Georgia Health Budget Primer for State Fiscal Year 2024

Georgia’s 2024 health budget

The Departments of Behavioral Health and Developmental Disabilities, Community Health, and Public Health are primary agencies in the state’s health care and public health systems. Georgia plans to provide these three agencies with $6.7 billion in state funding in fiscal year (FY) 2024, or about 21 percent of total state spending. General Fund assessments account for $5.9 billion, or about 89 percent, of the total state funds for these three agencies. Other sources, such as the Tobacco Settlement Fund, account for the remaining $712 million in government health spending. Total funding dollars for these three agencies increased by $638 million, or about 11 percent, from the FY 2023 budget.

The Department of Community Health (DCH) accounts for $4.8 billion, or 71 percent, of state health spending. The Department of Behavioral Health and Developmental Disabilities (DBHDD) accounts for $1.5 billion, or 23 percent, of government spending on health. The Department of Public Health (DPH) accounts for $400 million, or 6 percent, of government health spending.

Health priorities affected by the governor’s directive not to comply with the budget language

In May 2023, when approving the 2024 fiscal year, the governor directed state agencies to ignore some budget language and made that language non-binding. In total, the governor is directing state health agencies to ignore nearly $104 million in funding and seven additional budget actions unrelated to FY 2024 funding (also known as ‘yes’ line items). These omissions are a small portion of each department’s budget, but they represent significant changes to address pressing needs such as staffing gaps. For DCH, reimbursement rates for most neglected Medicaid providers will increase—from home and community services to obstetrics and gynecology. Because of concerns about a funding shortfall under Medicaid, the governor redirected the money to Medicaid spending and growth instead.

For DBHDD, much of the undisputed funding for NOW/COMP discharge gaps (to expand home and community-based services and supports for people with disabilities) and behavioral health crisis centers is still available with slightly modified language for the agency’s services. However, nearly $17 million in funding for various purposes — from raising salaries for the state’s psychiatric nurses and health aides to funding a 988 suicide and crisis lifeline — has been completely ignored.

Georgians face inequitable access to care.

Inequitable access to high-quality health care continues to affect Georgians. With the third highest rate of uninsured people nationally, the state’s decision not to fully expand Medicaid reflects a history of oppression and an unbalanced power structure. While more than 1 in 8 Georgians lack health care coverage, the burden is particularly heavy on Georgians living in rural communities and Georgians of color, especially Latinx Georgians.

Georgia also has lower Medicaid costs per enrollee. On average, Georgia spent about $5,953 per full benefit enrollee in 2020, compared to a U.S. average of $9,303 (the most recent data available). Children make up a large portion of Georgia’s Medicaid and Medicare population, and the state spends $2,426 per child enrollee—the second lowest in the nation. By 2024, Georgia expects to spend $4.4 billion in state funds to serve Georgians covered by Medicaid or Medicare. Of note, FY 2024 includes about $584,000 to allow pregnant women and children of legal permanent residents to enroll in Medicaid/PeachCare without waiting five years. This small investment opens up access to health care for new Georgians during the critical pregnancy, postpartum and childhood years.

Medicaid and PeachCare enrollment and costs

Medicaid and PeachCare serve about 3 million Georgians, or about 1 in 4 residents. Low-income Medicaid is for children, pregnant and postpartum people, and some very low-income parents. The program’s Aged, Blind and Handicapped segment serves low-income seniors and those with physical and developmental disabilities. PeachCare is a separate program that serves children from families with incomes above Medicaid limits, but who often do not have access to other types of coverage.

46 percent of Georgia births are covered by Medicaid, and 70 percent of Medicaid and Medicare beneficiaries are children in the state. Medicaid is also the primary source of health coverage for Georgians with long-term health care needs, in nursing homes and community-based settings. Medicaid helps pay Medicare premiums for more than 268,000 Georgians age 65 and older and adults with long-term disabilities.

Georgians—especially children and families of color—at risk of losing coverage during Medicaid dismantling

Thanks to the pandemic policy, millions of Georgians have had access to affordable health care over the past three years—allowing them to see doctors, fill prescriptions and get vaccines during times of health and economic uncertainty. Beginning in April 2023, that unbroken Medicaid and Medicare coverage begins to roll back, and children and adults enrolled in Georgia’s health care safety net will have their eligibility determined again before May 2024. This unprecedented health care event creates pressure. It threatens state agencies and the health and financial well-being of low-income Georgians. Hundreds of thousands of Georgians will lose coverage. An estimated 45 percent of those who lose coverage are affected by system failures, meaning they’re still eligible but denied coverage because of a human or technological error in the process — like being sent to the wrong address. The burden of this loss of health care coverage falls heavily on children, adults, and postpartum communities of color.

Georgia will continue to receive additional federal funding to cover Medicaid enrollees through the end of 2023.

