Every mid-January Arizona Governor’s propose their budgets for the upcoming fiscal year. Those budgets set the governor’s priorities and can be influential in what ultimately comes out in the budget. The extent to which the governor’s budget drives the ultimate outcome depends a lot on the relationship between the governor and the majority party in the legislature chambers.

The relationship between the current governor and the majority party in the legislature is cozy and so in the era that we’re in right now- the content of the gov’s budget will likely closely resemble what ultimately comes out this session.

The governor released his budget last Friday and there were some good things in it but also some disappointments. Here goes a summary of his proposal.

Good Things in the Proposed Budget

Newborn Screening Expansion

Arizona’s newborn screening program is run out of the ADHS public health laboratory.  The team tests newborns for a series on metabolic and other disorders and gets the information back to doctors and parents fast so that they can make quick interventions that are critical to good outcomes.  The program is funded by a fee that hospitals and health plans (and AHCCCS) pay for the services which include testing blood spots immediately after birth and again with a new blood spot after a few days.

The program currently bills $36 for the first test (the blood spot test that’s collected right after birth) and $65 for the second test which is collected several days later. The governor’s budget proposes combining the fees into one and boosting the total from $101 to $113.

More revenue would come to the program because of the higher fee ($12 total) and because collections would increase because there would only be one bill.  The extra money would cover the deficit that the program is currently running and allow them to  do 2 additional tests now recommended by HHS:

1) spinal muscular atrophy, a genetic disorder that affects motor nerves; and

2) X-linked Adrenoleukodystrophy, which causes deterioration of myelin, reduces the ability of nerves to communicate with the brain.

Childcare Help for Working Families

The Child Care Development Fund provides subsidies that help low-income working families and foster parents afford childcare. The proposed budget increases funding for the Development Fund by $55M which would go toward boosting rates to childcare providers that participate in the program (which should hopefully build the network and perhaps even get rid of the waiting list).

Some of the money would also go toward providing incentive bonuses to quality childcare facilities ranked by First Things First and help unranked facilities achieve certification.

The folks that can participate in the program include low-income parents who are working; teen parents in school and residents of homeless or domestic violence shelters.

Assistance to Kinship Families

The governor’s budget proposes increasing what is called “kinship assistance funding” which is financial assistance for family members who are caregivers for children that’s called “kinship care.”

Last year Arizona extended the eligibility to all caregivers, regardless of income levels, without filing an application. This year, the proposal is to double the “Grandmother Stipend”.

Suicide Prevention

There have been some solid interventions in the last year to help reduce suicides in Arizona enhancing crisis-response teams, expanding suicide-prevention resources, initiating a campaign to address social isolation, and establishing a Suicide Mortality Review Team. I reviewed some of that in last week’s policy update.

The governor’s budget proposes a general fund appropriation of $400K to help with the work at the Suicide Mortality Review Team. We expect additional evidence-based policy interventions to result from the surveillance work that the Team will undertake using this appropriation.

Protecting Vulnerable Adults and the Elderly

The governor’s proposed budget proposes increasing some (targeted) reimbursement rates to providers of therapy and respite and habilitation care (hopefully stabilizing and improving the availability of those serves for folks that qualify).  The proposal is to increase state funding by $5M which would bring in an additional $11.7M in federal matching funds.

The budget also proposes reimbursement rate increases for providers of aging and adult services for vulnerable and homebound adults and seniors. That increase is $1.5M plus the federal match.

Interestingly, he also proposes tapping the Medical Marijuana Fund to the tune of $6M to provide health care services to 18,000 uninsured or underinsured Arizonans who need treatment for substance abuse. No match or general fund impact with that one.

Disappointments in the Proposed Budget

Adult Protective Services

We had hoped that the governor would have recognized (as did the vulnerable adult task force did) that ADES’ Adult Protective Services needs additional funds and technology to better follow up on neglect and abuse complaints of vulnerable adults. No additional resources were proposed by the governor for this important need. 

Hopefully legislators will recognize the performance shortcomings in the Adult Protective Services program and determine whether additional funds are needed or whether processes and/or personnel and leadership need to change to improve performance. Look for an upcoming series from Stephanie Innes in the Arizona Republic for more on APS.

Abuse & Neglect Investigations in Nursing Homes

We’re disappointed that the governor’s budget proposal fails to address the fact that the ADHS licensing program needs additional funding to be able to adequately follow up on complaints filed by families about nursing home neglect. 

A recent Auditor General’s Report showed that many important complaints are not currently being followed up on.  The agency acknowledged in their response that they don’t have adequate resources to follow up on complaints.

Editorial Note: I’m partly responsible for the lack of resources in the program.  Back during the Recession, the licensing general fund was swept and we were given the ability to charge fees to nursing homes to support our inspections. When we did the math to calculate those fees, we neglected to include Indirect costs which shortchanged the program by 25%.  My bad.

The Senate’s proposed budget includes additional funds (I don’t know if that’s general fund or a fee increase) to help do a better job following up on nursing home complaints.

State Loan Repayment Program

Last year the state’s health care provider loan repayment program which places practitioners in rural and underserved areas that have a dearth of health care providers received a $750K increase. We had hoped that this would be continued for future years, but alas the governor’s budget proposes not funding that increase again.

Oral Health Coverage for Pregnant Medicaid Members

We had hoped to see a proposal to make the small appropriation that would be needed to begin providing oral health coverage for pregnant Medicaid members.  Here’s a blog post from back in March that lays out the case for this important intervention.

State Employee Salaries

We had hoped that there would be a proposal to increase the salaries of public health workers in state government.  Nope.  Again, no increase for hard working state employees (except at DCS etc).

Salaries aren’t the only thing that slows turnover- employees also need to know that their efforts are valued and that they have the ability to make decisions and participate in the development of agency priorities- but salary is part of the equation and state employees have not seen raises in many years.