State Government

2015 legislative update: Medicaid long-term care reforms sail through Alabama Senate

Medicaid patients in Alabama would have more options to receive long-term care in their community under a bill that the state Senate passed 27-0 Tuesday.

SB 431, sponsored by Senate Majority Leader Greg Reed, R-Jasper, would create one or more integrated care networks (ICNs) to deliver a broad range of Medicaid long-term care services, ranging from home- and community-based supports to nursing home care. A House version of the plan – HB 585, sponsored by Rep. April Weaver, R-Brierfield – won committee approval earlier this month.

The new system would operate in coordination with the Medicaid regional care organizations (RCOs) set to take effect Oct. 1, 2016. The new RCO model is designed to keep patients healthier while cutting costs, but Medicaid could have to abandon it if the severe cuts under the House’s no-new-revenue General Fund budget become law.

SB 431 effectively would lift long-standing participation caps on home- and community-based waivers, enhancing patient choice and expanding care options that are less costly than institutionalized care. The plan represents a significant breakthrough with the nursing home industry and was developed by the Medicaid Long-Term Care Workgroup, of which Arise is a member. The bill calls for each ICN to have a Citizens’ Advisory Committee that includes members nominated by Alabama Arise and a number of advocacy partners.

By Jim Carnes, policy director. Posted May 19, 2015.

2015 legislative update: Alabama would suffer for years to come under no-new-revenue General Fund budget

Alabamians’ quality of life would suffer for years to come if the no-new-revenue General Fund (GF) budget that the House’s GF budget committee approved Thursday becomes reality. The House is expected to vote Tuesday on the budget, which would slash vital services like health care, child care and public safety. The state’s promising new reforms of Medicaid and prisons would end, and services for low-income children could face devastating cuts.

With the Legislature’s regular session nearing an end, talk of one or more special sessions is running rampant, and the threat of deep cuts to services that make our state a better place to live and work is real. Here is a look at a few of the ways Alabamians would feel the cuts in their everyday lives:

Proposed budget cuts would end new Medicaid reforms and impose severe cuts to other health care programs. The proposed GF budget would reduce Medicaid funding by 5 percent. While the Medicaid agency has not specified what services would be reduced or eliminated, State Health Officer Don Williamson has said the cut would force Medicaid to abandon its new regional care organization model, designed to keep patients healthier while cutting costs.

Williamson said last month that a smaller 3 percent cut would force the agency to end coverage of outpatient dialysis, forcing kidney patients to be admitted to the hospital to receive routine dialysis. Medicaid also would have to eliminate hospice care coverage and stop paying for adult eyeglasses and prosthetics.

In addition, Medicaid would reduce reimbursement payments to doctors, which could mean fewer physicians treating Medicaid patients. Medicaid also would contract with a single provider of prescription services, likely forcing many local, independent pharmacies to close.

The committee’s budget would cut home health services for the elderly and disabled by more than 9 percent. Patients losing these services could be forced to enter much more expensive nursing homes, reducing patients’ independence and increasing costs to the struggling Medicaid program. Funding for life-saving HIV and AIDS medications also would be cut by 50 percent.

Proposed budget cuts would reduce community mental health services. In recent years, the Department of Mental Health responded to budget cuts by closing nearly every public mental health hospital. Many advocates applauded the new focus on less restrictive (and less expensive) community-based services.

But the 2016 GF budget proposal would reduce funding for those very services by 5 percent. Patients unable to receive mental health treatment may be forced into private hospitals, or they may end up incarcerated in local jails without access to needed counseling and medications.

Proposed budget cuts would devastate social services for low-income families and children. Together, the committee’s GF budget and the education budget awaiting House committee approval would reduce Department of Human Resources (DHR) funding by 14 percent.

DHR commissioner Nancy Buckner last month outlined draconian service reductions in the event of major budget cuts. These could include the elimination of the Temporary Assistance for Needy Families (TANF) program, which provides cash assistance and services for extremely low-income families, including more than 30,000 children.

