The Legislature passed and the governor signed what turned out to be a bipartisan budget last week. The $17.8B budget was negotiated by House Speaker Toma, Senate President Petersen & Governor Hobbs.
Many members in both chambers expressed frustration that there hadn’t been a more collaborative process, but ultimately voted in support. In general, all of the Republicans voted for the budget as did 9 Democratic senators and 16 D representatives.
Both chambers are meeting today for floor calendar action (COW and 3rd Read). Word on the street is both chambers will break until Monday, May 22 after today.
Last-minute questions by Senator Bennett in a (R) caucus meeting highlighted the damage the measure would cause to emergency management if the voters would have approved it. Let’s hope it fails in what’s likely to be a final 3rd read vote Monday. If it passes, Governor is unable to veto it and it’ll be on the November 2024 ballot.
SB1234 is up for a final vote in the House this afternoon. That one would prohibit cities or counties from using photo enforcement technology to enforce speeding or red light running.
Here’s a breakdown on what the final budget package looked like from a public health perspective.
Housing Trust Fund Gets Big Cash Infusion
The biggest public health benefit in the budget is an unprecedented infusion of $150M into the state Housing Trust Fund. That fund provides the AZ Department of Housing with its most flexible source of money and includes healthy match for federal housing funds. It can be used for affordable housing development, housing aid programs and money for homeless shelters, transitional housing, eviction prevention, rapid rehousing, and other innovative activities. The Dept of Housing will set those priorities in the coming months.
Kids Care Extended to 225% of FPL
The second biggest, good thing for public health in the budget was a more generous eligibility level for families to take part in KidsCare. The budget bill relaxed the eligibility level from 200% of the federal to 225%. This is expected to expand access to health insurance for approximately 9,500 kids in FY24, and 12,000 in FY25.
No Medicaid Adult Dental Benefit
The biggest public health disappointment was the failure to include a preventive oral health benefit for adult AHCCCS members. A reasonable and inexpensive proposal to begin covering a limited dental benefit was not made a priority and wasn’t included in the negotiated agreement.
Adult Medicaid members will still be eligible for a very limited $1K/year emergency dental benefit – but nothing else. That’s about enough to cover a couple of pulled teeth, but that’s about it.
Collaborative Care Initiative
There are a couple small scale things in the budget that are worth mentioning including a $1M line item that ADHS is getting to set up ‘collaborative care model’ templates to encourage formal collaborative arrangements among primary care physicians, care managers and a psychiatric consultant.
ADHS is supposed to ask for proposals from and enter into grant agreements with collaborative care technical assistance center applicants to supply technical aid to primary care physicians on providing behavioral health integration services through the collaborative care model.
Looks to me like this is set up to benefit a specific entity- but I’m not sure who.
Dementia & Alzheimer’s Disease
ADHS is also getting about $1.5M to coordinate a plan to deal with Alzheimer’s disease and dementia. They’re supposed to coordinate ‘support of policies and programs’ in the executive branch that relate to Alzheimer’s disease & dementia with the money.
The work is supposed to include a State Plan that ‘coordinates outreach programs and services between state agencies, local public health departments, tribal nations, educational institutions, and community groups to foster public awareness and education about Alzheimer’s disease and related forms of dementia’.
They’re also supposed to facilitate the ‘coordination of services and activities among the area agencies on aging, service providers, advocacy groups, legal services, emergency personnel, law enforcement, local public health departments, tribal nations and state colleges and universities’. Another responsibility includes incorporating early detection and risk strategies into existing public health programs.
ADHS is only getting $964K for all that work, which doesn’t seem very much compared to what they’re expected to do.
They’re also getting another $500K for an “education campaign to increase awareness of Alzheimer’s disease in rural and underserved urban areas”. The language in the law is super specific and it’s pretty clear that this is an earmark for the Alzheimer’s Association.
Psilocybin (Magic Mushroom) Research Council
The budget also created a Psilocybin Research and Advisory Council that’s supposed to oversee competitive research grants (using the $5M appropriated) for ‘whole mushroom psilocybin clinical trials’ to evaluate the effects of whole mushroom psilocybin on treating a host of conditions.
Interestingly, the law didn’t give the money to the Arizona Biomedical Review Centre as would have been logical. Not sure why a separate entity was set up instead.
Budget Line-Item Breakdowns
Department of Health Services
- Arizona State Hospital (ASH) Contracted Services $1,100,000
- ASH Contracted Services One-time $6,000,000
- ASH Video Security One Time $3,500,000
- Alzheimer’s Research Ongoing $500,000
- Dementia Services and Alzheimer’s State Plan non-lapsing through FY 2026 $964,100
- Dementia Awareness GF One-time; non-lapsing $500,000
- Psilocybin Research GF One-time $5,000,000
- Collaborative Care Uptake Fund GF Onetime $1,000,000
- Health Crisis Review and Wraparound Services GF One-time $5,000,000
- Arizona Health Care Cost Containment System KidsCare Expansion GF Ongoing; from 200% to 225% of the Federal Poverty Level $5,000,000
- Critical Access Hospitals GF One-time $4,200,000
- On-Call OBGYN Services GF One-time; non-lapsing $7,500,000
- KidsCare Expansion OF Children’s Health Insurance Program Fund; ongoing $16,620,800
- Adult Protective Services Backfill GF One-time $9,100,000
- Produce Incentive Program GF One-time; non-lapsing; “Double Up Food Bucks” $5,462,600