The Massachusetts House Ways and Means committee released their proposed FY '05 budget on Wednesday April 14, 2004. As you may recall Gov. Romney released his proposal last month. Next the Senate will release their budget. Differences between the two legislative houses' budgets are then worked out in conference committee before being forwarded to Gov. Romney for his signature or vetoes.

What follows is the highlights of the House proposal.

HEALTH PROGRAMS

MassHealth

• Maintains MassHealth Coverage for Basic, HIV, and Breast and Cervical Cancer Patients. Maintains coverage for these populations.
• Essential Underfunded: seriously underfunds MassHealth Essential, which covers very low income adults. The program is funded by the Uncompensated Care Pool and federal reimbursements. The current funding level, and the Governor's recommendation for next year, is for $160 million. The House proposal only provides $110 million, which will cover only about 25,000 of the 36,000 long-term unemployed who are expected to be eligible for the program. This funding level reverses the commitment made by the legislature last year to cover this group. Without adequate funding, the program will close enrollment and over 10,000 people will have no alternative other than using expensive hospital emergency rooms for their care.
• Immigrant Eligibility Restrictions: terminates coverage for 2,750 legally residing senior and disabled immigrants who are expected to have their MassHealth benefits restored on June 1st. The proposal also continues to deny coverage for 7,000 additional adult legal immigrants who were cut from coverage by the FY 2004 budget.
• Grandfathering Health Coverage for Immigrants Cut from Cash Assistance: The House budget adopts the Governor's proposed cut of immigrants from EAEDC cash assistance. Section 82 appears to grandfather health coverage for current immigrants losing EAEDC cash assistance. No health coverage is offered to future immigrants who would have met the former EAEDC eligibility standards but who applied after February 29, 2004.
• MassHealth HIV Expansion: increases funding from $6.1 million to $8.3 dollars. This amount remains far less than the amount appropriated in prior years, but is closer to the actual cost of running the program with the existing caseload. Also, DMA has authority to enact enrollment caps in this program, as well as the CommonHealth and Family Assistance insurance subsidy programs. The eligibility level remains at 133% of poverty, reduced from 200% at the start of FY 2004.
• Personal Care Attendant Services: adopts the Governor's proposal to allow the Administration the open-ended authority to amend the standards for personal care attendants.
• Covering More Children. DMA must seek a federal waiver to expand MassHealth coverage to children between 200 to 400% of FPL.

The House leadership is rejecting a controversial plan by the Romney administration that would force low-income patients to get their primary care at community health centers instead of at hospitals, Democratic officials announced yesterday. Instead, the House budget would offer low-income people a $5 incentive to seek their basic care at lower-cost community health centers. It would also fund a pilot program to encourage, but not force, disabled Medicaid recipients to use community health centers.

In addition, the budget designates $9 million to hold beds in nursing homes for residents who leave briefly to visit family or who are hospitalized. Last year, the state eliminated funds to hold the beds, but ordered nursing homes to hold the beds anyway if the patients were hospitalized. The money would be drawn from an account that in the past has funded other nursing home services.

Other Health Programs:

Prescription Advantage Program is funded at $110 million, which should be sufficient to meet the program's needs. However, if the program is projected to exceed this appropriation, the office of elder services is directed to control costs. Section 76 lists a number of cost controls that can be implemented including: limiting enrollment and/or eligibility, increasing out of pocket spending limits, increasing deductibles, increasing copays, or increasing premiums. The governor had proposed level funding of $96 million, but would have increased copayments; the House version would eliminate the increased copayments.

Children's Medical Security Plan (CMSP): provides $13.9 million to CMSP. While this is approximately $2.1 million more than the Governor's proposal, it still falls short of the $19.4 million that Health Care For All estimates the program requires. Over 12,000 kids are currently on the waiting list for CMSP, and the House budget will still leave over 9,000 with no coverage.

Department of Mental Health Funding. Overall mental health funding is reduced by $6.7 million or 1% below FY04 appropriations of $592.8 million. Funding for payments to hospitals and CHMC's is reduced by 3% as compared to cuts of 5% under Governor Romney's proposed budget. For contracted acute inpatient and emergency programs, funding is increased by $468K or 2%. Child and adolescent mental health services funds are modestly increased.

