Wednesday, April 22

Wednesday, April 22

Fiscal notes complicate budget picture; Nursing homes try to carve special deal; Jindal opposes TOPS reform; Budget cuts threaten hospital partnerships

Fiscal notes complicate budget picture
Efforts by legislators to put a deal together that re-balances the state budget -and adheres to the governor’s “no net new revenues” pledge – have hit an unexpected snag: The financial impact of several bills being considered to close the budget gap is far less than the authors had anticipated. Case in point – Sen. Robert Adley’s bill to get rid of the state inventory tax (and the tax credit that accompanies it) would save no money in the 2015-16 fiscal year, and the big savings would not materialize until 2017-18. As reports:

But the state senator is hardly the only legislator running into these types of problems. Several lawmakers are finding that the legislative fiscal analyses of their budget bills — often called fiscal notes — show financial returns for the coming fiscal year far lower than they had anticipated. A number of the tax bills the House Ways and Means Committee is seriously considering as solutions to Louisiana’s budget crisis aren’t hitting the revenue numbers legislators had thought they would. “My fear is we are getting these low fiscal notes. [The financial estimates] differ significantly from the early ones from the Department of Revenue,” said state Rep. Joel Robideaux, R-Lafayette, head of the Ways and Means Committee, which oversees tax policy for the House. While the proposals may save the state money over time, many won’t help generate the quick cash needed to address Louisiana’s $1.6 billion gap in the state budget next year. They would have had to be implemented last year, or the year before, to see the full financial return in the coming year.


Nursing homes trying to carve special deal
The final phase of Gov. Bobby Jindal’s plan to privatize health services for the poor in Louisiana involves hiring a managed care company to oversee long-term care for the elderly and people with disabilities. The idea is to save the state money – and provide people with appropriate care – by making sure people are cared for in the most appropriate settings, whether that’s a 24-hours nursing facility or less intensive home-care services. But as Marsha Shuler reports in The Advocate, Louisiana’s powerful (and lucrative) nursing home industry wants no part of the deal.

State Department of Health and Hospitals Secretary Kathy Kliebert confirmed that the Louisiana Nursing Home Association “has expressed concerns about nursing homes being included.” Jindal’s office said he had no opinion on the exclusion of nursing homes. In a statement, Jindal said DHH should continue its “due diligence to ensure the process results in the best quality care.” AARP Louisiana director of advocacy Andrew Muhl said managed care companies are “incentivized” to move people to home- and community-based settings if it’s suitable and less expensive. “If nursing homes are able to carve themselves out, it’s going to fragment health care opportunities for everyone and reduce choices for seniors,” Muhl said. “It will likely result in longer wait times for people who want to live independently in their homes.”


Jindal opposes TOPS reforms
Despite support from Phyllis Taylor, whose late husband start the state’s TOPS program,  Gov. Bobby Jindal is opposed a bill proposed by Sen. Jack Donohue to cap spending on the college tuition program.’s Julie O’Donoghue reports that legislators are concerned that the ballooning cost of the program will continue to strain the state budget.

Currently, the TOPS scholarship award — which is paid with state government funds — increases every time tuition rises. If state Sen. Jack Donahue’s bill became law, the Legislature would have to approve any TOPS award increases after the 2015-2016 school year, so the scholarship wouldn’t automatically cover future tuition increases. Several legislators have expressed concern over the escalating cost of TOPS, worrying the state won’t be able to afford the generous tuition program in future years. TOPS was expected to cost the state over $250 million this year and $387 million by 2018-2019. In a state facing a significant budget problem, the price tag of the program could grow to be too expensive for Louisiana to keep.


Budget cuts threaten partnership hospitals
The nine private hospitals that received no-bid contracts from Gov. Bobby Jindal’s administration to provide charity care for the uninsured have banded together into a new coalition. And they want more money. The Alliance of Partnership Hospitals visited the Senate Health and Welfare Committee Tuesday to make its case for more funding, reported Marsha Shuler for The Advocate.

The Jindal administration’s proposed budget is between $300 million and $400 million shy of the revenues required for a standstill budget for the public- private partnership. It would translate into a 33 percent cut. Jindal relies on legislators passing a series of tax law changes to fund his budget. In addition, the budget proposal does not provide for $159 million in additional funding the partners say they need to care for the poor and uninsured in the fiscal year that begins July 1. That number has risen from the original $142 million projected by the eight hospitals as Our Lady of the Lake Regional Medical Center in Baton Rouge upped its requirements. “Certainly all partners are going to be in a very difficult situation if these monies don’t come through,” said David Callecod, the president and chief executive officer at Lafayette General Health. Callecod said the hospitals can’t operate with a 33 percent budget cut. And if hospitals don’t get the additional dollars requested, “it’s going to result in service reductions,” he said.


Number of the Day

70 – Percentage of Louisianans over 45 who “strongly support” more dollars being spent on home- and community-based care options at the expense of nursing homes (Source: AARP survey via The Advocate).