National Public Policy/Legislation

Bush Budget Includes Deep Cuts in Medicaid





AMHCA E-News from Washington

Vol. 05-07

February 8, 2005

Bush Budget Tops $2.5 Trillion, Includes Deep Cuts in Medicaid

President George W. Bush, on Monday, February 7, 2005, sent to Congress a $2.7 trillion budget plan that seeks deep spending cuts across government agencies, including cutting health care payments for the poor and veterans, and trimming spending on education programs. Overall, the budget is directed at boosting military spending and extending tax cuts, while cutting back or eliminating funding for education, health care and other programs that aid the most vulnerable of Americans.



Democrats immediately called the budget a “hoax” because it left out the huge future costs for the war in Iraq and Afghanistan and did not include the billions of dollars that would be needed for Bush’s number one domestic priority, overhauling Social Security.



The President’s budget request for fiscal year 2006, which begins on October 1, 2005, proposes $60 billion in cuts to Medicaid over a 10 year period. If enacted, these cuts will make deep reductions in provider payments and reduce coverage for millions of recipients. The President proposed more than $15 billion in new Medicaid spending, so that the net spending cut in the program equals $45 billion over 10 years.



The Medicaid law, passed in 1965, mandates that certain individuals must be covered and that certain services be provided in all state Medicaid programs. These include health care to poor children and to elderly and disabled persons who fall below very minimal income levels. Most states also provide optional services to other people in need, including many working poor adults, children and seniors. Medicaid is jointly funded by the states and the federal government, with the government paying between 50 and 77 percent of the total bill, depending on the state. The share paid by the federal; government is expected to reach $190 billion this year, less than half of the defense budget.



The Medicaid changes recycle budget cuts proposed by Bush during its first term, which would make them harder to see to Congress this year. The budget cuts are generally limited to reductions in payments to providers, mostly in case management services, and states and they avoid a block grant most feared by advocates of the program.



Bush’s Medicaid budget proposals are expected to receive broad support from fiscal conservatives in Congress, but many governors and advocates will likely actively oppose deep reductions in the program. Bush’s plan is intended to limit the increase in Medicaid spending over the next decade to an average of 7.3 percent annually, compared to a projected growth rate of 7.8 percent if the cuts are not made. Administration officials are hopeful that members of Congress will be more willing to make cuts in the past because of the rising federal deficit



Mental Health Programs



The Administration’s budget request includes $3.3 billion for the Substance Abuse and Mental Health Services Administration, a decrease of $56 million from Fiscal Year 2005. In addition, the proposal includes $837 million for the Center for Mental Health Services, a decrease of $64 million from current spending levels. Funding for jail diversion grants, which provides up to 125 grants to states to develop or implement programs to divert individuals with a mental illness from the criminal justice system to community based care, is reduced 7 million to 4 million. Substance abuse prevention programs would be cut by $14.4 million or 7 percent from last year’s funding level.



Of particular interest to mental health counselors are provisions related to last year’s enactment of the Garrett Lee Smith Memorial Act (GLSMA), legislation to prevent youth suicide. That law establishes grants for suicide intervention efforts directed at youths and would authorize creation of a technical assistance center to help local and state providers of suicide prevention programs.



Late last year, the 108th Congress passed legislation to provide $3 million in funding for a new technical assistance center to help local and state providers of suicide prevention programs. In addition, the bill provides for $7 million for grants and cooperative agreements to develop early intervention and prevention strategies. Unfortunately, the bill did not include funding for the college grants established under the law. Bush’s budget request for fiscal year 2006 includes flat funding for programs authorized under the GLSMA, but does not include funding for the college grant program included in the law.



AMHCA, in working with the Mental Health Liaison Group, will take a more active role in advocating for increased funding for these programs. As the budget process moves forward, stay tuned to E-News from Washington for legislative alerts and updates, as well as requests for grassroots support.



If you have any questions, please feel free to contact Beth Powell, director of public policy and professional issues, at 800-326-2642, ext. 105 or by e-mail at bpowell@amhca.org






Beth Powell
Director, Public Policy and Professional Issues
American Mental Health Counselors Association
801 N. Fairfax Street, Suite 304
Alexandria, Virginia 22314
Phone: 800-326-2642, ext. 105
Phone: 703-548-6002, ext. 105
Fax: 703-548-4775
Website: www.amhca.org

The only organization working exclusively for mental health counselors.

Join us in Philadelphia July 21-23, 2005 for AMHCA's Annual Conference!

Montana's Carol Staben-Borroughs/ AMHCA President
Carol Staben-Burroughs, President
American Mental Health Counselors Association


Greetings from Bozeman! As I write this in early April, I’m nearly done serving my term as AMHCA president (ending June 30). It has been an amazing experience to meet the people involved in state AMHCA organizations around the United States and to get to do some of the “behind the scenes” discussions and decision-making that keeps our profession alive and kicking. I’ve been able to travel to a number of states, given four keynote addresses at state conferences, and have been the AMHCA representative at the Rosalyn Carter Health Symposium in Atlanta and our representative at the American Counseling Association’s council meetings. Last July, I attended the Int’l. Assn. of Marriage and Family Counselor’s Summer Institute at Northampton, England. Lots of fun and lots of travel!
Something that has become VERY clear throughout this year, is how far ahead Montana is than many of the other states in 1) our licensure, 2) vendorship, and 3) extent of our practice standards. We can really thank those people who insisted we create high standards in our laws.
Two states are still trying to achieve licensure for counselors: Nevado and California. Imagine the surprise of counselors who move to those states who find out that they can’t work anymore. The biggest opposition to counselor licensure is from other provider groups. We work well with the other groups here in Montana and have assisted each other when needed. Again, our spirit of community and “there’s enough business for everyone,” is a real asset, I think.
In many states, counselors are not included in vendorship laws, meaning they can’t receive 3rd party payments. Here, we’ve had vendorship for so long, we take it for granted. Many states counseling laws don’t include title and practice protection, so they have to compete with “counselors” who really aren’t; they can’t do psychological testing or be included in referral lists. In these situations, it is the uninformed public who are really at risk. In Montana, we have done what we can to protect the consumers of mental health services.
This year, our profession made two valiant attempts to change laws at the national levels: we attempted to become independent providers for Tricare/Champus and we tried to get added as recognized providers for Medicare recipients. Though neither attempt was successful, we became more recognized in the legislative world. As our visibility continues to increase (in other words, we aren’t going away!), we will eventually achieve the ends we seek. Just as it took us a few tries in Montana to achieve licensure and parity with other provider groups, it will happen nationally. We won’t give up or be defeated by our setbacks.
Finally, I’d like to encourage you to get more involved at the state and national levels. Attend the MCMHCA and AMHCA conferences, get on the list serves, write to legislators as needed, take an office, serve on a committee, join your professional organization. Most of the benefits are intangible, except for the accomplishments, friends made and the frequent flyer miles. The benefits of service far outweigh the sacrifices!
Please plan to join me in St. Louis in July at the AMHCA conference “Gateway to Healing: Keys for Recovery.” For more information, go to amhca.org.
Recent sighting: “I tried a dessert called “Death by Chocolate,” but it only made me stronger.”