Department of Public Health Funding. State Public Health expenditures are increased by 4% as compared to Governor Romney's proposed reductions of 6% (on top of 18% reductions in the previous fiscal year). Approximately $7.1 million in funding for Community Health Centers is restored, along with $18.6 million in funds for school-based health centers or services. The following is a list of Public Health increases and reductions from FY04:

Community Health Centers	$1.7M	restoration
School-Based Health Systems	$18.6M	restoration
Gambler's Treatment	$655K	restoration
Environmental Hazards	$223K	cut
Dental Health Services	$170K	cut
Suicide Prevention	$125K	cut
Prostate Cancer Prevention	$1M	restoration
Teen Pregnancy Prevention	$525K	cut
HIV Support Services	$1.7M	cut
Substance Abuse Services	$2.9M	restoration
Universal Newborn Screen	$14K	cut

John Auerbach, executive director of the Boston Public Health Commission, said Romney's proposed cut in substance-abuse spending would put Massachusetts in danger of forfeiting more than $9 million in federal aid. The state is struggling with an epidemic of heroin use, and previous budget cuts have slashed the number of treatment beds for people urgently needing detoxification from 1,000 a year ago to 420 now.

The state spent $45 million on substance-abuse programs in 2001, but health and human service agencies have been hit especially hard by the budget crisis of the past three years: Excluding Medicaid, the agencies have lost $326 million, a 14 percent decrease, since fiscal 2001. The Department of Public Health, which oversees the state's substance-abuse services, has been cut by 27 percent.

Community Health Care earmarks $4 million increase for home health nurses and aides who serve Medicaid patients in the hope of allowing more patients to return home from hospitals or nursing homes sooner. A shortage of visiting nurses has sometimes forced patients to stay longer than medically necessary in hospitals.

SOCIAL SERVICES

Emergency Assistance To The Elderly, Disabled And Children (EAEDC)

• funds the EAEDC program at $63.2 million down from $69.3 million in FY'04 (including mid-year supplemental funding). Most (but not all) of the reduction is accounted for by program cuts.
• did NOT adopt the Governor's proposal to tighten the disability criteria but DID adopt the Governor's other proposed program cuts. These include the elimination of cash assistance to lawfully present, non-citizens (Outside Section 35) and the elimination of benefits to Mass. Rehabilitation Commission participants (authorization eliminated in the line item language).

Transitional Aid to Families with Dependent Children (TAFDC)

• HW&M adopted the Governor's proposal to Increases the TAFDC work requirement from 20 hours per week to 34 hours per week for parents of school age children and to 24 hours/week for parents of preschool children.
• Funds the TAFDC program at $315 million. Although a slight increase over the FY'04 expenditures reflecting increases in the caseload, this appropriation counts on savings attributable to the increased work requirements contained in outside sections of the budget. These savings are largely due to families being terminated from the program because they cannot meet the work requirements.
• HW&M did NOT adopt the Governor's proposal to tighten the definition of disability under the TAFDC program.

Emergency Assistance Family Shelter Program

Funds the family shelter account at $73.7 million, down $2 million from FY'04 appropriations. This is less than the Governor's FY'05 budget request which level funded the program at the FY'04 appropriation level. The HW&M appropriation should be enough to cover the current number of families in shelter. However, given the federal government's proposed cuts in the Section 8 program (see accompanying story), the appropriation may not be enough to cover all eligible families in the future.

Massachusetts Rental Voucher Program

• Funds the MRVP program at $24.3 million, a $1.5 million increase over FY'04 funding levels. This is much better than the Governor's budget which reduced the funding for the MRVP program by $2.5 million.

- Adapted from: Health Care For All,FY 2005 House Ways & Means Preliminary Budget Analysis by Brian Rosman and Karla FortunatoHealth Care For All, based on summary prepared by Neil Cronin, MLRI, 4/15/04; Massachusetts Coalition for the Homeless' Overview of House Ways and Means (HW&M) FY'05 Budget Recommendations and the Budget Prioritie, Partners Government Relations Update, by Joy Rosen - 4/16/04; "House Eyes Boost For Metco, Drug Programs" By Scott S. Greenberger, the Boston Globe, 04/12/2004; "House Panel Rejects Romney Cuts And Restores $70m For Hospitals" by Alice Dembner, the Boston Globe 04/13/2004; and "Human service workers could get raises" by Alice Dembner, the Boston Globe, 4/15/2004.

04/2004