Gov. Nathan Deal’s budget proposal for the 2019 fiscal year adds $50.6 million more than last year’s budget in state general funds for the Department of Behavioral Health and Developmental Disabilities. The budget directs $14.9 million in state funds toward waiver programs and community support services. This helps continue implementation of a 2010 settlement with the U.S. Department of Justice that requires Georgia to serve individuals with intellectual and developmental disabilities in community settings instead of institutions.
The two-year settlement extension in 2016 required the state to transition more individuals with developmental disabilities out of state hospitals and provide them with additional support in their communities. The targeted end of the settlement agreement is June 30, 2018. Another $20.6 million of the department’s 2019 budget is directed toward child and adolescent mental health and addictive disease services.
The amended 2018 budget includes $2.8 million in new state general funds. Most of that increase is $2.4 million for crisis services and new capacity to serve children under 21 who are diagnosed with autism.
The department consists of the Division of Behavioral Health and Division of Developmental Disabilities. The behavioral health division provides mental health services to children, adolescents and adults at five state hospitals and through community partners at Community Service Boards and other providers. This division also provides services for Georgians of all ages with substance use disorder.
The developmental disabilities division serves Georgians with chronic conditions that developed before the age of 22 and that limit their ability to function mentally or physically. This division manages the New Options Waiver and the Comprehensive Supports Waiver Program. These are Medicaid 1915(c) home and community-based services waivers that provide services such as physical therapy, speech therapy, community living support, transportation and specialized medical equipment.
The New Options waiver program supports people who do not need 24-hour care and Comprehensive Supports waiver program supports people with more intensive needs. The need for these services is greater than the number of openings available and the state continues to work on funding new program slots.
As of December 2017, the Department of Behavioral Health and Developmental Disabilities reported 8,555 people on the waiting list for these programs.
The department’s $50.6 million in state general funds budgeted for 2019 is a 4.7 percent increase from last year that includes:
- $20.6 million for programs and services recommended by the Commission on Children’s Mental Health
- $6 million to annualize the cost of 250 New Options and Comprehensive Supports waiver program slots to meet the requirements of the Justice Department settlement agreement and $3.1 million for 125 new waiver program slots
- $5.9 million to fund crisis services for children who are under 21 and diagnosed with autism
- $4.2 million to reflect the decline in the federal medical assistance percentage from 68.5 percent to 67.62 percent in federal 2019 fiscal year starting Oct. 1, 2018
- $3 million for one behavioral health crisis center to begin operations in January 2019. These centers provide around-the-clock walk-in crisis intervention and counseling services as well as crisis stabilization beds. They are also emergency receiving facilities where law enforcement officers can bring people who are in mental health crisis
- $2.2 million for a new 40-bed forensic unit at the Georgia Regional Hospital in Atlanta. These units serve people who are referred for psychiatric evaluation and treatment from the state’s criminal justice system.
2019 Budget Lacks Increase for Substance Abuse Prevention
Fighting substance abuse is a growing priority of state leaders as Georgia continues to see rapidly increasing drug overdose rates. From 2012 to 2016, Georgia drug overdose deaths increased by 35 percent. About 69 percent of these deaths in 2016 were due to opioids, including heroin and synthetic drugs such as oxycodone and morphine, according to the Georgia Department of Public Health. This indicates a public health epidemic that requires increased early intervention and prevention efforts. Opioid abuse prevention within the department’s child and adolescent addictive diseases services is allotted $790,800 in the proposal. But there are no additional funds for adult addictive disease services or substance abuse prevention.
Funding these services relies mostly on federal block grants, but Georgia used to provide more state money to supplement these grants. The state slashed funding during the recession that started in 2007. In 2009, Georgia invested $1.2 million in state general funds for substance abuse prevention. The state cut the investment to $121,627 in 2010 and it remains relatively low at $236,479 in the proposed 2019 budget. As the need for prevention grows in the face of the state’s opioid epidemic, state lawmakers can consider increasing state funding for substance abuse prevention to pre-recession levels.
About 41 percent of the proposed 2019 budget for the department is a $20.6 million increase in funding for services recommended by the governor’s Commission on Children’s Mental Health. Children’s behavioral health is one of the governor’s top health care priorities, with his 2018 budget including an additional $2.5 million for behavioral health services for children from birth to age five. The commission’s eight members conducted a review of current programs and opportunities for improvement within the children’s behavioral health system.
The commission released eight recommendations aimed at solving the state’s key challenges in this area. These include the rising rates of suicide and opioid abuse among Georgia’s youth and difficulties in accessing behavioral health care, especially for children and families in rural areas. The funded recommendations listed below are a significant step forward in improving the behavioral health system to better serve children and prioritize prevention and early intervention.
Here are the Commission’s Recommendations Included in the 2019 Proposed Budget
|One-time and ongoing funding for crisis respite services||$10,400,198|
|Money for the school-based mental health Georgia Apex Program for 13 additional grants||$4,290,000|
|Money for supported employment and education assistance for 500 more young adults at the rate of $6,120 per year||$3,060,000|
|Money for suicide prevention||$1,092,000|
|Money for youth opioid abuse prevention||$790,801|
|Money for high-fidelity wraparound services training||$610,545|
|One-time and ongoing funding for telemedicine services||$382,500|
|Total state general funds for Children’s Mental Health Commission recommendations||$20,626,044|