Other cuts could include major reductions in child care assistance for thousands of working families, the elimination of adult day care services, and the elimination of child support collection services for more than 200,000 Alabama families. Because much state DHR funding is matched by federal money, the agency’s total cuts would be much larger than the lost state dollars alone.

The House committee budget would eliminate GF support for the Department of Youth Services (DYS), which provides supervision and services for youthful offenders and their families. The total reduction would be 12 percent, accounting for DYS funds in the education budget.

Like mental health, DYS has moved in recent years toward less expensive and more appropriate community services and has closed expensive residential beds for low-risk offenders. These community services would be cut under the proposed GF budget. With fewer residential beds, juvenile offenders would be left unsupervised or incarcerated in county facilities instead.

Alabama’s network of Community Action Agencies provides nutrition, housing, Head Start and energy assistance services to low-income people. The proposed GF budget would cut state funding for these services by 50 percent.

Proposed budget cuts would end prison reform and could risk a federal takeover of the state prison system. The committee’s GF budget would make devastating cuts to Alabama’s civil and criminal justice system, ensuring that the recently passed (and highly praised) prison reform legislation could not be implemented.

The state’s already reeling trial courts would face a 16 percent cut under the budget, leading to hundreds of layoffs. The budget also would cut juvenile probation services by nearly 40 percent and forensic sciences by 22 percent. These cuts could force courts to close at least two days a week, delay trials and hearings, and delay criminal cases that require DNA and other forensic evidence. The deep cuts also would result in more unsupervised juvenile offenders even as youth services are slashed.

Alabama’s prison system, already operating at nearly twice its designed capacity, would absorb a 5 percent cut under the proposed budget, increasing the risk of federal intervention. The budget also includes major cuts for the very programs needed for prison reform to succeed. The state’s drug court program would be cut nearly 40 percent. Community corrections, the alternative to imprisonment, would be cut by half. And parole services, essential for reducing recidivism, would be reduced by 14 percent.

Bentley has said he plans to sign the prison reforms that the Legislature passed last week into law. But before any of those reforms can be implemented, the governor’s office must certify that the Department of Corrections and the Board of Pardons and Paroles have enough money to move ahead with the changes. The proposed GF budget would derail prison reform by making this certification impossible.

Our state needs new revenue to avoid these cuts. Overall, the committee’s $1.64 billion GF budget falls more than $200 million short of the amount needed to prevent deep service cuts and invest in reforms. Lawmakers thus far have not considered Gov. Robert Bentley’s proposals to raise revenue and avoid those cuts, including increasing the state cigarette tax and automobile sales tax. Other tax bills that won House committee approval last week have stalled.

Alabama faces an important choice that will help determine what kind of state our children and grandchildren will inherit. Do we raise new revenue to protect vital services like health care and public safety? Or do we erode our state’s quality of life with devastating cuts to those services? The House committee’s budget would side with the latter option, and Alabama would suffer the consequences of that choice for years to come.

By Carol Gundlach, policy analyst. Posted May 15, 2015.

2015 legislative update: Testimony from Arise's Kimble Forrister on cigarette tax increase

Arise’s Kimble Forrister testified before the House’s General Fund budget committee Tuesday, May 5, 2015, about HB 572, which would increase Alabama’s cigarette tax by 25 cents per pack. The committee approved the bill along with several other tax measures. Here’s the full text of Forrister’s prepared remarks:

“Alabama Arise has changed its position on the cigarette tax. We used to oppose it because it was regressive, so an increase would fall heavily on low-income workers. This year, our board (including some former smokers) held a lengthy debate and decided the health benefits outweigh the other concerns. If we increase the cost per pack enough to discourage teens from starting to smoke, and give adults one more reason to quit, fewer children will suffer from secondhand smoke.

“Our concern with this bill is that the increase is only 25 cents a pack. Studies show that you need sticker shock to change behavior. A 10 percent increase in the cost of a pack – about 55 cents in Alabama – would reduce teen smoking by 5 percent to 15 percent. After the federal tax increase in 2009, low-income people paid 12 percent of the increased taxes but gained 46 percent of the improvement in health, measured by mortality.”

