Don Schofield was worried on Tuesday.

The executive director of East Central Mental Health, Schofield says he knows first-hand the impact Tuesdsay’s special election potentially will have on Alabama.

At stake in the special election is an amendment that would allow the state government to borrow $197 million from the state’s oil and gas trust fund to balance the 2013 budget. The amendment also would allow the state to borrow $145 million from that same fund in 2014 and 2015.

The money would be used, in those three years, to offset budget shortfalls and continue to fund what proponents say are necessary programs, particularly those funded by Medicaid.

While opponents are rallying against the measure, health care officials such as Schofield find themselves in the cross-hairs. While he is a fiscal conservative at heart, the realities of the situation drive him to support the amendment. And if it doesn’t pass?

“It’s been nice knowing y’all,” he said with a laugh.

Jokes aside, Schofield said at issue is whether or not the agencies funded by the state Medicaid program – such as East Central Mental Health – can continue to provide the basic services now covered under Medicaid.

ECMH leases and oversees 60 beds for mental health patients in Pike County and another 41 in surrounding counties. The agency provides treatment and housing for seriously and chronically mentally ill individuals.

“If they didn’t need that level of care, they wouldn’t have it,” Schofield said.

But if the amendment doesn’t pass on Tuesday, funding likely won’t remain in place. And then where will those patients go?

“It’s not just these mental health patients,” he said. “The prisoners will be released, the elderly will not be taken care of.”

Ben Busbee, director of Charles Henderson Child Health Center in Troy and a longtime healthcare administrator, shares Schofield’s concern. A self-professed “conservative in terms of my lifestyle and my voting practices,” Busbee finds himself lobbying friends and associates in the Rotary Club for support.

“The conservative side of me says we should have remedied this long ago, but we didn’t,” he said. “Now, we have to bite the bullet and deal with it.”

And by that, he believes voters should pass the amendment: to ensure patient care isn’t negatively affected, to prevent cuts to physicians, to protect the future of Medicaid.

“No is not the answer,” he said. “Without approval of the constitutional amendment and the subsequent transfer from the trust fund, the Medicaid budget for 2013 will have a more than $100 million hole in it which cannot be plugged by simply cutting services, as some opponents of the transfer have advocated,” he said.

Busbee’s agency already is reeling from the first round of state Medicaid cuts this year – some $16 million.

“We’ve already taken a 10 percent cut in physician reimbursements, and that’s about a $200,000 cut in revenue for us,” he said.

Patients feel the impact daily, as Medicaid continues to revise and reduce its formulary for prescriptions, now often refusing to pay for many medications, including those used to treat children with chronic illnesses such as asthma. “Our doctors are already having to talk with parents and explain to them that their child’s medication isn’t covered by Medicaid anymore … they just ask, ‘what am I supposed to do?’”

Busbee readily acknowledges that tapping the rainy day reserves to fund Medicaid and the budget for the next three years is simply a short-term solution to the problem.

“The day of reckoning will still come, if not now three years from now, when the lawmakers have to balance the budget and pay back what they borrowed,” he said.

In the meantime, patients will be cared for and treated.

And that, health care officials say, is important.

Stacy G. Graning is publisher of The Messenger. Contact her at stacy.graning@troymessenger.com.