JAC Index 011816am1 Monday, January 18, 2016 Agenda Public Comment 002-Secretry of State 049-DFS 048WDH Governor’s Letters Additional callbacks, Committee planning, work budgets, as necessary 1/18/2016 8:58:48 AM Committee called to order by Chairman Harshman Roll Call by Don Richards – Quorum (Representative Greear and Senator Perkins excused) 1/18/2016 8:59:41 AM Harshman: Welcome. Explanation John Corra; Trona Alkali Corporation: Support of Medicaid Expansion. Business Council in favor of it. Reasons for support include lowering costs for employees, slowing costs to employers, recruitment. Deacon Mike Leman, Legislative Liaison for the Diocese of Cheyenne: Support of Medicaid Expansion. Focus on people. Lack of care leads to Emergency Room Visits. Harshman: New to Cheyenne? Leman: Not new to Cheyenne, new to this position Eric Boley, President of Wyoming Hospital Association and Leading Age of Wyoming; Support of Medicaid Expansion. Costs over 110 M per year for uncompensated care. Budget and humanitarian view. Coverage would give preventative care, management of chronic illnesses. Example: Colorado. Long term care perspective. If expansion is only for a limited time, still making peoples’ lives better. Stubson: How much of the Medicaid dollars would go to hospitals, not to other providers? Boley: Do not know woodwork effect. We expect at least 10% of uncompensated charity cost would be covered. Burns: Is decision unanimous for all hospitals, including Sheridan? Boley: yes, spoken personally Burns: Not, what he told me. Connolly: Boley: At least 10% covered Harshman: That is cost, not charges. Charges are more than double that. Federal reporting standard and uniform or reported differently by county. Boley: SF last year. It is a standard form, that is where the figures are coming from. Charlie Katebi, Liberty Group. Against Medicaid expansion Policy Analyst. Individuals 100% of poverty level up are eligible for significant benefits on ACA. Medicaid reimburses hospitals for 84%. Insurance covers over 100%. Hospitals are better off is individuals seek insurance under ACA, than under Medicaid expansion. 3rd option of Governor Mead: Assumptions: 1 Fed gov. will cover 90+%of cost 2. Wyoming can repeal Medicaid expansion, if funding is cut. 3. Enrollment numbers and Medicaid will save money Rebuttal of assumptions. 1; Fed government can’t afford it. Congress does not intend to keep the promise. 2. Supreme Court ruling. If state expands then rolls back, federal govt. can roll back all Medicaid dollars. Handout 999-007 Buckeye Institute 3. Enrollment projections only estimate number of people eligible to enroll. 50 to 75% of people dropped employee insurance to enroll in Medicaid. If Wyoming enrolls twice as many as expected, it will cost over 22M and if it mirrors Colorado, cost will be over 33 M. Under federal law, Medicaid can’t pay for involuntary commitments. Forslund testimony will allow at-risk individuals to seek treatment. WDH does have information on this. There is a reason Governor Mead’s plan is so low on details. Sarah Gorin, Retired as executive Director of Downtown Clinic, Laramie: Board of Directors is on record as being in favor of Medicaid Expansion. Handout 999-006. People taking care of elderly family members are saving the state cost of a Medicaid bed in a facility. Reasons people can’t hold jobs. This is an investment in the workforce. Connolly: Respond to we have downtown clinic, do not need Medicaid expansion Gorin: We turn away clients from other communities. We serve only Albany county residents. Clinic is not a solution. Charity care is paid for by insured and self paid. Limited hours, volunteers. Cindie Langston, Wyoming solid Waste & Recycling Associations: Topic is landfills. !. Support allocating 17 M to cease and transfer program to close landfills. 2. Concerned about orphan site being funded by LSRA. 3. Rep. Larsen has an amendment to give DEQ an alternative to give landowners who have no funding to do a higher percentage of the loan grant. (standard is 25%). Mary Crosby: President of the Board: Support Cindie Langston’s comments. Do not want to see anything stop the momentum of closing landfills. Burns: How far through the list are you? Langston: Just beginning to start the closures. Do not want landfills to end up in the remediation program. Six for the next year (annual) Jeff Gardner, Laura McKinney: Jeff is executive director of Wyoming service providers. Collectively, members support adults through home waiver program. Proposed rates in governor’s budget will eliminate many of the providers of this program. Current rate approach is inadequate. HB 52 provided $8M but did not fully fund costs. Gave history of legislative action. There is a crisis, need immediate relief and a long-term fix. Flaws in costs study. Stubson; $3 M federal and $3M state. What is correct number? Gardener: Closer to 22M Stubson: Total amount Gardner: That is the total amount. Jason Mincer removed name from the list. Dr. Hollis Hackman, representing Wyoming Psychological Associations, part of Healthy Wyoming: Last week in Joint Labor, Title 25 joint subcommittee. Trouble