2015 legislative update: Alabama Medicaid long-term care bills head for full House, Senate votes

Alabama would deliver Medicaid long-term care services in a new way under two identical bills that won legislative committee approval Wednesday. House and Senate committees approved the respective bills – HB 585, sponsored by Rep. April Weaver, R-Brierfield, and SB 431, sponsored by Senate Majority Leader Greg Reed, R-Jasper – without opposition.

State Health Officer Don Williamson said the plan’s goal is two-fold: to enable more people receiving long-term care to remain in the community instead of going to nursing homes, and to slow the growth of health spending for people who need long-term care. At-home care costs $10,000 per year, compared to $60,000 for nursing home care, he said.

The legislation would remove the current state cap on participation in Medicaid home- and community-based services. When fully operational, the plan could save between $700 million and more than $1 billion per year, Williamson said.

The bills would bring Medicaid long-term care services under a provider-led managed care system similar to (and coordinated with) the new Medicaid regional care organizations (RCOs), Williamson told the Senate Health and Human Services Committee. The RCO model, set to take effect in October 2016, is designed to keep patients healthier while cutting costs.

Alabama’s Medicaid Long-Term Care Workgroup recommended the plan to set up integrated care networks. The group has been meeting since February and includes Arise policy director Jim Carnes.

The plan would create citizens’ advisory committees for the integrated care networks that include representatives of Alabama Arise member groups and other health advocates. Committees amended both bills Wednesday to help ensure the membership of those committees and the networks’ governing boards reflects the diversity of the population served. Arise requested the diversity changes.

“Arise and our advocacy partners have been working for years to expand Medicaid home- and community-based service options for long-term care,” Carnes said. “The integrated care network plan is a historic breakthrough that will help Alabama meet looming health care challenges as our senior population grows.”

By M.J. Ellington, health policy analyst. Posted May 6, 2015.

2015 legislative update: Another win for payday lending reform as Alabama House committee OKs six-month repayment bill

Payday lending reform advocates in Alabama scored two victories at the State House on Wednesday. First, a strong reform bill (HB 531) cleared the House Financial Services Committee without opposition. Shortly thereafter, a bill to expand the maximum size of payday loans (SB 446) stalled in the Senate Banking and Insurance Committee.

HB 531, sponsored by Rep. Danny Garrett, R-Trussville, would extend the amount of time that payday borrowers have to repay their loans to six months, effectively reducing interest rates to 36 percent a year. Current state law allows lenders to demand repayment of payday loans anywhere between 10 and 31 days after the loan is issued. In practice, most payday loans in Alabama are for 14 days.

Garrett presented a robust defense of his legislation, which has 38 bipartisan co-sponsors. He presented a lengthy description of the history of payday lending reform, along with the importance of giving borrowers sufficient time to repay their loans.

Payday loans in Alabama are short-term loans that carry annual interest rates of up to 456 percent. “I’m a free-market conservative, but I don’t think this makes sense,” Garrett said.

The House committee approved Garrett’s bill without an opposing vote. It now awaits action by the full House. A Senate version of the measure – SB 335, sponsored by Sen. Slade Blackwell, R-Mountain Brook – also won committee approval last month and awaits a Senate vote.

Bill to expand payday loan size in Alabama delayed in Senate committee

Later Wednesday, Arise’s Stephen Stetson and other consumer advocates testified against a bill that would double the size of payday loans allowed in Alabama. A Senate committee took no action on SB 446, sponsored by Sen. Tom Whatley, R-Auburn, but the bill could return as soon as next week.

The bill had been moving quickly this week. Whatley introduced the measure Tuesday, and it was brought up for a committee hearing the next day. The plan received a public hearing before Whatley agreed to carry over the bill until a future date after Sen. Bill Holtzclaw, R-Madison, raised questions about interest rates on other loans.

Under current Alabama law, payday loans may not be for more than $500. But Whatley’s bill would allow payday borrowers to take out up to $1,000 at a time while leaving the maximum interest rate on the loans – 456 percent a year – unchanged.

