Health-care needs focus of first day of state budget hearings

By Rebecca Grapevine, Capitol Beat News Service

ATLANTA – The mental health of Georgians, especially children, took center stage Tuesday during the first day of state budget hearings at the state Capitol.

Leaders of Georgia’s main health-care agencies told legislators how they plan to address the challenges Georgians face as well as how much those plans will cost.

Candice Broce, director of the Georgia Division of Family and Children Services (DFCS), told lawmakers about the problem of “hoteling,” which refers to boarding foster-care children and youth in hotels or offices because appropriate placements cannot be found for them, usually due to complicated behavioral health issues.

“On any given night in Georgia, roughly 50 to 70 children in foster care with complex needs will sleep in a local office or hotel,” Broce said. She called the practice “heartbreaking,” adding that the practice cost the state more than $28 million in fiscal year 2022.

“Since joining this agency, we have been hell-bent on ending hoteling,” Broce said.

DFCS started a program to pay enhanced per-diem rates and provide emergency grants to incentivize caretakers to take on the foster-care children most at risk for hoteling.

The pilot project is working, Broce said. Last June, the state hit an all-time low of fewer than 20 children in hotels or offices. And, she said, stays in offices and hotels have also been shortened for many foster-care children.

Broce also said DFCS has developed draft legislation to address the hoteling problem for lawmakers to consider this session. The issue has emerged as a top concern for lawmakers on both sides of the aisle, including Sen. Blake Tillery, R- Vidalia, chairman of the Senate Appropriations Committee, and Rep. Mary Margaret Oliver, D-Decatur, a leader in the state’s mental health reform efforts.

Kevin Tanner, a former state representative who took over as commissioner of the Department of Behavioral Health and Developmental Disabilities (DBHDD) last month, outlined several steps his agency is taking to help stem the flow of children into foster care in the first place. He noted that the Multi-Agency Treatment for Children (MATCH) Committee – created by last year’s mental-health-reform law – began meeting last month to work on child-welfare issues like hoteling.

Tanner also said his agency works with DFCS and local community-service boards to provide residential treatment to mothers who are experiencing substance abuse or behavioral health issues. The programs allow children to stay with their mothers during treatment and help prevent the fracturing of families, Tanner said.

“I look forward to … [making] sure every family at risk of foster care because of a parent’s substance abuse has access to the program in the future,” Tanner told lawmakers.

DBHDD also plans to build a behavioral health crisis center in Fulton County and convert an existing facility in Dublin to a higher-level behavioral crisis center if the legislature approves Gov. Brian Kemp’s request for $11.1 million for the two projects.

State agencies across the board are struggling to hire and retain the workers necessary to provide the social services Georgians need. Kemp’s proposed budget includes a $2,000 pay raise for all state employees.

Statewide, the turnover rate is around 25%, a historic high, said Rebecca Sullivan, commissioner of the state Department of Administrative Services. The high turnover rates come with increased financial costs as well as intangible hits, such as the loss of institutional knowledge, Sullivan said.

Tanner said his agency has been unable to fill positions at the five state psychiatric hospitals, forcing them to rely on Jackson Healthcare, a staffing agency, to fill more than 450 jobs.

Broce said many frontline caseworkers leave due not to pay but to the heavy emotional demands of the job, though she said turnover for such workers has started to decrease since the height of the pandemic.

In good news, Commissioner Caylee Noggle of the Georgia Department of Community Health explained how new funding strategies and increased federal funds will increase resources for hospitals across the state, both rural and urban. The goal, she said, is to eliminate the burden of uncompensated care that small, rural hospitals must shoulder for uninsured and low-income patients.

The state’s health-care agencies are collaborating to staff up and prepare for what is known as “the great unwinding,” which will take place in April, when the federal government will relax pandemic-era regulations that prevented states from disenrolling people from Medicaid. Georgia will need to re-examine the eligibility of more than 2 million people now enrolled in the Medicaid insurance program.

The health-care administrators said they have developed plans for what will be a complicated cross-agency operation. Kemp’s budget includes funding for the staffing and technology upgrades necessary for the big change.