Gov. Robert Bentley is considering calling a special session of the state Legislature after lawmakers approved a general fund budget in April that would underfund Medicaid by $85 million.

The lack of money for the program has caused major concerns, including from local physicians and pediatricians.

“Medicaid in Alabama is primarily healthcare funding for children,” said Nola Ernest, a pediatrician in Enterprise who formerly worked in Troy and is active in raising awareness about the Medicaid funding issue. “Underfunding of Medicaid affects all of primary care, but disproportionately affects pediatricians.”

Ernest said that underfunding Medicaid will have both immediate and long-term effects on Alabama.

“Immediately, this will result in hardships on local doctors’ offices that will lead to layoffs,” she said. “It will also lead to fewer open doctors’ offices, as a poll showed that 4 percent of responding offices have already decided to close their doors. Some pediatrician offices will have to stop providing care, and these kids will grow up and create a less healthy workforce and military.”

Bentley vetoed the general fund budget in March due to its underfunding of Medicaid, but the legislature overrode his veto.

Sen. Jimmy Holley, R-Troy, was one of only 13 senators to vote no on the budget, not nearly enough to keep it from passing. Holley said that he has not received word from Bentley about a special session, but that the timeframe of calling one could cause issues.

“We have a tight window of opportunity to pass legislation,” Holley said. “It takes three weeks to advertise a bill and at least five days to pass one. That puts us close to the November general election.”

Rep. Alan Boothe, R-Troy, said that he doesn’t see how the timing of the special session would be impacted by the general election, unless the proposed solution to funding Medicaid was a state lottery, which as a constitutional amendment would have to go on the general election ballot in November.

In February of this year, the federal government approved Alabama’s planned overhaul of the Medicaid system by creating five Regional Care Organizations (RCOs) and committed to $328 million in federal funding in the first three years and another possible $420 million over a five-year period to keep it going.

But the funding require the state to fully fund Medicaid, which means that the state is on the brink of losing hundreds of millions in federal funding due to the budget.

“In the past two years, there was a plan put in place to reform Medicaid by establishing delivery through five RCOs,” Ernest said. “ It’s a very novel plan. The state had to apply for a waiver to get it approved, and the federal government approved it. However, we will not get the start-up money to put the reforms into place because of underfunding. The state government crafted this plan and now they’re not implementing it.”

Ernest said that the RCOs are on hold for now, and isn’t sure what will happen if the budget doesn’t fund Medicaid by October 1, when the RCOs were supposed to go into effect.

There are several possible funding solutions, Ernest said.

“We’re asking for Gov. Bentley to address problem by finding another revenue source,” Ernest said.

“Senators have been working on legislation for possible lottery that could be a solution. Another way to fun Medicaid would be to make changes in budget structure or raising a tax such as the cigarette tax.”

Ernest said it’s worth the effort for the state to fund Medicaid, as the federal government gives the program $2.20 for every $1 that the legislature commits.

Another possible solution that has come up in the past was using money from the BP oil spill settlement, but disputes over how to split the money killed the possibility at the time.