1. 2003 State Budget Crisis Eli Briggs Policy & State Affairs Manager National Rural Health Association 2003 State Budget Crisis Eli Briggs Policy & State Affairs Manager National Rural Health Association

2. National Picture 31 states cut spending 14 states: across the board cuts 1.5 – 15% 23 states reduced workforce 13 states tapped rainy-day funds 17 states raised taxes more than 1% Net tax increase $6.9 billion

3. National Picture 8 states used tobacco settlement Tobacco taxes: $642 million $3 billion in 2002

4. Medicaid 37 states changed Rx policies 9 states expanded or started medication assistance programs 23 states reduced or eliminated optional benefits (dental, vision, chiropractic or mental health)

5. Medicaid 38 states changed provider and services reimbursement rates 31 states reduced or froze rates $205 million tax increase on providers 23 states increased or established patient co-pays

6. State-by-State OR: $1.1 billion tax increase, to be voted on Feb. ‘04 GA: Closing mental hospitals, Raised $180 million in cigarette taxes UT: 600 state employee jobs cut SCHIP cap, Medicaid benefits limited PA: $4 billion shortfall

7. State-by-State MN: Health care provider tax extended Loan forgiveness for health profs reduced 2 rural hospital grant programs combined and reduced Funding for rural hospital capital improvement program reduced Collaborative NP program eliminated

8. State-by-State CA: 5% Medicaid cut Rural Health programs preserved AL: $675 million shortfall, tax increase rejected by voters NE: $750 million shortfall over 2 years 5% tax increase, Cuts to Medicaid KY: SCHIP and Transitional Medical Assistance to pay premiums

9. Advocacy Strategy Grassroots Invite Policymakers to hear from you Rural Caucus Links to national resources

10. …. The mission of The National Rural Health Association is to improve the health and well being of rural Americans and their communities though advocacy, communications, education and research. NRHA

11. NRHA Government Affairs Office 703-519-7910 Steve Wilhide, Executive Director Alan Morgan, Vice President of Gov’t Affairs and Policy Eli Briggs, Policy and State Affairs Manager Greg Lynskey, Government Affairs Manager Shelly TenNapel, Organizational Development Manager