How an Alabama father made Easter egg hunts accessible to deaf, blind kids nationwide
SOUTH UNION STREET

General Fund goes to Bentley; Medicaid issues remain

Brian Lyman
Montgomery Advertiser

The Alabama Legislature Wednesday gave final approval to a $1.8 billion General Fund budget, sending it to Gov. Robert Bentley.

Senator Rodger Smitherman, D-Birmingham, speaks during the Alabama Senate legislative session on Wednesday, March, 23, 2016, at the Senate chambers in Montgomery, Ala.

They’ll likely see it again.

The Senate Tuesday voted 20 to 13 to concur in the House version of the budget, which level-funds most state agencies but gives the Alabama Medicaid Agency $85 million less than what the agency says it needs to maintain current services, which would allow it to begin implementation of a managed-care model for the program aimed at easing costs.

The budget does not provide a raise for state employees but boosts the state’s share of their insurance coverage from $825 per employee per month to $850. That could ease potential increases to employees’ out-of-pocket costs next year.

Gov. Robert Bentley has said a budget with less than a $100 million boost for Medicaid would bring his veto and a special session. The House-passed version of the budget raised the agency’s allocation from $685 million – level-funding – to $700 million. But legislators, who would likely override a Bentley veto, have said that they want to draw a line on Medicaid, which consumes about 38 percent of the General Fund budget.

"It’s not fair to the state employees, it’s not fair to the taxpayers to continue to cannibalize money from the troopers from mental health from DHR from every other area of state government because all of the money of the increases is going to Medicaid," House Speaker Mike Hubbard, R-Auburn, said Wednesday evening.

Medicaid eligibility is strict, and more than half of those who were eligible for the program last June were age 17 or younger. Childless adults almost never qualify, and parents of children who do usually have to make 18 percent of the poverty level -- $2,867 a year for a family of two – to receive benefits.

Despite the limits, more than 1 million Alabamians – about 21.5 percent of the state population – qualified for Medicaid last June. Medicaid also plays a critical role in keep the state’s primary care providers and rural hospital functioning.

The Medicaid Agency has warned that cuts to the program could endanger existing services and also prevent the implementation of regional care organizations (RCOs), aimed at providing better case management for Medicaid recipients and preventative services that, over time, could slow the growth of costs in the program.

“We are asking for an $800 million bond issue to build new prisons, and we can’t find the money to fully fund Medicaid,” said Senate Minority Leader Quinton Ross, D-Montgomery, who voted against the budget. “You almost could include the money for Medicaid in the bond issue to prop it up.”

The Legislature approved $166 million in new revenue for the General Fund last year. The money was less than what Bentley and House leadership first sought, did not include all the revenue the House approved, and came after three legislative sessions over six months. Marsh and other legislative leaders have said the Republican-controlled Legislature is not interested in revisiting the revenue issue.

“Medicaid is a problem, (but) how are you going to solve it?” Senate President Pro Tem Del Marsh, R-Anniston, said. “If you can’t deal with additional tax revenue, then you’ve got to live within the means and that’s what we’re doing.” 

Proposals to establish a state lottery, a popular hypothetical funding source, appear to have stalled. Democrats have pushed for a lottery for years as a means to fix revenue problems, but House Minority Leader Craig Ford, D-Gadsden, said he wanted to see a full gambling bill to address the issue.

"The lottery bill won’t solve the problems right now," he said. "If you bring a lottery bill, you need casino-type gaming with it."

Hubbard said the support for such a bill was lacking, pointing to a fantasy sports bill that ran into fierce opposition earlier in the session.

"You can imagine what would happen if we brought a real gambling bill," he said. "I don’t think the votes are there."

At least one Republican suggested he would consider revenue to help out the General Fund budget. Sen. Dick Brewbaker, R-Montgomery, voted for the budget but said he would support a “good revenue” bill from the House of Representatives to help Medicaid, expressing concern about the state losing providers.

“The idea of doctors leaving the state isn’t just rhetoric,” he said. “I think we’re already there.”

The vote on the budget fell mainly along party lines. Republican Sens. Rusty Glover of Mobile; Jimmy Holley of Elba; Jim McClendon of Springville and Paul Sanford of Huntsville voted against the budget, joining eight Democrats and independent Harri Anne Smith of Slocomb. All the affirmative votes came from Republicans.