Wednesday’s committee action came two weeks after an Alabama Supreme Court decision cleared the way for a statewide payday loan database. The court upheld the state Banking Department’s power to create the database to help enforce the state’s existing $500 cap on overall payday loan debt.

By Stephen Stetson, policy analyst. Posted May 6, 2015.

2015 legislative update: Testimony from Arise's Kimble Forrister on 'flat tax' proposal

Arise's Kimble Forrister testified before the state Senate's education budget committee Wednesday, April 29, 2015, about SB 409. The bill would raise income taxes on the lowest-paid Alabamians but cut taxes for the top 1 percent by thousands of dollars on average. The committee carried the bill over at the sponsor's request, but it could return later this year. Here's the full text of Forrister's prepared remarks:

“Alabama Arise believes that Alabama can’t move forward as long as we have an outdated, upside-down tax system. Several church bodies have passed resolutions calling for lower taxes for those who pay too much and higher taxes for those who pay too little. As it stands now, middle-income workers pay twice the share of income paid by the top 1 percent in state and local taxes.

“Alabama Arise worked closely with Rep. John Knight and Gov. Bob Riley in 2006 to raise Alabama’s income tax threshold for a family of four from $4,600 (worst in the nation) to $12,600 (now worst in the nation again). No state would tax that family except Alabama. In fact, very few states still tax workers whose income is below the poverty line.

“Under SB 409 as written, millionaires get a great deal: a tax cut of nearly $4,000 on average. At the lower end, Alabama families would pay income tax on their first $100 of income. No other state does this. In fact, every other state with a flat tax has created some mechanism to exempt families at $12,600 from the income tax.

“One such approach is Colorado’s, where a 4.25 percent flat tax is imposed on federal taxable income, not adjusted gross income (AGI). It’s just as simple as SB 409, but far more family-friendly. Instead of paying 2.75 percent of line 37, you’d pay 4.25 percent of line 43: Taxable Income. The result would be lower taxes at all income levels, on average, and the overall effect would be more revenue-neutral than SB 409 is now.

“Another approach is Pennsylvania’s, where the flat tax is softened by a tax forgiveness provision that applies only to lower-income families. Those who qualify would pay less, giving a break to low-income people and retirees.

“Finally, there’s the possibility of a state Earned Income Tax Credit, which half of the states now have. If we designed one at 10 percent of the federal EITC, it would reduce total revenue by $137 million, and the bottom quintile would no longer be the only quintile that would pay more under SB 409. Thank you for your time.”

2015 legislative update: Alabama Supreme Court clears way for statewide payday loan database

A single decision by the Alabama Supreme Court may cut the number of payday lenders in the state by half. In a holding without a written opinion, the court affirmed Friday that the state Banking Department has the authority to require lenders to use a common statewide database to help enforce Alabama’s cap on total payday loan debt.

The case, Cash Mart, Inc., et al. v. Alabama State Department of Banking, was a challenge to the department’s regulatory authority. The Banking Department issued the database rule in light of the Legislature’s failure to pass the requirement in a statute.

Arise has long sought a statewide payday loan database to close a loophole that allows many payday borrowers to exceed the state’s existing $500 cap on payday loan debt. Without a common database as an enforcement mechanism, payday borrowers can go from store to store and rack up thousands of dollars of debt at annual interest rates of up to 456 percent. Creation of the database could shutter about half of Alabama’s payday loan storefronts, industry representatives have estimated.

The court’s ruling also eliminates the need to create a database by statute. HB 417, sponsored by Rep. Patricia Todd, D-Birmingham, would have required lenders to use a centralized database and won House committee approval earlier this month. Todd withdrew the bill Tuesday after the decision.

The Banking Department already has selected a vendor for the database and originally announced June 1 as the date for the system to go live. However, the department since has announced a delay in that date and has yet to announce a new one.

Arise and other consumer advocates will continue to push the Legislature to approve payday loan interest rate caps in Alabama.

By Stephen Stetson, policy analyst. Posted April 28, 2015.

