Evaluation issue in mental health programming in the juvenile justice system

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Gov. Jan Brewer has rightfully placed all options on the table in her difficult and, at times, bruising work with other state leaders to address what is approaching a $2 billion shortfall in our state budget.

This includes a request by the governor to all state agencies asking for plans that will cut each agency’s budget by 15 percent. A significant part of these reductions will come from the Arizona Health Care Cost Containment System (AHCCCS) and other state health programs. AHCCCS is Arizona’s Medicaid program.

At first blush, a 15 percent AHCCCS reduction may seem like a necessary although painful action that we must take. However, the math behind a 15 percent cut at AHCCCS isn’t so straightforward. It is critical that our state’s leaders and the general public appreciate the fact that every dollar spent in AHCCCS is matched by $3 from the federal government. The real formula that would quickly emerge from a 15 percent reduction by AHCCCS is cut one dollar and lose three more.

The elimination of Arizona’s KidsCare program also is being contemplated. If this insurance is eliminated for 47,000 children in Arizona, we will not save a dime for the people of this state. Once uninsured, many of these children will need health care, but they will become at-risk for delayed care due to the cost of that care.

Routine health care matters. Illness or injury left untreated can quickly evolve into serious or even catastrophic health-care issues. As a result, many of these children eventually will get their care in the most expensive health-care settings – ERs and hospital rooms. A great deal of the costs for this care will then be shifted to Arizona’s insured consumers.

If we assume that national health-care reform will significantly cover more people, we also should assume it will take many years for this coverage to be implemented. In my view, retaining KidsCare until another plan becomes available makes good sense for Arizona.

Another cut being proposed is a 30 percent reduction in the state’s contribution to Graduate Medical Education. This cut ultimately could reduce the number of physicians in the state.

Hard decisions must be made to address the state’s climbing budget shortfall, and all of us must be part of the solution. Our governor and Legislature deserve that support. However, decisions that look good on paper or even on a budget spreadsheet in the short term, can prove highly damaging to the state’s fiscal health and people’s physical health in the long term.

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