Moderated by Tom Sabulis
Grady Memorial Hospital could learn next week if Fulton County plans to cut funding for mental health services. Rosalynn Carter, a longtime champion of mental health issues, writes that the county cuts would send an unfortunate message just as Georgia was making strides in the mental health arena. Fulton Chairman John Eaves says others need to help share Grady’s load, beginning with state expansion of Medicaid.
By Rosalynn Carter
The Fulton County Commission must avoid the proposed cuts to Grady Memorial Hospital’s mental health services. The loss of the Grady programs these monies fund will be devastating. Emergency rooms at area hospitals will overflow with mental health patients in crisis. With an already inadequate capacity, the regional hospital will have to turn away more citizens in need. The jail population likely will increase as it becomes practically the only alternative for shelter and care. The county may cut the Grady contract, only to end up paying for more expensive psychiatric services at other hospitals.
In metro Atlanta, Grady provides a large volume of inpatient and outpatient mental health services. The clinics of the Fulton County Health Department and a few nonprofit entities, such as Community Friendship and St. Jude’s House, back up the Grady system. Last year, Grady opened a walk-in clinic downtown that has helped homeless citizens and long-time Grady patients receive community-based services, including counseling, medications and peer support. This clinic helped divert patients from Grady’s and other hospitals’ emergency rooms to a less expensive setting where they get better care. Grady serves over 10,000 patients annually, representing more than 66,000 visits.
The hospital is funded in large part by Fulton County through a contract to serve indigent patients from the neighborhoods as well as the Fulton County Jail. Unfortunately, Fulton County faces significant budget pressures, and the county’s staff has proposed to cut the Grady contract by up to $25 million. Fulton County also provides the bulk of funding for community mental health services, which also are slated for cuts. The service and financing systems are inextricably intertwined.
Grady has indicated that cuts of this magnitude could force it to discontinue services to Fulton’s jail inmates. Furthermore, Grady’s support of the overcrowded Georgia Regional Hospital in DeKalb County is threatened.
Georgia has made great strides in moving away from state hospital-based mental health systems to ones rooted in community-based services, an evolution central to supporting a best practice “recovery” model where people who have mental illnesses receive services near home, close to their families and support systems. One reason for our state’s significant progress is the settlement agreement between the Georgia Department of Behavioral Health and Disabilities and the U.S. Department of Justice. The agreement requires the establishment of a range of community-based services for Georgians who have been in state hospitals because of developmental disabilities or mental illnesses. Gov. Nathan Deal has proposed, and the General Assembly has appropriated, significant new state funds to pay for the department’s efforts.
I worry that the progress Georgia has made will be thwarted in our state’s capital and most populous area. Surely, the Fulton County commissioners can find a way to prevent these cuts.
Former First Lady Rosalynn Carter has worked on mental health issues for more than four decades and founded the Carter Center’s Mental Health Program in 1991.
By John Eaves
I love Grady Memorial Hospital. I have worked diligently to ensure Grady’s success. I believe in the mission of the hospital and have chosen to be a patient there because of its high quality of care, and because I believe it is critical that Grady has patients that help the hospital financially.
I believe Grady is the most important thing Fulton County funds; that includes physical health and mental health. Since I came into office in 2007, Fulton has invested more than $466 million in Grady. But I don’t believe we are mandated to fund Grady, and that puts us in a tough financial position.
Fulton faces a significant budget shortfall in 2014; 2015 looks worse.
We have not increased our millage rate since 1991 despite the Great Recession and revenue policy changes from the General Assembly.
Since 2006, the Legislature has cut our annual budget by $64 million. In 2006, it slashed the county’s share of the sales tax formula from 35 percent to 15 percent, for a $40 million annual reduction. In 2009, it increased the county’s homestead exemption from $15,000 to $30,000, resulting in a $24 million annual reduction. In 2014, the county faces a further annual cut of $48 million if the Senate approves legislation already approved by the House.
Fulton is the only one of five core metro Atlanta counties that did not increase its millage rate since the beginning of the 2008 economic downturn. We used our reserves instead of raising taxes, waiting for property values to rebound. We cannot do this anymore.
Fulton must create a new sustainable business model. We are working to that end. But expecting us to meet constitutional obligations to the jail, the courts and the health system while the General Assembly removes tens of millions from our budget is unrealistic.
Grady also faces tough times. Georgia’s failure to expand Medicaid significantly affects Grady. The Affordable Care Act (ACA) reduces health care costs by incentivizing the right care at the right time at the right place, a culture shift for the patients who use Grady staff as their primary care physicians.
Regrettably, these savings are attained in part by decreasing existing reimbursements and supplemental payments, which significantly affects safety-net hospitals. By 2018, Grady’s loss alone will be over $45 million per year. Finally, Georgia is considering a change in one of its formulas that could cut funding to Grady by $24 million a year.
So, Fulton reaches a crossroads. Shall we maintain our current course, which will likely require $25 million in cuts to Grady this year? Or shall we consider a dedicated revenue stream of funding for Grady through the establishment of a hospital assessment that pays for both operations and debt?
I believe Atlanta can’t live without Grady. But why is it that Fulton County and, to a lesser extent, our friends in DeKalb, are the only governments expected to stand with Grady? We ask citizens to contact their representatives and senators in the General Assembly and ask them to support Grady by supporting Medicaid expansion and not further cutting Grady or Fulton County.
John Eaves is chairman of the Fulton County Commission.