finding space in state hospital. Projected spike in admissions to the state hospital for commitments. Explanation of situation for an individual with no insurance. If folks had insurance, it would be more likely they would pursue health services. We believe it would help with suicide rate in the state. Handout 999-008 from Healthy Wyoming. Maureen Bader, Wyoming Liberty Group: State fiscal situation. Last downturn was for 17 years. Alternative funding sources is thinly veiled reference for tax increases. Private sector is going to also turn down. Weed waste out of the Wyoming budget. Fundamental reforms, bring spending down to a level that existing taxpayers can fund. Shrink size of government. Harshman: Break then agency callbacks, may mark up budgets later today. Governor’s letters will be arriving. Budget is crafted in summer, finished by October. Takes 7 votes to change the governor’s budget. Mirror budget bill. Each chamber then makes amendments. 1/18/2016 9:56:28 AM 1/18/2016 10:05:37 AM Harshman: Meeting called back to order. Agency 002- Secretary of state Hastert: Asked SOS to come back in and discuss the PR position. Karen Wheeler, Deputy Secretary of State with Tom Cowan and Kyndra Herrera Wheeler: page 22 of the budget book. ER #3. Explanation of our need. Handout. I need this position. Oversees elections, files for businesses, transport of bodies for international areas, international adoptions, study abroad need apostille. Investment fraud. 1800 filings in one day. 5 days to turn those around. 4000 phone calls a month. The public information officer works to identify a strategy to get information to constituents and limit phone calls. Asking for position. Not asking for new money. Hastert: Clearer understanding of the need. Currently have a person on contract. Wheeler: Contract bais, hired in August of last year. We would like to do an AWAC and use existing money within our budget. Stubson: current position paid out of 900? Herrera: Originally under 900 series, then B-11 for position in the 100, so using the 100 slush fund. Ross: 100 slush fund, Herrera: 100 series vacancy funds Stubson: All or nothing request? Wheeler: Greear:? Wheeler: Wyoming cost is 100, Nevada is 600. Annual report fee is minimum of 50. We will continue to see an increase from Nevada. Greear: inundate at year end? Wheeler: end of year is a peak time but increase is across the board Connolly: length of time using 900 series then moving to 100 series Wheeler: hired in August, December received AWC, which expires March 31. Connolly: prior to August was anyone doing this work? Wheeler: No. In 31 years, Mr. Cowan and I have seen change and growth. I have seen necessity for this position beginning 8 years ago. Example: New rules program. Hastert: Explanation of discussions regarding this position Wheeler; contract form sent to AG office, entered into AandI heat process, sole source contract approved by Director of AandI. Burns: How is this going to help people not get scammed? Wheeler: Not just for fraud, for other areas where we have services people do not know about. Burns: narrative social media, not legacy media. Older people who do not use social media are the ones who tend to get scammed. Wheeler: Newsletter development. Greear: When was the last time the annual fee, the minimum, was raised? Wheeler: around 1993 1/18/2016 10:25:19 AM Break. 1/18/2016 10:29:36 AM 049- Department of Family Services Baird: Crosswalk narrative, crosswalk on handout 049-158 Burns: Cross reference to the budget book Baird: page 20 and 21, explanation of columns on the handout. Harshman: Unit 5701 Baird: Energy Assistance Harshman: former unit was 6015? Baird: No it was 6021. Intent of budget is to give a better overall view of how we are spending the dollars Burns Greear: I agree with Burns, that we get the page numbers. Baird: I will update. Burkhart: In the third column, those do not correlate with the first column. They are just a summary. Harshman: Discussion of the spreadsheet. Baird: 7059 is energy assistance, 7824 is weatherization program, 5001R is Governor Statutory. We do not expect to claim those dollars, take out of the budget. Burkhart: Description of fund from LSO – penalty payment for mitigation of violations. Is this appropriate utilization of those funds. Baird: Probably not. Have not collected that money in. Burkhart: is that money sitting in a fund? Baird: I do not know about the fund. I know we collected dollars into our budget from that fund and used it for weatherization and low income assistance. Harshman: Funds? Richards: We will get you the fund balances. All of those funds should be pulled out of their budget. Both the revenues and the expenditures should be pulled out. The 1.8M has not been available for several years. Agencies should keep those up to date and pull back revenues they are not receiving. Agar: Funds are part of the state plan – provide restitution through the dept .of energy. Use of funds are governed by the federal govt. Harshman: Primary use? Burkhart: LSO spreadsheet. Energy office of WBC administers these funds. Gave balances of 3 funds. Agar: JAC fund analysis worksheet. Will be in your pre session thumb drive . Support for statewide energy plan. These are one time funds. Encouraged to pursue other sources of funding. Several biennia since they have been used for weatherization/energy purposes. Corsi: 1.8M needs to be pulled out. We will make the policy adjustments to bring the expenses back in line. Ross: Under 5701, 21.9M. GF plus FF should equal 21.9M. Will redact out the 1.8M? Do the funds revert? Agar: They just sit in that fund. They do not revert or do not grow. Deposited and earn interest as part of pooled funds so interest goes to the GF. Burkhart: Restrictions placed on the funds. Analysis of restrictions? Fund 404, 405 and 406. Agar: We have a request into the WBC for those restrictions. 