TAFDC

• Would narrow the TAFDC definition of disability
• Would increase the work requirement from 20 hours to 34 hours a week for parents of school-age children and 24 hours for parents of preschool children.
• Would allow DTA to cut TAFDC benefits at any point during the year if DTA thinks that the appropriation will not be sufficient.

EAEDC

• Would rename the program "Transitional Supplemental Security Income" and would provide benefits to disabled people only if they meet (for at least 60 days) the very strict standards for the federal SSI program.
• Would expressly authorize DTA to reduce the monthly payment standard if DTA determines that the appropriation will not be enough,
• Would continue to provide limited MassHealth benefits for former EAEDC recipients who lose eligibility because of the EAEDC changes, as long as they meet the EAEDC eligibility standards in effect on February 29, 2004. However, new applicants would have to meet the stricter criteria.

SHELTER

• EA family shelter and adult homeless shelter - level funded
• Moves teen living programs to a new teen account that combines it with teen child care. The combined account is a cut of $1 million from current expenditures for both programs.

HOUSING

• Proposes $30.2 million to help housing authorities meet the expenses of maintaining the state's 50,000 public housing units. This recommended 20 percent increase over the FY 04 appropriation, would reverse some of the steep reductions in this important account over the past few years, during which time legislation authorized the demolition of nearly 400 units of state-funded public housing in two cities.
• Proposes a cut of $2.5 million for the Massachusetts Rental Voucher Program (MRVP) which helps elders and low-income families pay private housing rents. This represents a cut of 11 percent from the FY 04 amount and a decline of 43% over the past four years.
• Proposes $2.3 million for the Alternative Rental Voucher Program (ARVP), which provides a rental subsidy for disabled single persons with very low income. This amount is a decrease of $400,000, or 15 percent, from the FY 04 appropriation.

The administration anticipates that these reductions will not cause anyone currently holding a voucher under either MRVP or ARVP to lose that voucher.
• Family public housing rents increased
• Public housing rent escrow program restored $500,000 for this program, which gives public housing residents the option of putting some of their rent payments into a savings account, partially matched by the state, to be used to pay for expenses in moving to private housing. The program was not funded at all in FY 04.

HEALTH

• Healthy Families, a program to visit young parents at home to assist them with parenting, is funded at $6.1 million- half of what it was allocated in FY 04.
• Prescription Advantage- level-funded. The current amount was not enough to open enrollment to seniors in January 2004. Secretary Preston has said the Administration will support the program until the Medicare prescription drug benefit is available in 2006.
• CMSP- level funded. Program was cut substantially in FY 04.
• Healthy Start, which provides prenatal coverage for uninsured pregnant women- level-funded. In 2004, the administration was able to get federal matching funds for 65 percent of program costs, but has not restored this program to its FY 2003 funding level.

MEDICAID/MASSHEALTH

• Eliminate Hospital-Based Primary Care. The Governor claims $16 million savings by disallowing outpatient departments from serving as primary care clinicians.
• Funds Hospital Discharge Screening. Provides $3M to support hospital discharge screening to prevent nursing home placements and "strong control of the front door" into nursing homes. $9M in Medicaid savings is anticipated by the Romney administration. ASAPs will start in-person screening of patients in SNFs before they convert to long-term care to determine if they qualify.
• Funds Home Health Audits. Claims $8M in savings through increased auditing of home health agencies.
• PCA Process Reforms. Claims $5M savings for revising the PCA process.
• MassHealth coverage for HIV positive individuals- Drastically reduced- $6 million proposed for FY 05 compared to over $14 million appropriated in FY 04. According to the Administration, FY04 expenditures are only projected to be $6 million, and were the basis for the FY 05 amount; however, the House 1 proposal appears to leave no room for enrollment growth or health care inflation.

UNCOMPENSATED CARE POOL

• Hospital and Insurer Liability. The Governor proposes overall cut of $32 million (or 5%) less than FY04, with statewide hospital and insurer liability increased by $7.5M each over FY2004. An additional $28 million is diverted from the pool for Community Health Centers in FY2005. Overall pool funding is projected by the MHA to result in a $311 million shortfall for hospitals, with an estimated impact on Partners of a $32 million loss.
• Hospital Primary and Preventive Care Discontinued. The scope of services covered by the pool will be limited to "emergent and urgent" care, and newly created "critical access" services at acute hospitals (services that may only be provided by acute hospitals), as well as medical hardship coverage. Because of changes in the law last year, only community health centers will be reimbursed for all "medically necessary" care provided. The change was undertaken in FY04 to shift more care to community health centers (CHC's) and to reimburse hospitals only for services that CHC's cannot provide.

Department of Mental Health (DMH)
Overall mental health funding is reduced by $5.1 million below FY04 appropriations of $592.8 million. Funding for payments to state psychiatric hospitals and inpatient services is reduced by $7.5M, and for contracted acute inpatient and emergency programs, funding is reduced by $1 million or 3%. Child and adolescent mental health services funds increase by 3%, and $3M is targeted for enhancing housing opportunities for the mentally ill. The Governor also allocates $2.5 million toward a program to eliminate over-prescription of psychiatric drugs to children.

Department of Public Health (DPH).
State Public Health expenditures are reduced by more than $20 million, with overall Public Health expenditures at $335 million for FY05. While a number of prevention programs were eliminated in FY04, most remaining programs receive the same funding as in FY 04. Funding for community health centers and school-based health centers, however, is eliminated. Smoking cessation funds remain at last year's level of $2.5M, which represents a loss of more than $30 million since FY03. Funding for family health services is increased by more than $1 mil-lion in FY05. The following is a list of some of the Public Health reductions from FY04:

• Community Health Centers $6.9M
• School-Based Health Svcs. $12.6M
• Gambler's Treatment $655K
• Environmental Hazards$133K
• Dental Health Svcs.$170K
• Suicide Prevention $125K
• Prostate Cancer Prevention $1M
• Teen Pregnancy Prevention $525K
• HIV Support Services $1.7M
• Substance Abuse Services $1.54M
• CNA Recruitment $250K
• Health Plan Coverage for Child Vaccines. Authorizes the Commissioner of Public Health to charge health plans to cover the costs of purchasing and distributing childhood vaccines that are covered by health plans. Universal immunizations are level funded in the Governor's budget at $19.1 million statewide.
• Health Plan Increases for Early Intervention Services. Increases the mandated coverage for early intervention services from $3,200 to $5,200/annually, and from $9,600 to $15,600 over the total enrollment period.

Governor Romney Acknowledges Under-Reimbursement of Providers and Announces Plans for Universal Coverage Program . . . Secretary of Health and Human Services Ron Preston later described the administration's efforts to model several packages and present them to Governor Romney as early as March. Preston told members of the House and Senate Ways and Means Committees that he intends to work with Legislators and providers prior to going forward with any plan.

-Adapted from Mass. Law Reform Institute House 1 for FY 2005 Preliminary Analysis of Selected Welfare, Child Care, Housing and Health Issues, January 29, 2004 and Partner's Government Relations Update No. (03-18), by Joy Rosen. Additional material courtesy Marta Frank, Exec. Director, Boston Senior Homecare.