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House | May 14, 2015 | Committee Room | Appropriations: Health and Human Services

Full MP3 Audio File

Like to welcome everyone to the House Appropriations for Health and Human Services afternoon committee meeting. Like to recognize our Sergeant at Arms, we've got Young Bay, Bill Morris, Jim Maren. Members, ladies and gentlemen, what we're going to do, we're going to in just a minute take 20-minute recess to evaluate amendments, but members before that time, if you have any questions for staff or comment before we take the 20 minute recess please feel free to do so now, also want to recognize the pages liquite[sp?] we've got Eliza Becker from Halifax sponsored by Representative Ray please stand waive your hand Daniqer Lucas Wake county Representative Marvin Lucas, Representative Zachary Rue from Pier, Representative Paul Stam. Speaking for a Kim Paul Stam. Thank you all for your service, appreciate you all being with us today. So as I said, we're going to take a 20-minute recess if members don't have any questions this time to evaluate amendment in a third time when we come back we will start going through this amendments as quickly and efficiently as  we can, thank you Come to order. Okay we are going to be alert into the amendments and today we we have four amendments, member we are going to start with Representative Insko's amendment H97 eight LU-3 version 2. If our Sergeant-at-Arms would pass it out. Representative Insko recognized to explain her amendment. Thank you Mr. Chairman and members it's been my experience with putting things that if you don't pay attention they go away for someone its important all what this amendment does is it directs the department to bring back recommendation for how to use this remaining money specifically to increase community based behavior health treatment and service with the key focus of Dorothy Edicts, so I move with the approval of the amendment Chairman Marlon Thank you I'd like to second that motion I think it's very reasonable and good motion thank you. Further discussion further debate from the committee, all in favor signify by saying A, any oppose? members the next amendment we have is H97 ATR-4 version one, it's Representative Isco's amendment as well, we'll have the sergeant arms pass it out. Representative Insco recognized to explain her memo. Thank you Mr. Chairman, the purpose of this amendment is really to draw your attention to the biggest problem with our mineral health system, and that is  that we don't have enough community based behavior health services for the uninsured, and that population is growing and we can't expect providers to provide mental health services to various sick people for no money, so what happens is that they end up in our ERS and end up in a jails and prisons, you remember that governor MacCoy was opening a mental health facility in central hospitals we propose that a simple prison and also wide to open up a clinic, middle health clinics in some of the other prisons, those people are in prison because, probably because they have used drugs has bribery convictions because they are trying to get money to buy drugs to treat their own mental illness, so if you look at our current budget I will just go through some of the provision we have that number 64

on our manual report is paramedic ER which is really a good program, it allows our paramedics to evaluate middle illness people with illness instead of taking them to the ER, they would take them to the crisis unit but that doesn't provide services that they need when they're past that point. We also putting more money into our three way beds, that's really a good idea, I really like that 4.9 million, those are for when people have a crisis in the community they don't have to go to a state facility they go into their own community hospital and then they go back out into the community but once again there are no services there and they aren't insured and then at 53 is the crisis unit, we're going to open more crisis units and it serves the same population population, people who go into crisis but there is no services for them when they can get over their crisis, and they we're taking the trust fund as really another good and a good proposal to put 25 million into local beds, transitioning our local beds to our local acute beds to fit but when they get discharged there won't be any services, to provide services and then they'll end up recycling back into that so, these patients are treated with what we call IPRS or 100% state dollars and we haven't had an increase in that fund I believe since 1992, meanwhile in the last ten years we've cut 100 million out of it and at the same time an increase in population, none of us should be surprised that we have these problems with our emergency rooms or with our increased jail and prison populations, so my proposal is to take $10 million out of our medicaid re-base. So our economy is growing at the national level and at the state level to and I think it's safe to make an assumption that we will not need that amount of money for our state march next year in our medicaid fund so this money would take $10 million recurring out of our medicaid re-base and put it into this quickly needed community based services for people with mental illness, and I'd be glad to answer questions and I would move for the adoption of the amendment. Chairman Abel. Thank you Mr. Chairman. I think representative Insko has pointed out a significant gap in the mental health, continue of care for the citizen of the State, however from a financial stand point in creating the structural whole that is created through this approach, I am afraid I cannot support that. I feel like we need a much more defined stream of funding, and that we are going to have to look a little bit closer at exactly what and where the community services are needed, right now I'm not sure we have a true evaluation of a lot of problems I think you've seen, what we have began to approach and see where to find and I would like like us to start that process program by program and all the state does. So at this time, I'd really have to say that a no vote would be the way to go. We got some issues ahead of us on this particular direction. Rep. Peddleton.   Thank you, Mr. Chairman. Can I asked Rep. Avila a question? Does the lady yield? Yes. I just wanted to see would you consider a lower amount, going along with a lower amount, $4 or $5 million? It not so much the amount of the money. It's the structural hole that you create in the budget. Chairman Dollar. Just a question for staff. How much new money in mental health is in this budget. Maybe give us a rough number. Roughly about 30 million. 30 million? Above what was last year. Alright. Mr. Chairman, I would poss two things. One, this budget, putting at least 30plus million in additional funds into mental health is a huge step forward and is being done so in consultation with the department and the efforts of the administration to aggressively deal really last couple