1/18/2016 10:52:49 AM Harshman: Unit 5801 Baird: unit 5801 Boys School, page 28 and 29. Total Ross: 5906 is girls school? Baird: correct, transferred 14000 from boys school to the girls school, equal split which it should not be because of the population so made a slight split. Harshman: Baird: Title 1 dollars, education component. Harshman: Last column are all federal dollars. Baird: Correct Unit 5802 Girls school unit. Majority GF, some education non-statutory. 4E independent federal living dollars. Unit 5901 pages 60 and 61 – Director’s unit – Historically had 2 people, will move to 47 people so funded from many different unit Harshman: People in Cheyenne or dispersed? Baird: majority are in Cheyenne, HR, Accounting, Director’s staff. Burns: What is special revenue? Baird: page 61 – statutory, TANIF,etc. Most would be administrative portion Connolly: Example unit 6015 – same dollars or proportioned out. Baird: Correct, you nailed it Connolly; The old 6015 will zero out? Baird: 6015-6061 will disappear Harshman: 5902 new unit – Baird 5902 on pages 72 and 73 of budget book. Name is protective services. Stubson: Why do we have 5901 if there are zero dollars, people, etc. Baird: I did not take it out. Harshman: new proposed unit 5903? Baird: It is the old crisis bed unit, no change, page 101. Page 2 of spreadsheet handout 049-158 Unit 5904, pages 106- 108, juvenile justice unit. Developed from a lot of different units. 23 employees, About 50/50 GF. Federal dollars and special revenue. I will have to look up what the 36,000 is. In budget book, 5905 and 5906 are being eliminated. Unit 5908, child and abuse neglect trust page , pg. old unit developed into new one, no change Unit 5909, substance abuse and treatment pg 150 and 151, developed from old unit, no change, primarily tobacco funds, this is first of the two tobacco fund changes. Harshman: fund Baird: Fund 1567 Harshman: Baird: unit 5909, does not include the governor’s recommendation to reduce so development of the budget did not include the 800,000 Harshman: What is the number? Baird: 4.71M 4,710,789 dollars in tobacco fund money in this unit. Connolly: Looking at the agency’s recommendation or the governor’s Baird: development of the agency’s request, did not include the governor’s recommendation. It is the only issue, happens in two cases Burns: 800,000 cut from urinalysis Baird: a lot of different things, working on contractor list. Ankle bracelets, others Burns Baird: The number is set, will have to look at what is being cut. Harshman: unit 5910 Baird: page 156, unit 5910 - developed from unit 6016 Unit 5911, child support enforcement, unit pages 157-162 Unit 5912, child care unit, page 168-169; unit 6020 titled early childhood development xxx Unit 5913 Page 177-78, Unit 5915, pager 185-186, Field staff, Unit 5916 tribal unit, page 230, new unit Harshman: Baird: TANIF funds Harshman: mainly unit 6017 which will go away Baird: Correct Burns: New units from old units, Total amount on the first page under GF? Baird: no. unit 5016, located in 5701, 5901,5904, follows throughout. Greear: Units 5916, tribal assistance, 4 E relationship, shift of 65% of cost of this unit. Northern Arapahoe tribe has started in that relationship. Corsi: Clarification – 65% of the foster youth served by the northern Arapahoe would be eligible for 4E funding. Does not mean they would receive it. Lengthy process. Biennium 19-20 before it happens. Other tribes have expressed interest, are 6 to 8 months behind. We assume they will move ahead. Greer: Thank you. Connolly; Reorganization that is an accurate reflection of the work being done and make accounting more transparent. With the new units, TANIF, Tribal units, have new distinct units but no personnel. How to explain we have a new TANIF unit but without administrators. Baird: There is an administrator but she does other duties. Like expenditures lumped together. Difficult to identify federal funding sources. This budget allows us to do that in a more timely fashion. Connolly: You want us to allow this new reorganization. How do we know who is in charge of TANIF or Tribal or Crisis Beds? Baird: There have never been personnel in the crisis beds, not big enough for full time, basically a subsidy. Connolly: Burns: Where are the people? Baird: Explanation Nicholas: Follow-up from previous week. Unit 5915, how are we going to be able to manage your 100, 