State health agencies said Monday their budget requests were prompted by staffing shortages and growing demand for services.
The Alabama Department of Human Resources (DHR) is seeking $180.4 million from the general fund and $100.8 million from the Education Trust Fund (ETF), compared with $121.8 million from the general fund and $80.7 million from the ETF this year.
The Alabama Department of Mental Health (ADMH) is requesting $242.2 million from the general fund (up from $211.4 million this year) and $85.4 million from ETFs (up from $76.9 million this year).
The Alabama Medicaid agency is requesting $955 million from the general fund. The budget for this fiscal year is expected to be $862 million.
“As always, it goes without saying that some of the reasons for the rise are rising inflation. You could say I’ve just listed a few here: inflation in nursing homes, pharmacies, Medicare Advantage, and we have that across the board in other areas as well. situation,” said Medicaid Agency Commissioner Stephanie Azar.
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The presentation on the agencies’ budget requests for fiscal year 2024-25, which begins Oct. 1, came ahead of the start of the 2024 legislative session on Tuesday. Lawmakers will decide how much funding these agencies receive.
Agencies cited workforce issues as the primary reason for their requests. In fiscal year 2023, DHR child welfare staff turnover rate was 61.5%, DHR Commissioner Nancy Buckner said. This is slightly lower than the previous year’s 64%, but still a significant increase from 2021’s 46%. The commissioner cited child welfare worker staffing challenges in his fiscal year 2024 budget request but did not provide that data.
In fiscal year 2023, the turnover rate for all DHR employees combined was 23.4%.
Buckner said there are challenges recruiting and retaining employees because of wage competition, unpredictable hours and challenging working conditions. Staff face dangerous situations including stabbings, altercations and bites.
“We are no longer an employer of choice. Twenty years ago, we were,” Buckner said.
While Buckner’s remarks focused on staffing issues in the budget request, reasons for the increase include funding to move children out of psychiatric treatment facilities, increases in inflationary costs and other administrative expenses such as travel and in-home services increase. Previously funded by federal grants.
Asked whether the funds would address staffing shortages, she said she could absorb the costs in the overall budget.
ADMH committee member Kimberly Boswell said previous investments in workforce development have shown improvements, but gaps remain in mental health services, particularly nursing staff shortages and Taylor Hardin Secure Medical ), which provides mental health services to incarcerated Alabamians.
There are currently 340 inmates awaiting inpatient assessment and the waiting list is growing due to staffing shortages. The department plans to use the funds to increase staffing at the facility and add 85 beds, bringing the total number of beds to 225, to address the waitlist issue.
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The department also faces a nursing shortage under the nurse delegation program, which allows nurses to train and supervise non-nursing staff in the ADMH program. ADMH would increase wages from $8 to $12 an hour.
“our [mental health] Alabama’s labor shortage is twice the national average,” Boswell said.
Azar said that in addition to normal factors affecting increased funding, the federal government reduced its match for the program after pandemic-era rules ended. Since the state cannot terminate people’s Medicaid in exchange for more federal funding, the state must also redetermine whether Medicaid beneficiaries are still eligible for coverage. Azar also said people are using Medicaid services more, with utilization rising by about 11%.
“After COVID-19, our program went from covering just over 1 million Alabama citizens to more than 1,375,000 Alabama citizens by the end of the emergency declaration,” Azar said.
Medicaid receives 77% of its funding from the federal government, or just over $7 billion in fiscal year 2023. $813 million comes from the general fund and just over $1.2 billion comes from other state funds such as provider taxes for nursing homes, pharmacies and hospitals.
House Ways and Means Committee Chairman Rex Reynolds, a Huntsville Republican, seemed pleased with the state agency’s request.
“We got a lot of one-time funding, about $361 million in additional funding. Not to mention the growth in the general fund budget itself for the 25-year budget, this is going to be the year that all of those one-time needs are met,” Reynolds said.
Rep. Greg Albritton, D-Atmore, chairman of the Senate Finance and Taxation General Fund Committee, expressed concern about funding increasing year over year and projects no longer being funded by the federal government, forcing states to fund projects.
He said it was their job to decide whether the money was in the budget, asking: “How do we get it? Whose pocket are we going to pick from?”
Sen. Linda Coleman Madison, D-Birmingham, said they must find other sources of funding.
“To me, I think the problem is that the pie is not big enough. We don’t have enough money. We don’t have enough money,” she said.