The recurring theme of the upcoming state budget is cut, cut and cut some more. But Gov. Steve Beshear also is proposing some modest but strategic increases in spending on human needs that lawmakers should approve:
■ Most important is $7.8 million over the next two years to expand substance abuse treatment for adults and adolescents through the Medicaid program.
Kentucky has remained one of few states with no Medicaid coverage of substance abuse treatment, even as the misuse of prescription painkillers and other addictive drugs has mushroomed into a crisis for entire communities.
More Kentuckians die now from drug overdoses than car crashes. Drug or alcohol abuse is a factor well over half the time a Kentucky child dies from abuse or neglect. And well over half the prison population suffers from addiction. Yet, treatment options have remained woefully inadequate.
Kentucky Medicaid can finally afford to add a substance abuse treatment benefit because of new flexibility granted by the Affordable Care Act of 2010.
The health care reform law authorizes states to target certain populations for some new benefits, meaning Kentucky won't risk unleashing a runaway entitlement.
(Medicaid, a federal-state health care program for the poor, elderly and disabled, now enrolls more than 800,000 Kentuckians or almost 1 in 5, and has been the biggest strain on state resources. Medicaid recipients were increasing at a rate of 3,300 a month in 2010. As the economy improves, the increase is expected to decline to 1,550 a month over the next biennium.)
What Beshear is proposing would provide community-based outpatient treatment to 5,800 adults and teens. That won't come close to filling the need. But it's a start.
Every $1 Kentucky spends on Medicaid is matched by more than $2 in federal funds. And treating addicts is much cheaper for taxpayers than locking them up or repairing the carnage of untreated addiction.
■ By the same token, it's more humane and cost-effective to serve the mentally ill and developmentally disabled in community settings rather than institutions. Beshear is seeking $16 million for Medicaid to expand supports for the mentally ill and disabled. Again, this falls short of need but moves in the right direction and would wisely leverage federal Medicaid funds.
■ Beshear also is seeking $4 million to improve the electronic system for prescription drug tracking. The improvements would better identify "doctor shoppers" who obtain large numbers of addictive pills from multiple medical professionals and prescribers who are feeding the illicit pill trade.
■ Finally, the Department for Community Based Services, which includes child protective services, has lost about $80 million to budget cuts over the last four years.
Child protection workers have unrealistically heavy case loads and flee to less stressful jobs as soon as possible.
The losers are Kentucky children and families who suffer and sometimes die for want of the support and protection they need.
Beshear is asking the legislature to appropriate $21 million to reduce caseloads and hire about 300 caseworkers. About 100 of them would work in child protection.
If anything, the legislature should find more money than proposed for child protection,