The MA Senate budget proposal was released earlier this month. House and Senate budget writers are preparing for Conference Committee negotiations with talks expected to end in mid-June in time for the fiscal year start on July 1st. The conference budget then goes to the Governor for any vetoes and then back to the legislature for any possible overrides before it becomes final.

MassHealth Essential Level Funded: The Senate W&M committee level funds MassHealth Essential at $160 million. The section allows for enrollment above the cap of 36,000 members if the appropriation permits. (Section 292) The House-approved budget only allocated $110 million for Mass-Health Essential. The House funding level would require the program to freeze enrollment at its current level of about 24,000.

MassHealth Dental Coverage: The Senate budget includes a provision (section 300) to allow dentists to cap the number of MassHealth patients they treat. This proposal would further hurt access to dental care for children in the MassHealth program. A better alternative has been proposed by Senator Chandler. Her amendment would direct the state to explore using a third-party administrator for the dental program that would use standardized forms and codes for paying dentists. Dentists say this would encourage them to accept MassHealth patients.

MassHealth HIV: Item 4000-1400 funds this program at $8.3 million. While the amount is less than the amount appropriated in prior years, it is closer to the actual cost of running the program with the existing caseload. The eligibility level remains at 133% of poverty, reduced from 200% at the start of FY 2004.

Immigrant Eligibility Restrictions: The Senate Ways and Means proposal terminates coverage for 2,750 legally residing senior and disabled immigrants who will have their MassHealth benefits restored on June 1st. Their coverage will end September 30, 2004 unless further action is taken. (Continuation of this coverage, however, was subsequently proposed as an amendment, and passed the Senate.) The proposal continues to deny coverage for 7,000 additional adult legal immigrants who were cut from coverage by the FY 2004 budget. Similar provisions were included in the House budget.

EAEDC: The Senate W&M committee fully funds Emergency Assistance for the Elderly, Disabled and Children. The Senate does not include House language limiting health benefits for immigrants joining the program.

Children's Medical Security Plan (CMSP): provides $21.4 million to CMSP, fully funding the program. This will eliminate the waiting list and enable the 14,000 kids waiting for coverage to enroll. The House appropriated $13.9 million for this program, which would reduce the waitlist to about 9,000 kids. The Governor originally proposed $11.8 million, which would maintain the current waitlist. Both the House and Senate bills do not rollback the increased premiums in CMSP.

Healthy Start: Item 4000-0895 appropriates $14.2 million to the Healthy Start Program, fully funding this program. This will ensure that all low-income pregnant women have access to prenatal care. The House funded Healthy Start at $10.6 million, which would require significant cutbacks in services or eligibility. The Governor proposed $6.2 million for the program.

Disabled Managed Care Pilot Program: Section 298 directs EOHHS to create a pilot program within the managed care system for 25,000 disabled MassHealth recipients. Their care would be paid under a fixed per member per month capitated rate. A more restrictive, but similar proposal was included in last years House Ways & Means budget, but was rejected by the Senate and did not survive conference committee. This year's language does not establish the fixed reimbursement rate; last year, it was set at a level substantially below the current costs of care.

Personal Care Attendant Services: Under section 272, the Senate directs EOHHS to consult and collaborate with personal care attendant program stakeholders in the development of any program changes. In addition it requires EOHHS to communicate regularly communicate with stakeholders on any personal care attendant issues.

Prescription Advantage is funded at $110M, which should be sufficient to meet the program's needs. Section 273 requires an open enrolled period of at least one month and restricts the Administration from imposing any additional cost sharing increases during FY2005. Section 274 directs elder affairs to maximize federal revenues available through the Medicare Discount Card Program for members of Prescription Advantage at or below 135% FPL. This section protects members' access to drugs now available through Prescription Advantage.

Redirect Dedicated Tobacco Taxes to Health: The Senate W&M budget directs all tobacco taxes into a dedicated fund to be spent on health care, both MassHealth expansion programs and the Children's Medical Security Plan.

Uncompensated Care Pool: The Senate provides substantial increases in funds for the Pool. Their proposal provides $891 million in Uncompensated Care Pool funds in hospital fiscal year 2005, almost $200 million more than fiscal year 2004. Of that, $665 million will help reimburse hospitals' free care costs, an increase of $165 million from fiscal year 2004. Represents $200 million in additional funding for the Pool over the budget proposed by the Governor. An additional $56 million will go for Community Health Center free care.

Home & Community Care Expansion: Section 279 expands eligibility for home and community based services for elders from 100% fpl to 300% fpl.

Mandatory Nurse Staffing Pilot Program. A Mandatory Nurse-Staffing Ratio Pilot Program was adopted in the Senate, which phases-in staffing ratios over three years, beginning with 10 hospitals in January, 2005.

Medical Malpractice Liability Reform. The Senate adopted a health care provider liability reform proposal that requires the Commissioner of Insurance to approve rates and premium changes; changes the interest rate on judgments; requires malpractice insurer reporting on major categories of losses and claims each year; delineates requirements for "expert" testimony; and establishes a special commission to examine the feasibility of a medical malpractice claims court and a worker's compensation model for malpractice claims.

Statewide Permanent Physician Advisory Council. The Senate adopted a provision which would establish a permanent physician advisory council to advise the Governor and the Legislature annually on public policies impacting physician care and practice in Massachusetts, including patient care, claims payment and reimbursement policies.

-Adapted from: Health Care For All FY 2005 Senate Ways & Means Preliminary Budget Analysis, Partners Government Relations' Senate Ways and Means Highlights by Joy Rosen, and additional information from Pat Baker of Mass. Law Reform Institute.

05/2004