Alabamians’ quality of life would suffer for years to come if the no-new-revenue General Fund (GF) budget that the House’s GF budget committee approved Thursday becomes reality. The House is expected to vote Tuesday on the budget, which would slash vital services like health care, child care and public safety. The state’s promising new reforms of Medicaid and prisons would end, and services for low-income children could face devastating cuts.
With the Legislature’s regular session nearing an end, talk of one or more special sessions is running rampant, and the threat of deep cuts to services that make our state a better place to live and work is real. Here is a look at a few of the ways Alabamians would feel the cuts in their everyday lives:
Proposed budget cuts would end new Medicaid reforms and impose severe cuts to other health care programs. The proposed GF budget would reduce Medicaid funding by 5 percent. While the Medicaid agency has not specified what services would be reduced or eliminated, State Health Officer Don Williamson has said the cut would force Medicaid to abandon its new regional care organization model, designed to keep patients healthier while cutting costs.
Williamson said last month that a smaller 3 percent cut would force the agency to end coverage of outpatient dialysis, forcing kidney patients to be admitted to the hospital to receive routine dialysis. Medicaid also would have to eliminate hospice care coverage and stop paying for adult eyeglasses and prosthetics.
In addition, Medicaid would reduce reimbursement payments to doctors, which could mean fewer physicians treating Medicaid patients. Medicaid also would contract with a single provider of prescription services, likely forcing many local, independent pharmacies to close.
The committee’s budget would cut home health services for the elderly and disabled by more than 9 percent. Patients losing these services could be forced to enter much more expensive nursing homes, reducing patients’ independence and increasing costs to the struggling Medicaid program. Funding for life-saving HIV and AIDS medications also would be cut by 50 percent.
Proposed budget cuts would reduce community mental health services. In recent years, the Department of Mental Health responded to budget cuts by closing nearly every public mental health hospital. Many advocates applauded the new focus on less restrictive (and less expensive) community-based services.
But the 2016 GF budget proposal would reduce funding for those very services by 5 percent. Patients unable to receive mental health treatment may be forced into private hospitals, or they may end up incarcerated in local jails without access to needed counseling and medications.
Proposed budget cuts would devastate social services for low-income families and children. Together, the committee’s GF budget and the education budget awaiting House committee approval would reduce Department of Human Resources (DHR) funding by 14 percent.
DHR commissioner Nancy Buckner last month outlined draconian service reductions in the event of major budget cuts. These could include the elimination of the Temporary Assistance for Needy Families (TANF) program, which provides cash assistance and services for extremely low-income families, including more than 30,000 children.
Other cuts could include major reductions in child care assistance for thousands of working families, the elimination of adult day care services, and the elimination of child support collection services for more than 200,000 Alabama families. Because much state DHR funding is matched by federal money, the agency’s total cuts would be much larger than the lost state dollars alone.
The House committee budget would eliminate GF support for the Department of Youth Services (DYS), which provides supervision and services for youthful offenders and their families. The total reduction would be 12 percent, accounting for DYS funds in the education budget.
Like mental health, DYS has moved in recent years toward less expensive and more appropriate community services and has closed expensive residential beds for low-risk offenders. These community services would be cut under the proposed GF budget. With fewer residential beds, juvenile offenders would be left unsupervised or incarcerated in county facilities instead.
Alabama’s network of Community Action Agencies provides nutrition, housing, Head Start and energy assistance services to low-income people. The proposed GF budget would cut state funding for these services by 50 percent.
Proposed budget cuts would end prison reform and could risk a federal takeover of the state prison system. The committee’s GF budget would make devastating cuts to Alabama’s civil and criminal justice system, ensuring that the recently passed (and highly praised) prison reform legislation could not be implemented.
The state’s already reeling trial courts would face a 16 percent cut under the budget, leading to hundreds of layoffs. The budget also would cut juvenile probation services by nearly 40 percent and forensic sciences by 22 percent. These cuts could force courts to close at least two days a week, delay trials and hearings, and delay criminal cases that require DNA and other forensic evidence. The deep cuts also would result in more unsupervised juvenile offenders even as youth services are slashed.
Alabama’s prison system, already operating at nearly twice its designed capacity, would absorb a 5 percent cut under the proposed budget, increasing the risk of federal intervention. The budget also includes major cuts for the very programs needed for prison reform to succeed. The state’s drug court program would be cut nearly 40 percent. Community corrections, the alternative to imprisonment, would be cut by half. And parole services, essential for reducing recidivism, would be reduced by 14 percent.
Bentley has said he plans to sign the prison reforms that the Legislature passed last week into law. But before any of those reforms can be implemented, the governor’s office must certify that the Department of Corrections and the Board of Pardons and Paroles have enough money to move ahead with the changes. The proposed GF budget would derail prison reform by making this certification impossible.
Our state needs new revenue to avoid these cuts. Overall, the committee’s $1.64 billion GF budget falls more than $200 million short of the amount needed to prevent deep service cuts and invest in reforms. Lawmakers thus far have not considered Gov. Robert Bentley’s proposals to raise revenue and avoid those cuts, including increasing the state cigarette tax and automobile sales tax. Other tax bills that won House committee approval last week have stalled.
Alabama faces an important choice that will help determine what kind of state our children and grandchildren will inherit. Do we raise new revenue to protect vital services like health care and public safety? Or do we erode our state’s quality of life with devastating cuts to those services? The House committee’s budget would side with the latter option, and Alabama would suffer the consequences of that choice for years to come.
By Carol Gundlach, policy analyst. Posted May 15, 2015.