600, 900 series expenditures and know what you are doing and control of your ability to move those around. Baird: we agreed to provide you an updated narrative on that unit specifically. Historical comparison being provided Nicholas: Courtesy to us but does not fix the problem for the future so we have a full understanding. Harshman: We shared with the budget office. We will need more information before mark up and in the future. Baird: We have it, not finished yet Richards: Governor Letter 5 is about two large provisions with this department, revert and rescind. Harshman: 13-14 reversions are next topic. Baird: working with auditor’s office to get those finalized, 4,187,121.68 is the number we have for 13-14 for GF. Harshman: how much of federal funds was reverted? Baird: About 12 M Harshman: We want to make sure the burn rate is not to spend GF first. Harshman: 15-16 amount? Baird: 5 M. appropriated just under 14 M for WEST phase 2 – have slowed on that project. Wyo eligibility phase 1 still working on x. Giving back $5 Harshman: out of the 14 M how much has been spent or encumbered? Baird: only about 300,000, projection Corsi: returning that portion means WEST phase 2 won’t go forward at the same rate. Prudent thing to do. Hope to reapproach in the future. Corsi: Homelessness education funding in Dept. of Ed. We have followed up on initiating that conversation with that dept. Greear: Need to know so we can coordinate funding. Corsi: Need a meeting with them to find out what that is for. I think it is where it belongs. Harshman: 1/18/2016 11:29:14 AM 1/18/2016 11:50:51 AM Department of Health, 048 Tom Forslund, Director. Prepare an alternate budget without Medicaid expansion. Attachment B is the comparison of a budget with and without Medicaid budget. Table 1 is the department of health exception request without Medicaid expansion. MMIS, $5.6M general fund match and $57M with federal funds. $75M range, IT project. 90 federal funds/10 state fund match. Title 25 funding is now $11.9M shortfall. Equipment replacement for 2 facilities, paid by other funds. Computer replacement, 100% general fund. Department of Labor rule change. Pre-school enrollment growth. Health information exchange. $10M, 90% federal/10% state cost sharing. $23.7M state general fund, $63.4M federal funds, $1.M other funds. Table 2, budget exception request with Medicaid expansion. Obama has recommended that 19 states, if accept expansion, still be eligible for 100% funding. $9.2M state general fund, $332.3M federal funds. $1M other funds. Lower costs due to repurposing $$. Hastert: Drop out? Forslund: Voluntary program. States can opt out of Medicaid. Expansion, even if accepted, but can then opt out at a later date. Utilize a trigger percentage to opt out in legislation, then legislature would have to vote to maintain program. If state expands Medicaid, federal funds to providers, $263M over 2 years infused into state’s economy. 20,000 people with Medicaid coverage. 5 exception requests could be self-funded by the department if Medicaid expansion accepted. $22M-$23M savings to general fund. Hastert: Accurate number of those eligible? Forslund: Hired actuarial firm to formulate those numbers. Studied other states, and increased projections by 14%. Harshman: Why not offset exception requests within department Forslund: Still not cover 20,000 people. Harshman: Only effective for 2 years? Forslund: No bill, if no monies and strip out monies, then would have to withdraw coverage. Richards: Would roll into standard budget for next biennium with legislative approval. Forslund: approached CMS for accurate numbers in their experience with other states. Based on consultation and Wyoming experience. Other states have experienced an expansion of 1.5 to 3 times more than what was projected. Moniz: Track $1 thru expansion. Forslund: patient would see providers, providers submit costs to Medicaid, and Medicaid would pay providers. New blue budget book, tobacco fund reductions and expansion predominant changes. Burkhart: effects on state if withdraw once accept Medicaid expansion? Forslund: 75,000 people would lose insurance coverage, $1B less in federal funds. Elderly in nursing homes, waivers, children, CHIP program, pregnant women Burkhart: Who sets reimbursement rates? Forslund: State. Need to reimburse Medicaid providers a fair amount, highest participation rate in country for providers. Forslund: No state has opted out of expansion once accepting expansion, but some are instituting changes. Hastert: Eligibility, income levels? Johansson: 100% of federal poverty level is $11,000 per year; $16,000 for 138% of poverty level annually. Burns: 2-3 states which tried to alter coverage? Johansson: Some states wanted to reduce eligibility for Medicaid expansion, which was rejected. Connolly: private insurance that would move to Medicaid? Forslund: paying health insurance premiums on low income, co-pays, deductibles would help total income for those moving to Medicaid expansion. Burkhart: Attachment A, vacancies, biennium Forslund: Title 25 costs have been offset by vacancies 1/18/2016 1:03:27 PM Lunch Break until 3:00 p.m.