MONTGOMERY — Alabama could cut key services to Medicaid patients — including drug benefits for adults who use the program — under the $1.8 billion General Fund budget passed by the Legislature, state officials say.
"We're $85 million short," Gov. Robert Bentley said in a press conference Wednesday. "It is what it is."
Bentley earlier this year vetoed a budget, approved by both houses of the Legislature, that kept most state agencies at more or less their current levels, and increased Medicaid spending from $685 million to $700 million.
Officials from Medicaid say they need at least $785 million to keep up current services. With roughly 1 million clients in Alabama, Medicaid is a joint state-and-federal program that provides health care coverage to the state's poorest residents. More than half the program's clients are children; the income requirements are strict enough that very few non-disabled, childless adults qualify.
Both the House and the Senate on Tuesday overturned Bentley's veto. Senate and House leaders said there was no interest in finding the extra $85 million needed to pay for the program.
"We're listening to our constituents, and right now they're telling us to live within our means," Senate President Pro Tempore Del Marsh, R-Anniston, said Tuesday night after the vote to overturn the veto.
Bentley and Medicaid officials say that if the state has to cut services, Alabama's plans to reform its Medicaid program are in jeopardy. Medicaid had planned to switch some patients to a managed care program run by nonprofits on Oct. 1.
The hope for that plan was that it would slow the growth in the program's cost. The federal government has announced its intention to kick in more than $700 million toward setting up the managed care plan, but that deal will likely be off if Medicaid has to cut services.
At Bentley's press conference, Medicaid commissioner Stephanie Azar outlined the services the state could cut under the current budget. Eliminating adult prescription drug coverage would save around $50 million, she said. Other cuts, such as an end to outpatient dialysis or prosthetics, would save much smaller sums.
The budget is now law. Earlier this year, the governor said he might call a special session to rewrite the budget if Medicaid isn't fully funded. On Tuesday, he wasn't so sure.
"We have not made a decision on that," he said.
The governor didn't offer a specific prescription for solving the $85 million gap. Earlier this year, he asked lawmakers to transfer some money from the education budget to increase General Fund spending, but lawmakers rejected that idea.
Bentley said the Legislature needed "a change of heart, a change of attitude" on the budget.
The veto override wasn't Bentley's only setback in the Legislature this week. Four House members on Tuesday introduced articles of impeachment, citing the scandal that erupted after a former department head accused Bentley of an affair with a former staffer and the governor acknowledged making sexually-charged remarks to that staffer, former senior political advisor Rebekah Mason.
Bentley refused to discuss the impeachment drive Wednesday. He told reporters he'd take questions only on Medicaid and prisons.
Asked by a reporter if his relationship with the Legislature has been strained in recent weeks, Bentley said simply "no."