of years with mental health crisis issues and the like, and it looks to me like we're really moving in the right direction, and I would also certainly concur with Chairman Avila, that you cannot take money out of the rebase, that is a figure that is calculated on the enrollment growth for the medicaid program and you really cannot take money out of that item without creating as was mentioned a structural hole. Further discussion, further debate? Mr. Chairman, I withdraw the amendment. The amendment has been withdrawn. Next we have H97 ATR-3 Version 2, Representative Insko's amendment. Thank you, Mr. Chairman. The lady is recognized thank you, Mr. Chairman. This is a lesser amount of money but deals with the same program, and I would just add a couple of other things. If you look at item number 49 and your money report it is an $8 million appropriation to state facilities to cover a shortfall due to increased indigent caseloads, and to me that just jumped right out that we are really putting we need to put our money in prevention we're looking now I will have to say I'm very supportive of the effort to go to evidence space treatments I think it's it's a good use no one wants to misspend tax dollars so it really makes sense to say we're going to spend our dollars where we know we're going to get a good outcome and one of the best place to spend tax dollars is in prevention and early intervention it's the least expensive way to treat some of these chronic conditions and to intervene often so that a person actually can have a productive life, so and I would also point out that I don't believe maybe we could have maybe a provision somewhere that would direct the Health and Human services oversight committee that mental sub commitee of that to begin tracking our ER attendance and our jls and our precepts and some of these other collect some data to show us where we got to be intervening mad management we often end up doing mad management for mentally ill all that really is not an adequate service so I really thought representative Penilson was onto something that this morning and I noticed that we had a cut in the budget for cutting vacant positions and so I inquired about whether there was additional vacant positions where we could take some of that money and I have discovered that there's actually $6 million in vacant positions it's in the department of health and human services so answer just as a, just to send a signal that this committee is really serious about addressing this problem alright, what I'm proposing with this amend that we take one more million dollars from vacant positions and put that into comminity based service health and I move adoption in the amendment. Chairman Abram Thank you Mr. Chair, again I think if you saw that two amendments together, the 10 million and the 1 million which would be 11 million, to make any significant impact on the problem that we've got wont take a lot of money. I hesitate to decide to go in that direction, if we don't really know what the problem is so for that reason, I just ask that we not accept this amendment, but I will be more than happy. I think representative it got noose where my heart is on this issue, my head is going somewhere else. And work together through the session in the inner room, and come back in towards session and really be able to do something significant in the area of community by services I just have a question of Representative Amiller. Would you be willing to work on a provision that will directly how can human services oversight committee then help them to lay out some specific chores for them to do. We can discuss it. Thank you. Can't promise where it will go but I'm always open for planing Thank you and I was drogumented[sp?]   Without objection the amendment withdrawn.

We have one final amendment H97 AOU_ 2version5, Representative Inscor. Thanks again Mr Chairman. This is something that I think everyone in the state would want to do I'm not quite sure  this is amendment is drafted in the exact right language but it's very important for us as we transition the Dicks property to another to the city of Riley and for that future that we have no idea what it would bring is that we pay homage to Dorothea Dix and not recognize that her contribution is an important part of the heritage of Riley, of Wake county and the state of North Carolina. As to this amendment just department to propose some ways to permanently memorialize and honor Dorothea Dix and to preserve any of the documents or artifacts or memorabilia that would, the pictures that we have and at least take into consideration preserving a building or providing a space somewhere and so this, I think is a way to begin this discussion and the approval of the amendment. The chair would like to comment on this amendment first by saying that I commend Representative Insko for bringing it forward, I think I couldn't agree more with her comments. My only concern as Chair, is where you're directing the department of HHS to consider this, and because of that, I think it violates the chair determines that it violates rule three, we would encourage the lady if she so chooses to maybe submit an amendment that would maybe direct it to to another place outside of the purview of HSS so this time the Chair is ruling it out of order there's no other amendments I recognize chairwoman Havala.  Thank you Mr. Chairman. I move the house appropriation committee on health and human services, adopt the appropriations committee report as amended and for the move that stands to be authorized to make technical corrections and conforming changes related to reconciling the various amendments adopted and that the appropriate totals may be adjusted accordingly Further motion further no discussion further debate all members in favor signify by saying aye any oppose Thank you members of the committee, the meeting is adjourned.