Joint Committee Committee on Joint Health and Human Services (01/22/2009)

Final
STAFF SUMMARY OF MEETING

COMMITTEE ON JOINT HEALTH AND HUMAN SERVICES

Date:	01/22/2009	ATTENDANCE

Time:	01:38 PM to 04:14 PM	Acree	X
		Carroll M.	X
Place:	LSB A	Gagliardi	X
		Gerou	X
This Meeting was called to order by		Green	*
	Senator Boyd	Kefalas	X
		Kerr J.	X
This Report was prepared by		Lundberg	X
	Elizabeth Burger	McGihon	*
		Mitchell	E
		Morse	X
		Newell	X
		Nickell	X
		Primavera	X
		Schultheis	X
		Swalm	X
		Tochtrop	X
		Riesberg	X
		Boyd	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
JBC Briefing Review of Tobacco Settlement Moneys Briefing by the Dept. of Public Health and Envt.		- - -

01:39 PM -- JBC Briefing

Representative Ferrandino began the briefing by the Joint Budget Committee (JBC) to the Joint Health and Human Services committee. A handout was distributed to the committee (Attachment A). He discussed the state's revenue shortfall, noting that over $600 million must be cut from the current fiscal year budget. He discussed the FY 2009-10 budget request for the Department of Health Care Policy and Financing. He gave an overview of the funding sources for the department and described the responsibilities of the department. He drew the committee's attention to page 2 of the handout, which illustrates the eligibility levels for state health programs. He discussed the caseloads for various health care programs. He noted that enrollment in the Children's Basic Health Plan is declining, in part because more of the children previously eligible for the program are now eligible for Medicaid. In addition, new eligibility verification requirements have caused a decline in the enrollment of the program. He described some of the department's budgetary decision items. Representative Ferrandino responded to questions from Representative Gerou regarding increases in the Medicaid caseload. Representative Ferrandino responded to questions from Senator Lundberg regarding anticipated growth in the General Fund in FY 2009-10 and 2010-11 and revenue estimates from the Governor's Office and the Legislative Council Staff. Representative Kefalas asked how the state could cover the increase in Medicaid caseload, given the state's declining revenues. Representative Ferrandino discussed possible federal dollars that may come to the state as part of a federal stimulus package. Representative Ferrandino responded to questions from Senator Morse regarding whether an increase in federal matching dollars for Medicaid would help the state reach the allowable 6 percent limit on appropriations.

02:00 PM

Representative Ferrandino began his overview of the budget of the Department of Human Services, describing the funding sources for the department. He emphasized that the department receives a significant amount of reappropriated funds, most of which are transfers from the Department of Health Care Policy and Financing. He stated that the department is complex and administers services directly and through contracts with private providers, as well as through local agencies. He discussed some of the cost drivers within the department, including services for individuals with developmental disabilities and child welfare services. Representative Gerou asked why services for individuals with developmental disabilities were "unbundled" in recent years.

02:07 PM

Representative Ferrandino began his overview of the budget of Public Health and Environment, noting that the department receives limited General Funding. A large amount of the department's budget is comprised of federal funds. He described the major activities of the department. He highlighted two of the department's decision items. He stated that the first request concerns funding for a public health lab in Lowry. The second item concerns state funding for emergency preparedness, which will allow the state to access federal moneys on emergency preparedness activities.

02:12 PM

Representative Ferrandino noted that the handout (Attachment A) contains a summary of the budget cuts proposed by the governor for all three departments. Representative Kerr asked how the state can prioritize what cuts are made and the services that should be provided by the government. Various members commented on where the budget cuts should be made and the process for determining the cuts. Senator Schultheis asked for clarification regarding the timing of the budget cuts. Senator Lundberg commented on the possibility that the March revenue forecast may require further cuts to the state's FY 2008-09 budget. Senator Carroll asked if there was an opportunity to find administrative efficiencies that may prevent programmatic cuts.

02:37 PM -- Review of Tobacco Settlement Moneys

Steve Allen, Joint Budget Committee Staff, reviewed the requirements relating the statutorily-required review of tobacco settlement moneys by the JBC and the Joint HHS committee. A packet of materials was distributed to the committee (Attachment B). He gave an overview of the distribution of tobacco settlement moneys and of the required payments of the tobacco manufacturers that are not participants in the master settlement agreement. Mr. Allen responded to questions from Senator Carroll regarding enforcement policies for the nonparticipating states. He responded to additional questions from Representative Gerou regarding the escrow accounts that nonparticipating and participating tobacco manufacturers must pay into.

02:56 PM

Dr. Ned Calonge, Department of Public Health and Environment, stated that more master settlement agreement moneys are being used for direct health care services than in the past.

02:57 PM

Cindi Stetson, State Auditor's Office, noted that the packet contains the most recent audits on the programs that receive tobacco settlement moneys. She listed the audits that have been conducted since the JBC and Joint HHS committee last reviewed the use of tobacco settlement moneys in 2006. She responded to questions from Representative Kefalas regarding whether the programs that were evaluated by the auditor's office were meeting their programmatic goals. Mr. Allen responded to questions from Representative Swalm regarding the costs of administering the programs.