2015 legislative update: 'Flat tax' plan could raise income taxes on lowest-paid Alabamians

Alabamians struggling to make ends meet could have to pay state income tax on the first $100 they earn under a new “flat tax” proposal that the Senate’s education budget committee considered Wednesday. SB 409 would eliminate all personal exemptions and standard deductions and require an 80 percent majority of both the state House and Senate to add new tax breaks.

Alabama’s upside-down tax system would become even more skewed without such breaks for low-income families. Under SB 409, Alabama would be the only state that shields no income at all from tax. The state’s current income tax threshold – the minimum income level where one begins to pay income tax – is already the nation’s worst: just $12,600 for a family of four.

Overall, Alabamians with low and moderate incomes pay twice the share of their incomes in state and local taxes that the top 1 percent do. Requiring families who live in deep poverty to pay income tax would make that gap even larger.

Low-income workers would pay higher taxes under SB 409, while the richest Alabamians would get a tax cut. Families with incomes below $18,000 a year would pay an additional $73 in income taxes on average, according to an analysis by the Institute on Taxation and Economic Policy (ITEP), a nonpartisan research organization based in Washington, D.C. The top 1 percent, on the other hand, would get a tax cut of more than $3,800 on average, ITEP estimates.

More than half of Alabama families earning less than $18,000 a year would pay more in taxes under the plan, according to ITEP. By contrast, 90 percent of Alabamians earning $431,000 or more would get a tax break.

“Under SB 409 as written, millionaires get a great deal: a tax cut of nearly $4,000 on average,” Arise's Kimble Forrister told senators Wednesday during a public hearing on the bill. “At the lower end, Alabama families would pay income tax on their first $100. No other state does this.”

SB 409 would replace Alabama’s nominally progressive income tax rates starting in 2017 with a single rate: 2.75 percent for individuals and 4.59 percent for corporations. The top rates now are 5 percent for individuals (on taxable income above $3,000) and 6.5 percent for corporations. The plan – sponsored by Sen. Bill Hightower, R-Mobile – would offset some of the revenue loss by ending the state’s federal income tax (FIT) deduction, which overwhelmingly benefits high earners.

The plan would end most state income tax breaks for individuals – but not for corporations. Individuals could claim a deduction only if it is for a charitable contribution or required by federal law, unless 80 percent of the Legislature approves a new deduction. But SB 409 would protect almost all corporate tax credits, deductions and exemptions. More than 80 percent of SB 409’s corporate tax cuts would benefit out-of-state corporations and stockholders, ITEP estimates.

The proposal also could cut funding for public schools significantly. The plan as written would reduce revenues by $146.5 million a year, the Legislative Fiscal Office estimates. That would pile on even more cuts to K-12 and higher education in Alabama, which has made some of the nation’s deepest K-12 and higher education cuts since the Great Recession. State education funding is still well below 2008 levels.

SB 409 is a proposed state constitutional amendment. It would require legislative approval this year and voter approval in 2016.

The Senate committee carried over the bill at Hightower’s request Wednesday, but it could return later this session. Hightower said he intends to address concerns with the plan by making changes to help protect low-income families and retirees and to avoid reducing education revenues. Read the Associated Press' coverage for more details.

By Chris Sanders, communications director, and Carol Gundlach, policy analyst. Posted April 28, 2015. Updated April 29, 2015.

2015 legislative update: Alabama crossroads: We need new revenue

We all want to live in a healthy, secure and prosperous state. Alabama is taking important steps toward that goal now, but deep General Fund budget cuts could undo that progress.

Medicaid’s new regional care organizations will keep patients healthier while cutting costs. Prison system improvements will protect Alabamians while lowering costs and helping former inmates transition back into their communities. Investing in these changes now will save money later.

We’re at a crossroads in Alabama. Cutting vital services is the wrong path.

The devastating cuts in the no-new-revenue General Fund budget proposal would force us to abandon our Medicaid and corrections improvements. And without new revenue, Alabama faces deep service cuts that could make the state a worse place to live for years to come.

