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Health Programs Break Even in Budget Sweepstakes

The legislature’s billion-dollar scramble is over, and health care missed out.

But public health advocates can still celebrate successes as the Senate gets ready today to take the last substantive votes on the 2018-19 state budget. (It’s House Bill 1322, in case you get the urge to read a 600-page spreadsheet.)

Legislators learned in late March that the state’s general fund is projected to grow by $1.3 billion — the most robust growth in a decade.

Along with Gov. John Hickenlooper, they were quick to divvy up the windfall. Most will be split between an extra $577 million for K-12 schools and $495 million for transportation, plus $225 million to help shore up the Public Employees Retirement Association (PERA).

The allocation largely follows Hickenlooper’s request, and is a defeat for some Republicans who had pushed for an extra $1 billion for highways.

Health programs weren’t among the winners, although budget writers did set aside $6.5 million to cover the costs of two bills to address the opioid crisis, House Bill 1003 and Senate Bill 24. (See our previous blog on those bills). Notably, there is no funding set aside for the most expensive bill in the substance use package, HB 1136, which would pay for residential treatment for Medicaid members at a projected cost of $34 million a year.

Coincidentally, the most controversial amendment to the budget costs nearly the same amount. It sets aside $35 million for school security.

Medicaid Expansion Survives

However, health advocates should be happy about what didn’t happen.

First, an attempt by House Republicans to repeal the Affordable Care Act Medicaid expansion failed on a 24-39 vote, with all Democrats and three Republicans – Reps. Terri Carver, Bob Rankin and Dan Thurlow – opposing the move.

Public health programs that sparked intense opposition from conservative legislators in previous years passed this year without controversy. These include the state’s long-acting contraception program, the Healthy Kids Colorado Survey, school-based health centers and the Colorado Immunization Information System.

Some other health highlights:

  • The budget adds $1.8 million to pay for a full year’s supply of contraceptives for Medicaid members.
  • Senators added an amendment Wednesday night to spend $3 million in marijuana taxes on research into medical marijuana. It received broad support from both parties.
  • The budget even sends help to prisoners, with an extra $16.5 million to pay for Hepatitis C treatment, which should cover medicine for 630 more inmates, compared with just 150 who can be treated this year.
  • In a separate bill (HB 1327), the All-Payer Claims Database will get about $2.5 million to pay for research costs for nonprofit and government agencies that want to use the database.

The Department of Health Care Policy and Financing, which runs Medicaid, will get a fairly modest 2.5 percent increase, bringing its total budget to $10.1 billion.

Despite a recent drop in Medicaid enrollment — down to 1,298,000 in March — the department predicts enrollment will grow to 1,350,000 for the 2018-19 budget year. Meanwhile, Medicaid members are getting older, which is driving an increase in the per capita cost of covering enrollees, according to the legislature’s budget bill summary. The projected growth in these two areas is responsible most of the cost increase.

After passage in the Senate, which is expected today, the budget bill will go back to the Joint Budget Committee to resolve differences between the House and Senate. But all the major decisions have been made, so only formalities — including the governor’s signature — remain. The new budget takes effect July 1.

Find Joe Hanel on Twitter: @CHI_joehanel

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