To keep Georgians enrolled in Medicaid since the pandemic began, Georgia has received an enhanced Federal Medicare Assistance Percentage (FMAP). Medicaid is a partnership between the state and the federal government, and the FMAP determines how much the federal government pays the state to provide Medicaid services. In April, the federal government began gradually reducing the enhanced FMAP linked to the outbreak. While the Medicaid extension period runs through May 2024, Georgia will return to the regular FMAP in January 2024 at about 66%. Repeal of Medicaid could result in significant reductions in enrollment and, in turn, lower overall Medicaid spending. As the process progresses, additional adjustments to the budget will be needed to balance enrollment reductions and FMAP cuts.

Investments in the governor’s health care expansion plan for low-income Georgians

In the year In 2019, the governor’s signature health care law, the Patients First Act, or SB 106, paved the way for Georgia to seek federal approval for three new programs.

• The Georgia Streets Coverage Program, which provides for partial expansion of Medicaid eligibility for low-income adults who meet employment or other monthly reporting requirements;
• The Georgia Reinsurance Program, which establishes a claims-based reinsurance program to reimburse enrollees with large medical claims in the individual health insurance market; And
• Georgia’s access model removes the state from the federal marketplace (often called HealthCare.gov) without a state-based option. If SB 65 is passed in the 2023 legislative session, the state will move from the original Georgia Access Model plan to a state-based health insurance exchange. In the future, the program will be funded by user fees rather than state general funds.

Overall, the state has invested heavily in all three programs. Coverage Pathways and Georgia’s Access Model A state-based exchange is slated to begin in 2023, and a reinsurance program begins in 2022. It will be important to monitor the impact of these investments on increasing access to affordable and quality health care. .

In the year The Cover to Cover Roads program is short in FY 2024.

In this fiscal year, the region is going to start a program of covered roads. This program extends Medicaid coverage to low-income adults who make up to 100 percent of the federal poverty level and meet the following eligibility criteria:

• Complete at least 80 hours per month of qualifying activities such as work, community service, higher education, etc.
• Make monthly premium payments if your income is between 50 and 100 percent of the federal poverty level.

Fiscal year 2024 includes $52 million in 2024 state funds and recognizes $65.5 million in unused 2022 state funds (about $118 million in total state funds). According to GBPI’s analysis, the total state funds allocated to the program for coverage in fiscal year 2024 would allow the state to enroll about 47,500 Georgians — far fewer than the 345,000 Georgians the governor said the state would qualify for the program in 2023. Address of the state. In contrast, if the state expanded Medicaid eligibility to low-income adults without arbitrary limits or burdensome reporting requirements, the state could cover nearly 500,000 Georgians at much lower costs. In fact, the temporary financial incentives offered under America’s rescue plan would make the net cost of the statewide expansion zero for the first 2 years.

Behavioral health and developmental disabilities

The Department of Behavioral Health and Developmental Disabilities (DBHDD) provides services primarily to uninsured and underinsured Georgians with mental health conditions, substance use disorders, and/or developmental disabilities. It operates government hospitals and provides community-based services through contracted providers. The department operates programs for forensic evaluation and treatment under the jurisdiction of the court system. Georgia plans to provide approximately $1.5 billion in general funding, along with $10 million in tobacco settlement funds, to DBHDD. Total state spending for DBHDD in 2024 represents an increase of about 8 percent over the AFY 2023 budget.

Public health

The Department of Public Health (DPH) operates programs focused on disease and injury prevention, health promotion, and health-related disaster response and preparedness. The department will receive approximately $369 million in general funds and approximately $14 million in tobacco settlement funds. Large government-sponsored programs provide financial support to 159 county health departments, help prevent communicable diseases and provide services for children. Statewide spending in 2024 represents a 5 percent increase over the AFY 2023 budget.

Georgia’s public health programs also receive significant federal support. Federal funds make up about half of the department’s $806 million budget, with state and other funds accounting for the rest. Of these federal funds, more than half is earmarked for the Women, Infants, and Children’s Supplemental Nutrition Program (or WIC), which provides healthy food, nutrition information, and nutrition information to low-income pregnant and postpartum people and children up to age five. , breastfeeding support and other services.

Recruitment and retention of staff continues to be an issue for state health agencies.

Since 2016, the state health agencies’ rates have increased, ranging from around 20 percent for DPH to 35 percent for DBHDD. DBHDD projects a 28 percent reduction in employees from 2016 to 2022—from a high of 4,128 full-time employees to a low of 2,982. Similarly, DCH has seen a 32 percent reduction in staff between 2016 and 2022 – from a high of 943 full-time employees to a low of 641. The AFY 2023 budget includes a $5,000 cost of living increase and salary increase for select job categories at both DBHDD and DPH. The impact of those increases is not reflected in recent labor force data. Full-time employees at all three agencies received an additional $2,000 cost-of-living increase as of 2016. 2024 will be part of the budget. Even after these adjustments are implemented, continued efforts will be necessary to ensure our state agencies are fully equipped with a skilled, diverse, stable workforce to meet Georgia’s changing health needs.