The governor’s budget proposal for the 2020 fiscal year adds $78.7 million more in state general funds for the Department of Behavioral Health and Developmental Disabilities than the 2019 budget. It directs $10.4 million in state funds toward home and community-based waiver programs and housing support services. These efforts are a part of the continued compliance with the 2010 settlement with the U.S. Department of Justice that requires Georgia to serve individuals with mental health and developmental disabilities in community settings instead of institutions.
The Department of Justice settlement required the state to transition more individuals with developmental disabilities out of state hospitals and provide them with additional support in their communities. Georgia has invested $256 million in meeting the terms of the settlement since 2011. The targeted end of the settlement agreement extension was June 30, 2018, but some of the data was not available at that time and the state is still awaiting a final determination of whether continued federal oversight is needed. The agency’s 2019 spending directs $34 million towards crisis services, core outpatient services and residential addictive disease treatment.
Amended 2019 Budget Highlights
The amended 2019 budget includes $24.7 million in state general funds. A notable change in the amended budget is an additional $8.4 million for the Georgia Apex Project that provides grants for community-based mental health providers to provide services in schools such as screening, counseling and referrals to support services. This program started as a pilot project in 2015 that served 104 schools and currently serves more than 400 schools. As a continuation of Governor Nathan Deal’s Commission on Children’s Mental Health, recommendations added $4.3 million to last year’s existing $9.5 million allotted for the Apex Program. The program can bill most of the services through Medicaid, so the goal is to use the grant funds in more schools and be able to sustain in those schools over time through Medicaid revenues without additional state grants each year. The proposed $8.4 million in the amended budget would help to expand the program to more schools.
A result of declining Medicaid patient revenues is the addition of $7 million in the amended budget to maintain state hospital operations as patients receive care in their communities. This is the first year there has been a gap in the hospital operations budget and the Medicaid revenue. There are currently five state-operated hospitals with fewer than 200 patients and the number of patients will continue to decline as the state complies with the terms of the Department of Justice settlement.
Funding for the State’s Behavioral Health Safety Net System
The agency consists of the division of Behavioral Health and the division of Developmental Disabilities. Behavioral Health provides mental health services to children, adolescents and adults at five state hospitals and through community partners at Community Service Boards and other providers. It also provides services for Georgians of all ages with substance use disorders. These services are core to the state’s behavioral health safety net system that primarily serves the uninsured and low-income residents who receive Medicaid coverage.
Developmental Disabilities serves Georgians with chronic conditions that developed before the age of 22 and that limit their ability to function mentally and/or physically. This division manages the New Options Waiver (NOW) and the Comprehensive Supports Waiver Program (COMP). 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 NOW program supports people who do not need 24-hour care and COMP program supports people with more intensive needs.
The department’s $50.6 million in state general funds for 2020, a 6.8 percent increase from last year, includes:
- $18.5 million for behavioral health crisis bed capacity. The agency operates 24 Behavioral Health Crisis Centers and Crisis Stabilization Units to provide crisis intervention and stabilization services when an individual is experiencing a behavioral health crisis. The 535 crisis beds at these centers and units also help divert patients from emergency rooms and jails to treatment services. The budget includes $10.2 million to better fund and maintain these facilities. It includes $8.3 million to annualize the operating costs of two new Behavioral Health Crisis Centers in areas with the greatest need.
- $10.6 million to increase the number and quality of core behavioral health services. These core services are provided by the community service boards and include a range of services such as assessments, outpatient therapy services, case management and community supports. About 60,000 people are currently served each year, and this proposed 15 percent increase would serve about 9,400 more people.
- $4.2 million to add 125 new NOW and COMP waiver program slots and $3.7 million to annualize the cost of 125 NOW and COMP slots. At the end of fiscal year 2018, there were about 6,000 on the waiting list for these services and the state continues to add more slots each year to help reduce the wait time.
- $4.9 million to provide an additional 144 residential treatment beds for people with addictive diseases. The agency currently has 309 beds at 12 providers across the state for short-term treatment that typically lasts 90 days. People typically enter the residential treatment programs after being discharged from crisis services or they may decide to seek treatment without coming from a crisis facility.
- $4 million to reflect the decline in the Federal Medical Assistance Percentage (FMAP) from 67.62% to 67.30% in federal fiscal year 2020, which starts October 1, 2019. This is the matching percentage used to determine what percentage of each state’s Medicaid program the federal government pays for each year.
- $2.5 million to provide supported housing services to 655 more people with severe and persistent mental illnesses.
- $1.8 million for adult forensic services including eight forensic community coordinators, five forensic evaluator positions and one community integration home. The community coordinators provide case management services and the evaluators determine whether a person is competent to stand trial. The community integration home is a supervised group home model that houses people who are approved by the court to live in these homes and go to work while they transition back into the community.
State Funds Supplement Federal Funding for Substance Abuse Treatment in 2020 Budget
Fighting substance abuse has become a priority of state leaders as Georgia continues to see rapidly increasing drug overdose rates. From 2012 to 2017 the number of drug overdose deaths increased by 55 percent. About 66 percent of these deaths in 2017 were due to opioids, including heroin and synthetic drugs such as oxycodone and morphine.
This data indicates a public health epidemic that requires increased early intervention and prevention efforts. The 2020 budget proposal transfers the $790,801 in funds added last year for opioid abuse prevention to the agency’s substance abuse prevention budget that relies mostly on federal block grants. In 2009, Georgia invested $1.2 million in state general funds for substance abuse prevention. This funding was cut to $121,627 in 2010 and remained relatively low at $236,479 in the 2019 budget. With the transfer of funds, the budget for 2020 would be at $1 million and closer to the pre-recession level. The state would benefit from continuing on this progress to restore prevention funding as the rate of drug overdose deaths continues to grow.
In addition to substance abuse prevention efforts, the state is investing more general funds to enhance federal funding provided for substance abuse treatment services. The federal government is investing more funding in response to the opioid crisis, including about $1 billion in state targeted response grants to expand prevention, treatment and recovery support services for people with an opioid use disorder. In 2017 the agency received a grant in 2017 to conduct activities such as naloxone training for first responders, increasing peer support services and expanding the availability of medication-assisted treatment. Because of the requirements in how the money should be spent, the federal money did not cover additional funding for residential addiction treatment programs. The $4.9 million in state funding will help fill that need.
 Online Analytical Statistical Information System. Georgia Department of Public Health, Office of Health Indicators for Planning.