Department heads across state agencies began outlining their spending priorities this week in joint budgetary hearings hosted by the Georgia Senate and General Assembly.
During the hearings, department heads broke down Gov. Brian Kemp’s latest budget report, which amends some spending for the upcoming fiscal year starting July 1 and sets recommendations for fiscal year 2027.
Funding for the state’s four main departments of health made up nearly 40% of expenditures last year. That doesn’t change much in the governor’s new budget despite some mounting challenges.
In line to receive the biggest share of appropriations at $5.6 billion is the Department of Community Health (DCH), which oversees the state’s Medicaid programs for kids and adults as well as the State Office of Rural Health.
The Department of Human Services (DHS) comes in second with $1.1 billion, to go toward the Department of Family and Child Services, also known as DFCS, and other social services for children and aging populations.
Within that appropriation is $41 million for out-of-home care or foster care.
“So we’re going to fund services, we’re going fund placements,” said Candice Broce, commissioner of the Department of Human Services to state lawmakers Wednesday. “There are no staff funded in that program budget.”
That department is already over budget.
Rising costs for child welfare
As the end of the fiscal year approaches in June, Broce said DHS faces a projected funding deficit of $85.7 million. It plans to cut that roughly in half by severing contracts with service providers that Broce said are either duplicating existing services or “not meeting the standards” outlined in their contracts.
Broce expressed mounting pressure from a gradual loss of placements for children found to be abused or neglected and placed into the foster care system, and rising costs from complicated court orders issued by judges for their care.
“And usually, we agree with what they order,” Broce said. “Sometimes we don’t.”
Broce listed visitation orders from several different county judges that go “beyond” DFCS recommendations, totaling thousands of dollars in transportation and supervision costs, which DFCS is expected to pay. She cited one instance where a case manager had to pay out of pocket to buy clothes for a child after a misunderstanding about a clothing allowance.
“What we’ve been asking is under what case specific circumstances should we be allowed to cherry pick certain provisions of the court order or ignore them altogether?” Broce said. “That is something especially as of late, we’re asking hourly.”
There are around 10,000 youth in Georgia’s foster care system, and over 140,000 children total cited by DFCS to be receiving treatment, placement and other support services.
Tackling staffing, housing shortages
The majority of front-facing mental health services fall under the Department of Behavioral Health and Developmental Disabilities, or DBHDD.
A budget adjustment for fiscal year 2027 totaling $9.3 million dollars will fund 404 additional supportive housing vouchers in collaboration with the Department of Community Affairs.
“This is not just about housing: This will allow us to keep these individuals stabilized with wraparound services,” said DBHDD Commissioner Kevin Tanner during the budget hearings Wednesday. “I am laser-focused on getting that done before Gov. Kemp leaves office at the end of this year.”
The investment in housing vouchers comes as DBHDD seeks to be released from the provisions of a 2010 settlement agreement reached over a lawsuit from the state’s violations of the Americans with Disabilities Act. If released, a department promise of housing 537 people over the next three years would replace those provisions, Tanner said.
Tanner also hinted at a planned “overhaul” of the tools used to assess need under the New Options and Comprehensive Supports Waiver, or NOW/COMP, which helps individuals with disabilities live independently and in the communities of their choice. There are 7,891 people on the waiting list for those services.
At the Department of Public Health (DPH), Commissioner Kathleen Toomey pointed to staffing challenges across the network of 159 local public health departments.
“We have a challenge in hiring both health directors as well as nurses. It will continue,” Toomey said. “It was problem before the pandemic, it’s even more so now.”
DPH lost over 100 staff members last year from cuts to COVID-era grants. Then, the terminations were said to have minimal effects on local public health operations. But pressures to fill leadership positions remain — in Clayton County, there hasn’t been a permanent health director for seven years.
“Hopefully, I think we are on the right track,” Toomey said.
About 50% of the DPH budget comes from the federal government.
Beefing up education, training and recruitment programs for health professionals is the primary component of Kemp’s promises to improve health care access in Georgia.
In his annual state of the state address, Kemp cited “$40.7 million” for health care education facilities and medical workforce training and additional money spent on residency slots at state hospitals.
Managing a loss of federal funding
Cuts in federal spending on health insurance subsidies, Medicaid payments and nutrition services are expected to leave holes in Georgia’s health care budget. Lawmakers will have to decide which holes they want to fill.
Under the Department of Human Services, Kemp has asked already to set aside an additional $46 million in fiscal year 2027 for the Supplemental Nutrition Assistance Program. That’s to cover an additional 25% in program costs, which was previously funded by the federal government.
The state is also expecting a share of funding from President Donald Trump’s Rural Health Transformation Program, touted as a form of relief for hospitals expected to manage an influx of underinsured and uninsured patients.
In its application, Georgia’s Department of Community Health asked for $1.4 billion over the next five years. So far, it’s been promised $218,862,170. That money will be invested in screenings at public health departments, telehealth in rural communities and technology improvements according to a budget summary by DCH pending approval by the Centers for Medicare and Medicaid.
At an annual event hosted by the nonprofit health advocacy group Georgians for a Healthy Future, state Senate Minority Leader Harold Jones II said the biggest challenge facing the state’s health care system is the expiration of Affordable Care Act-enhanced premium tax credits.
One estimate from the Georgia Health Initiative projects an additional 460,000 people in the state could become uninsured by 2034 because of the loss of enhanced premium tax credit and other provisions of House Resolution 1, also known as the “One Big Beautiful Bill.”
Jones and other senate Democrats filed a bill last week to create a series of state-funded subsidies and cost-sharing reductions administered under the Office of Insurance and Safety Fire Commissioner to help people afford plans through Georgia Access.
The plan targets people earning from 200% to 400% of the Federal Poverty Level.
“I do think there’s an understanding that we as a legislative body, the government has some role to play,” Jones said. “I think there’s — no doubt there’s bipartisanship there.”
Republican representative and member of the House Appropriations Committee, Mark Newton, didn’t go so far as to agree with a state-funded subsidy program.
“We don’t want people to make life decisions based on unsustainable commitments,” Newton said.
Instead, he expressed party interest in further “expansion” of the Pathways to Coverage Program, Georgia’s experimental Medicaid program for low-income, working adults. Last year, eligibility for the program was expanded to parents of children under 6 years old.
Pathways to Coverage has enrolled far fewer people than originally planned. The program has already been found to have overspent on administrative costs.
This story comes to The Current GA through a reporting partnership with GPB News, a non-profit newsroom covering the state of Georgia.