03:00 PM

Senator Boyd stated that the committee's job is to recommend a draft bill with a date by which the committees should meet again to review the tobacco settlement moneys. Representative Riesberg asked Mr. Allen to summarize his recommendation to the JBC regarding further review of the programs by the Joint HHS committee and JBC. Mr. Allen summarized his recommendation that the meetings be discontinued. He responded to comments from Representative Kerr regarding whether the sunset process should be used to review the use of the tobacco settlement moneys. Dr. Calonge stated that the Department of Public Health and Environment agrees with the primary recommendation that the Joint HHS and JBC review of the program be ended.

03:08 PM

Senator Boyd suggested that tobacco settlement funding for the Read to Achieve program be discontinued. Mr. Allen commented on the programs that receive tobacco settlement moneys, but do not have a strong health care component. Various committee members commented on the programs that receive tobacco moneys that are not health-related.

03:18 PM

Senator Boyd made a motion that a bill be drafted to eliminate the requirement that the JBC and the Joint HHS hold a meeting to review the use of tobacco settlement moneys. Dr. Calonge responded to comments from Senator Carroll reporting requirements for tobacco settlement moneys. Senator Boyd stated that the draft bill should include language ensuring that oversight of the programs continue, even though the formal meeting would end. With no objection from the committee, it was agreed a bill would be drafted to eliminate the required meeting and to ensure that oversight will continue. The committee discussed a possible second draft bill to eliminate tobacco settlement moneys for the Read to Achieve program. The committee discussed whether the bill could be drafted in such a way to specify where the money currently funding the Read to Achieve program could be redistributed. Senator Boyd suggested that the committee consider drafting a bill to create parameters for the committee to consider whether tobacco settlement funding for certain programs should be eliminated.

03:30 PM

Dr. Calonge responded to questions from Representative Swalm regarding the effect of eliminating funding for certain programs. Mr. Allen responded to questions from Representative Swalm regarding whether the master settlement agreement requires that the settlement moneys be spent on health care.

03:33 PM

Senator Boyd restated that a bill would be drafted to eliminate the required meeting between the Joint HHS committees and JBC. She suggested that the committee revisit the issue of whether funding for specific programs should be eliminated at a later meeting. She suggested that such a bill may best be carried as an individual bill, rather than a committee bill. Seeing no objection from any members, it was affirmed that the bill to eliminate the required review of tobacco settlement moneys by the Joint HHS committees and the JBC be drafted.

03:34 PM -- Briefing by the Department of Public Health and Environment

James Martin, Executive Director of the Department of Public Health and Environment, began the briefing regarding the activities of the Department of Public Health and Environment. He described the activities of the department associated with the contamination of the drinking water supply in Alamosa in 2008. He stated that one of the major activities of the department in the past year was to bring the Denver metropolitan area into compliance with the federal ozone standard. He stated that changes were made to the State Implementation Plan (SIP) to bring the state into compliance with the standard. He stated that further SIP changes will be required in 2013 to comply with additional federal air quality standards, and the changes to the SIP will be far-reaching.

03:41 PM

Mr. Martin continued by describing the department's activities with regard to food recalls. He discussed the budgetary situation for the department. He stated that the department is hoping to find funding for the state laboratory, and that it is his belief that the lab should be funded with General Fund moneys, and that the department is working with the JBC to identify funding to permit the state to match federal moneys for preparedness activities.

03:45 PM

Mr. Martin discussed the department's efforts to expand the mobile auto emissions program into Weld County, stating that the universe of options to achieve emissions reductions was narrowing. He stated it was the department's hope to move away from centralized facilities and toward mobile screening. He stated that the department is challenged to provide public health services in the current budgetary situation. He described the cuts proposed by the department for FY 2008-09. He noted that the governor is current reviewing their suggested cuts for FY 2009-10. He stated that the department's goal is to maintain its workforce so that services can recommence with the fiscal situation improves.

03:48 PM

Representative Gerou asked how much the department was seeking in funding for the state laboratory. Mr. Martin responded that the request was for about $1 million. Representative Kerr asked for further information on the department's recommendation to eliminate funding for education and testing for Hepatitis C. Dr. Ned Calonge, Chief Public Health Officer for the Department of Public Health and Environment, responded to additional comments from Representative Kefalas regarding proposed cuts to the Hepatitis C program. Mr. Martin further noted that all of the cuts proposed by the department were painful. Representative Gagliardi asked for additional information regarding cuts in funding for school-based health clinics. Dr. Calonge stated that the funding cuts will not affect existing clinics, but will reduce efforts to expand the use of school-based health clinics. Representative Swalm asked for an update regarding the situation with the Leadville Mine Drainage Tunnel. Mr. Martin stated that it appears as though pumping efforts have reduced water levels, and that the threat caused by water blockage in the tunnel has passed. Mr. Martin and Martha Rudolph, Department of Public Health and Environment, responded to a question from Representative Kefalas regarding the recent peanut butter recalls. Ms. Rudolph noted that there have been 12 cases of salmonella in Colorado linked to peanut butter.

04:11 PM

Mr. Martin distributed a summary of some of the department's recent activities (Attachment C). Representative Riesberg announced that the House HHS committee would meet upon adjournment of the meeting. The committee adjourned.