Commissioners of state health agencies cite staffing issues in budget requests

During budget hearings Wednesday, Alabama Department of Human Resources Commissioner Nancy Buckner underlined the difficulties in retaining staff. 

The Alabama Department of Human Resources had a turnover rate of 64% among its child welfare staff last year, she said. That was up from 46% percent the prior year.

Buckner said that hiring and retaining workers has been difficult. The department can’t compete with wages, and the job has unpredictable hours and often difficult work environments, she said. Staff have experienced traumatic experiences, including stabbings, dog attacks, altercations, and, in one case, being run over by a car.

“In child welfare – the hours required, the nighttime calls, the nature of the job or the job which is going out and going into people’s homes at all hours of the day,” Buckner said. “Many other entities and agencies are competing for the same staff.”

If other state health care agencies had less dramatic stories, many also told the Permanent Joint Legislative Committee on Finances and Budgets for the State General Fund Wednesday that finding employees was a challenge.

The Alabama Department of Mental Health, for example, has launched a 988 mental health and suicide hotline.  But ADMH Commissioner Kimberly G. Boswell said they’re hesitant to start a public awareness campaign because they first need to staff the call centers that are operational now.

“We’re looking at the call volume,” Boswell said. “Right now, we’re a little bit hesitant to do a really broad media campaign around 988 because we need more staff.”

The presentations came amid two days of state agency testimony on their budget requests for the 2023-24 fiscal year, which starts Oct. 1. The Legislature, which convenes on March 7, will have the final say on what the agencies get. 

DHR is seeking $192 million from the state’s General Fund and $100 million from the Education Trust Fund in next year’s budget. The department is budgeted to receive about$105 million from the General Fund and $50 million from the ETF this year.

ADMH is seeking about $235 million from the General Fund and about $70 million from the ETF. It is budgeted to receive $193 million from the General Fund and $67 million from the ETF this year. 

The request includes about $11 million to provide raises for the developmental disabilities’ workforce. Boswell said support staff make an average of about $10 an hour while coordinators make an hourly average of $14. In the budget requested, support staff’s wages would increase to an average of $14.50 an hour. Hourly wages for coordinators would go to about $23.50. 

Rep. Barbara Drummond, D-Mobile, said that there is a “great need” for mental health services in South Alabama, and asked Boswell if there were plans to build new facilities. Boswell said there have been discussions on providing more services in the area, but that finding staff remains an issue. 

Boswell said that now that they have started building this system of care, they can probably go back and revisit their efforts based on what they know now and what makes sense for the community.

“There’s a whole second, third phase of the conversation that we will need to have,” Boswell said.

While Commissioner Jean Brown of the Alabama Department of Senior Services didn’t say she was experiencing staffing challenges, she requested about $75,000 to provide a raise for employees. She requested an increase of about $7 million from the year prior, for a total of about $46 million.

For the fiscal year 2024, the Alabama Medicaid Agency requested $863 million, an increase of $70 million.

Medicaid covers about 20% of the Alabama population. Its General Fund allotment is generally used to match federal funds. The federal government pays for roughly three-fourths of Alabama’s Medicaid program.

Stephanie Azar, commissioner for the Alabama Medicaid Agency, cited healthcare cost inflation as a factor in the request, which she said is normal. If they were to do “nothing, nothing changes and they were able to sit still,” Azar said the budget increase would still be anywhere from $50 to $80 million.