"This is the first year DBHDD has felt the gap between what it takes to keep a hospital running and Medicaid funding," said Commissioner Judy Fitzgerald of the Department of Behavioral Health and Developmental Disabilities.
Fitzgerald presented her case Monday to the House Appropriations Committee's subcommittee on human resources chaired by Rep. Katie Dempsey, R-Rome. It was the first day of what Dempsey said would be two sessions on proposed amendments to the fiscal year 2019 budget that runs through June 30.
The department still operates five state hospitals with shrinking populations. It's also responsible for two facilities that already have been closed: Northwest Georgia Regional Hospital in Rome and Southwestern State Hospital in Thomasville.
A settlement with the U.S. Department of Justice requires the state to move institutionalized patients with intellectual and developmental disabilities to community settings. But the transfers are also draining Medicaid funds that support the facilities.
Fitzgerald said expenses decrease when there are fewer patients but there are some fixed costs that don't change. The system has a total of 469 hospital buildings across the state, she said, and they generate an average of 5,000 work orders a month.
At this point in the process, fewer than 200 people remain in the institutions. They're medically fragile with complex conditions and each have a specific plan of care.
"We will continue to move individuals out when we have a place they can live successfully," Fitzgerald told the subcommittee. "The (DOJ) agreement is that no more can come in, so the number will decrease. But we need adjustments for losing that revenue."
The request led lawmakers to discuss the future of Georgia's state hospitals as they close. Rep. Tommy Benton, R-Jefferson, questioned the ongoing costs to maintain the facilities. Fitzgerald said she could provide estimates but couldn't speak to the Legislature's plans for the buildings.
"Our responsibility is to care for the facilities while they are still DBHDD facilities," she said.
Dempsey, who's familiar with efforts to re-purpose the vacant NWGRH property in Rome, said local communities can help determine a use but the state must continue its upkeep.
"The building and grounds (of NWGRH) are in excellent, show-able conditions for potential businesses and industries," she said. "The prohibitive challenge on that has been the bond ... But work is going on and the bond is much less than it was eight years ago."
The state has been spending about $1 million a year to maintain the 132-acre campus off North Division Street. It was appraised at between $6 million and $10 million and offered to the city of Rome at the lowest price.
Local officials have been working on redevelopment plans but balked at also taking on the $3.5 million or so in remaining debt from bonds issued to make improvements before the facility was closed in 2011. Most recently there's been a push for the state to make it a regional mental health hub — especially for crisis services — but lawmakers have been noncommittal so far.
In addition to the $7 million to offset the Medicaid funding loss, Fitzgerald's FY19 supplemental budget request includes another $8.4 million to expand the Apex Program, which brings mental health services into public schools.
She's also seeking $8.5 million to continue an administrative initiative integrating data from the divisions of behavioral health and IDD, intellectual and developmental disabilities.
"Sometimes individuals have both (conditions) and we can no longer silo," she said, referring to not being able to merge systems. "The more we can move toward 'how do we serve that individual?' ... we can deliver more efficient and effective care."
The increases are included in Gov. Brian Kemp's budget proposal.
House and Senate appropriations committees are delving deeper into departmental needs and plans before making their own recommendations. The two chambers are charged with adopting a final budget before the 40-day annual session ends.