Cuts to Medicaid, which covers one in five Alabamians, would top $300 million. That would force the program to end coverage of vital services like adult eyeglasses, prosthetics, hospice care and outpatient dialysis. It also likely would lead to even fewer doctors serving Medicaid patients, most of whom are children, seniors, and people with disabilities.

The costs for Alabama’s children would be real. Cuts to the Department of Human Resources (DHR) would make Alabama the first state to end its Temporary Assistance for Needy Families (TANF) program. That would eliminate cash assistance for more than 30,000 children living in deep poverty, as well as uniforms, car repairs and other job readiness assistance for their parents.

DHR cuts also would end child care benefits for 15,000 children. That could hurt our state’s economy by forcing thousands of working parents to quit their jobs. More than $340 million in child support payments would be risk if DHR ends collection services, and hundreds of seniors would lose adult day care services that allow them to live independently.

Mental health funding cuts would harm more than 25,000 Alabamians by reducing or eliminating community-based mental illness and intellectual disability services. That would reduce independence for thousands of Alabamians. The cuts also could cost hundreds of people their jobs by forcing them to stay home to care for family members who lose crucial support services. In addition, severe mental health cuts could land Alabama back in federal court.

Deep General Fund cuts would have serious public safety implications as well. Nearly a fourth of Alabama’s state troopers would be laid off. The prison system, which already operates at nearly twice its designed capacity, would close two facilities. That would mean even more overcrowding and an even greater chance of a federal takeover of the state’s prison system.

More than 1,100 state workers would lose their jobs, including more than 600 court employees. That likely would force courts to close at least two days a week, meaning longer wait times for criminal trials or restitution cases.

This is no way to invest in our state’s future. Alabama needs new revenue to end the chronic budget shortfalls that are holding us back. The General Fund needs a sustainable revenue stream to support Medicaid, corrections, mental health care and other vital services. Raising the cigarette tax and raising the state sales tax on automobiles to 4 percent – the same as we pay on groceries – would be two good places to start.

If we want a better Alabama tomorrow, we need to start building it today.

By Kimble Forrister, executive director. Posted April 23, 2015.

2015 legislative update: Bills to reform payday lending, change Accountability Act clear Alabama legislative committees

Alabama borrowers would have much longer to repay payday loans under a bill that emerged from a state Senate committee Wednesday. SB 335, sponsored by Sen. Slade Blackwell, R-Mountain Brook, now awaits action by the full Senate.

Blackwell’s bill would bring substantial reform to the payday loan industry in Alabama. It would extend the length of time that borrowers have to repay their loans to six months. Alabama law allows payday lenders to set loan terms between 10 and 31 days, but nearly every transaction is a two-week loan term.

The bill received a favorable report from the Senate Banking and Insurance Committee, which Blackwell chairs, by a vote of 11-1. Only Sen. Tom Whatley, R-Auburn, dissented.

Accountability Act changes clear House committee with two amendments

A bill that would expand tax credits and limit the size of scholarships under the Alabama Accountability Act (AAA) won House committee approval Wednesday. SB 71, sponsored by Senate President Pro Tem Del Marsh, R-Anniston, passed the Senate last month and awaits action by the full House.

The House’s education budget committee made two changes to the bill. Students already receiving AAA scholarships would remain eligible for that assistance as long as their family’s income does not exceed 275 percent of the federal poverty level – about $66,000 for a family of four – under an amendment offered by Rep. Phil Williams, R-Huntsville.

Another amendment by Rep. Terri Collins, R-Decatur, would require an independent comparison of the test scores of students participating in the AAA scholarship program to those of similar students in public schools. Collins’ amendment also would exclude schools that serve students with special needs from the act’s definition of “failing schools.”

The AAA, passed in 2011, allows Alabama businesses and individuals to get tax credits for donations to organizations that grant scholarships to help eligible students attend private schools. Click here to learn more about the act and how SB 71 would change it.

By Stephen Stetson, policy analyst, and Rebecca Jackson, communications and development associate. Posted April 15, 2015.

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