The Great Budget Debate: What This Year’s Long Bill Means for Health Care

This year's state budget proposal includes hundreds of millions of dollars in new health-related spending, including investments in mental health programs, increased Medicaid reimbursement rates and funding to overhaul the system that administers the state’s Medicaid program.

The Colorado Senate, after several days of heated debate, passed the Joint Budget Committee’s $22 billion budget proposal for FY 2013-14 -- also known as the long appropriation bill -- on a party line vote last Thursday. It’s expected to head to the House next week.

The total proposed appropriations in this year's long bill reflect a 6.2 percent increase over last year (this includes money from the general fund, federal funds and cash funds combined). The general fund is up 5.8 percent and makes up $8 billion of the FY13-14 budget proposal. The general funds is a closely-watched economic indicator, since this money comes directly from general tax revenues such as the state sales and income taxes. And with Colorado’s economy in recovery, there is more money in state coffers, which means lawmakers are able to restore funds to many programs that experienced cuts over the past few years.

The long bill’s health-related proposals include:

• A 10.7 percent hike in the operating budget for the Department of Health Care Policy and Financing (HCPF), increasing it to $6.2 billion ($2.1 billion from the general fund, up 12 percent).
• A 3.7 percent increase for the Department of Human Services (a 7.9 percent increase in general fund money).
• A 12.7 percent increase for the Department of Public Health and Environment (a 26.6 percent increase in general fund money).
• Funds to shore up the state’s behavioral health programs and services, including $19.8 million for a new statewide behavioral health crisis system, $4.3 million in additional funding for community mental health centers, $2.8 million for enhanced mental health services for criminal offenders, $2.1 million for a new 20-bed jail-based center to treat defendants deemed incompetent to stand trial and $1.1 million to increase community behavioral health resources in schools.
• A 2 percent across-the-board increase in Medicaid reimbursement rates for most providers, with a 3.6 percent increase for private-duty nurses and home health and community-based services and a 4.5 percent increase for dental services.
• Enhanced substance abuse disorder benefits for Medicaid clients to the tune of $5.8 million, including $1.8 million from the general fund, to expand treatment options and duration of services such as rehab. An estimated 6,786 Medicaid-eligible clients would use these services in FY 2013-14.
• A complete overhaul of the Medicaid Management Information System, the computerized program used to administer the state’s Medicaid program, as well as funding to beef up the call center that fields inquiries from Medicaid clients.
• Adding the equivalent of 7.4 full-time employees to the Department of Health Care Policy and Financing’s staff to help handle Medicaid caseloads, improve stakeholder relations and address requirements of federal health reform.

While last year’s budget garnered significant bi-partisan support, feelings about this year’s budget appear to be split along party lines, with Democrats praising the long bill as a smart and strategic approach to state spending and Republicans saying it isn’t prudent enough and doesn’t spend money in the right places.

The state budget can tell us a lot about the health-related priorities of Colorado’s lawmakers and the direction of health care policy in our state. We’ll keep you updated as the long bill makes its way through the legislative process.