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32 <br />HH -5: Oppose shifting or cutting money from federal and <br />state block grants, including TANF, SSBG, CCDBG, HCCBG <br />and WCH for mandated services. <br />• Counties have experienced an annual loss of $36 million in <br />federal welfare reform funds, and the state has eliminated its <br />$5.4 million annual appropriation in state aid to counties for <br />social services, although some state aid dollars remain for <br />county health expenses. <br />• The state has backfilled state budget cuts in childcare and <br />other human services programs with federal dollars once <br />designated for direct county programs. <br />HH -6: Seek legislation to improve financing and regulatory <br />issues for the purpose of ensuring the viability of rural hos- <br />pitals. <br />• Loss of Medicaid funding, rising health costs, and ongoing <br />hospital consolidation threaten the viability of rural hospi- <br />tals. To address this, several states have initiated a study <br />commission to identify issues facing rural hospitals, such as <br />Georgia's Rural Hospitalization Stabilization task force. <br />HH -7: Support Medicaid reimbursement to EMS for mental <br />health and substance abuse transport to crisis centers. <br />• While state Medicaid rules allow Medicaid payment for medi- <br />cally necessary transports to hospitals, it does not permit it <br />for ambulance transports to mental health crisis centers. <br />• The 2014 -15 state budget authorized a pilot study of Wake <br />County's mental health transports to determine what legisla- <br />tive changes and funding sources could support diversion of <br />mental health crisis patients from emergency rooms to loca- <br />tions offering more appropriate care. <br />