $500,000 in fiscal year 2017! The Senate also fails to invest in regions that would be ready to move forward with behavioral health integration before 2020 (“middle adopter” regions). But the Senate doesn’t neglect mental health completely – it provides funding for Western State Hospital to increase salaries, hire new staff, and open an additional civil ward. There is also funding for community diversion programs, housing, and housing support services for patients being released from state hospitals.
The press release on the Senate budget can be found here.
2016 Legislative Agenda
In 2016, access to integrated behavioral health care will be a critical legislative issue. To improve the quality of and access to behavioral health services in Washington, Community Health Network of Washington and the Washington Association of Community & Migrant Health Centers are asking the Legislature to expand the Loan Repayment Program for non-prescribing mental health professionals and incentivize regions committed to accelerate behavioral health integration. Our legislative agenda can be found here .
In 2015, the Legislature recognized the difficulties of staffing rural and underserved areas after health care expansion created an additional demand. They invested more than $9 million in the Health Professional Loan Repayment Program. Unfortunately, certain categories of providers were excluded from this program. In 2016, the Legislature should correct this oversight and add $3 million to the existing program, instructing the agency to prioritize these funds for the non-prescribing mental health providers who were excluded from the recent investment.
The full position paper can be found here.
Behavioral Health Integration
Washington State intends to achieve fully integrated physical and behavioral health in Medicaid by 2020. Southwest Washington decided to be an “early adopter” and implement fully integrated managed care in 2016. The Health Care Authority is working to create a round of “middle adopters” to integrate as early as July 2017. Ensuring middle adopters are ready to fully implement integrated managed care will require upfront resources. The 2016 Legislative Session provides an opportunity to incentivize middle adopter regions that sign binding letters of intent to pursue fully integrated care by July 2017 with up to $1 million each.
The full position paper can be found here.
Governor’s 2016 Proposed Budget
Governor Jay Inslee’s 2016 proposed budget makes modest adjustments to the current 2015 – 2017 budget. Since the biennial budget was enacted, Washington’s economic revenue forecast has been increased by about $245 million. The Governor states that this added revenue will only partly cover cost increases and unanticipated expenses that have accrued over the past six months. He anticipates that the state’s costs have grown by more than $700 million since June.
Given this fiscal backdrop, the primary focus of his 2016 proposed budget is to cover spending increases needed to continue delivering services at current levels, cover caseload and enrollment increases, and pay for emergencies and other costs not anticipated when the 2015-2017 budget was approved in June. Regarding education, the Governor proposes legislation to raise the minimum salary for beginning teachers from $35,700 to $40,000 per year, give all other teachers a 1% raise and increase funding for the teacher mentoring program. To pay for these improvements, the Governor proposes eliminating four outdated tax exemptions. Regarding health care, the proposed budget does not make any cuts to the health care safety net.
Our legislative priorities of adding $3 million to the exiting program for non-prescribing mental health providers who were excluded this year; and providing up to $1 million for each region that is ready to fully integrate physical and behavioral health in Medicaid by 2017 were not addressed by the Governor because the community health centers had not finalized these priorities prior to Governor’s budget. During legislative session, the community health centers will be working to ensure that the House and Senate recognize the value of these effort and fund them appropriately.
Further information about the Governor’s budget can be found here.
House 2015-2017 Proposed Budget
The House budget proposal includes additional spending ($2.4 billion) and new revenue ($1.5 billion). New revenue includes capital gains tax ($570 million), closing tax loopholes (including water bottles and requiring Oregon residents to pay sales tax, for a total of $300 million), and business and occupation tax increases ($532 million). The House plans to amend Initiative 1351 (class-size initiative) to reduce the cost, and spends $1.4 billion to meet the requirements of McCleary. The House proposal freezes higher education tuition, invests in early learning, and largely protects the health care safety net.
The House budget restores the loan repayment program with $7.65 million. This is an immediate solution to increasing access for underserved patients in our state.
Unfortunately, while the House budget “dedicates” 5% of the marijuana revenues to the CHCs, they propose to use those funds to supplant general fund dollars for Medicaid payments to CHCs. Initiative 502 clearly dedicated the funding to the Community Health Services grant program that was suspended in 2011. Despite the gains in health coverage in our state, CHCs continue to see uninsured patients (21% in 2014), and if the marijuana money is used for Medicaid payments, it cannot be used to support the uninsured.
Press release on the House budget can be found here.
Senate 2015-2017 Proposed Budget
The Senate Republicans budget prioritizes education and makes fewer investments in health care than the House proposed. The Senate does not add new revenue – although they do allow unspecified tax exemptions expire. Unfortunately, they swept most of the marijuana revenue into the Education Legacy Trust Account to fund K-12 and higher education, leaving only $11.7M for the general fund, which is allocated to counties and cities for criminal justice and other purposes. The Senate budget underfunds mental health and proposes potentially devastating changes for the Exchange.
Unfortunately, this means that the Senate did not allocate 5% of the marijuana revenue to the community health centers.
The Senate did invest in loan repayment, but includes some language about opening up the program to nursing education students. We are still working to understand how this will impact the program.
Press releases on the Senate budget can be found here.
2015 Legislative Agenda
During this legislative session, Community Health Network of Washington will be focusing advocacy efforts on a number of health care priorities. We cannot turn our backs on the health care coverage gains that our state has made – we must protect existing health care safety net programs. The final biennial budget should support community health centers with marijuana revenues, as specified by Initiative 502. Additional spending is needed to address the primary care shortage by investing in the Health Professional Loan Repayment Program and better integrating behavioral health and physical health in the primary care setting. Finally, the Legislature should evaluate affordability and continuity of coverage. To learn more about these priorities, please read our full Legislative Agenda or see below for more information on individual issues.
Following are position papers on our legislative priorities: