Patrick’s FY 12 Budget- Detailed Analysis

 

Last month’s MGH Community News reported a preliminary analysis of Governor Patrick’s fiscal year 2012 budget proposal. As advocacy groups have had more time to study the proposal, more detail has emerged. Here are some highlights.

Health Care

• Adult Day Health Services for the Elderly and Disabled. The Governor’s includes $55 million in cuts to the adult day health program. The budget proposal estimates that by cutting benefits for 80 percent of the 7,000 very frail elders and disabled adults who receive these supports, the state will save approximately $27 million. Only the most fragile persons with complex medical needs will be able to continue receiving adult day health services. The adult day health program was designed to provide nursing care in community settings to people with significant medical needs so that they could avoid hospitalization or nursing home placement.
• Co-payments. The Governor’s budget estimates that the state will save approximately $5 million by increasing co-payments for medications and charging $2 co-payments for non-emergency visits to the emergency room. For most people, the co-payment would rise from $3 to $4, but for brand name drugs for people over 150 percent of the federal poverty level, the co-pay would increase to $5.
• Provider Payments. The Governor’s proposal will cut $319 million in rates or payments to health care providers, for a net savings to the Commonwealth of approximately $159 million. These cuts include: not paying hospitals for what are considered “preventable” readmissions that occur within 30 days; reducing the payment rates for acute care for certain hospitals; reducing payments for certain specific services; eliminating rate increases for managed care.
• Provider Contracts and Coordinated Care. The Governor expects that with aggressive contract negotiations with health care providers that will emphasize new models for care management, service delivery and payment, the program will be able to cut up to an additional $351 million, netting the state $175 million in savings.
• Program Integration with Medicare. The Governor’s budget proposal estimates that the state will be able to net $25 million in savings by better integrating health care for young disabled adults who are eligible for both Medicare and Medicaid. With approval from the federal government, the program will be designed to improve access to primary care and ensure better coordinated and integrated health care services.

Note about Bridge:

Under the new federal health care law, however, the federal government will begin reimbursing states for these immigrants’ care in 2014. Close to 19,000 low-income legal immigrants are still currently ineligible for MassHealth, Commonwealth Care or the Commonwealth Care Bridge program.

Mental Health

• $127.5 million for mental health facilities, a $16.4 million cut from FY 2011 current budgeted totals, and an even larger cut from what it would cost to maintain the FY 2011 service levels in the hospitals. There are estimates that this proposal might cut 160 of the state’s current hospital capacity of 658 beds, and there is no comparable increase in community-based services to off-set the impact on services for people with mental illness who might lose facility-based services.

Public Health

• Cutting funding for early intervention services by $8.0 million, from $29.4 million in the FY 2011 current budget, to $21.5 million in the Governor’s proposal. This 27 percent cut could eliminate or reduce services for up to 15,000 of the 30,000 developmentally delayed infants and toddlers currently receiving the occupational, physical, speech or therapies provided by the program. The Department of Public Health anticipates that approximately 9,000 young children with significant delays would continue to receive services as funded by the federal government, while infants and children with slightly less severe disabilities would only be served as long as the state funding lasts.
• Eliminating the academic detailing program and the primary care loan forgiveness program. These two small programs, funded in FY 2011 at $93,000 and $157,000 respectively, were a product of the state’s health reform initiative. The idea behind these programs was that by supporting the provision of information to physicians about cost-effective prescription use (academic detailing) and by encouraging health professionals to chose primary care careers (the loan forgiveness program), the Commonwealth would be better able to begin to control health care costs. The Governor’s proposed FY 2012 budget eliminates funding for these programs entirely.

Children, Youth, & Families

Programs within the Department of Children and Families are proposed to be funded at $737.9 million, a decrease of $5.8 million from current FY 2011 levels. Assuming 2 percent cost growth, the Governor’s proposed FY 2012 funding level is roughly $20 million below the actual costs for providing the same level of services as FY 2011. Specifically, the Governor proposes:

• $242.5 million for Services for Children and Families—which funds family stabilization, unification, permanency, guardianship, and foster care—a decrease of $4.9 million from current FY 2011 levels.
• $40.0 million for Family Support and Stabilization, a decrease of 961,000 from current FY 2011 levels.
• $192.4 million for Group Care Services for children in DCF custody, a decrease of $9.2 million from current FY 2011 levels.

Programs within the Department of Youth Services are proposed to be funded at $135.6 million, a decrease of $8.5 million from current FY 2011 levels. Assuming 2 percent cost growth, the Governor’s proposed FY 2012 funding level is roughly $11 million below the actual costs for providing the same level of services as FY 2011.

Disability Services

Services for the disabled are funded at $1.36 billion in the Governor’s FY 2012 budget proposal, a 1.4 percent increase compared to current FY 2011 budgeted levels. Nevertheless, the Governor’s budget proposed budget is insufficient to continue funding current programs at their current service levels.

Services for the developmentally disabled, on the surface, might appear to have been spared from deep cuts in the Governor’s budget. Funding to the Department of Developmental Services receives $1.3 billion in the Governor’s budget, a $20.8 million increase over the FY 2011 current budget. The FY 2011 appropriated budget, however, is currently approximately $8.6 million below anticipated spending levels for the year, and there are estimates that it could cost as much as $30 million more to maintain current service levels into FY 2012. Accordingly, the Governor’s budget proposal does not represent a real increase in funding, but will necessitate closer to a $24 million effective cut in services.

• Family supports and respite services are cut by $13.9 million in the Governor's budget proposal, a 30 percent cut. These services - for which there is already a high wait list - offer families with disabled children flexible community-based supports that are particularly important for helping keep children with disabilities out of residential schools. The Governor's budget recommends a total of $32.6 million, compared to $46.5 million in the current FY 2011 budget.

Funding for services for the blind and visually impaired receive $18.1 million in the Governor’s budget, $450,000 less than current budget totals. Funding for rehabilitation services is $40.3 million, $898,300 less than current budget totals. Services for the deaf and hard of hearing receive $4.7 million, $112,100 less than current budget totals.

Elder Services

The Governor's budget recommends a total of $216.0 million for services for elders, a $4.2 million or 1.9 percent cut from FY 2011 current budgeted totals. Most of the cuts in the Governor's budget are borne by the community home care program.

• The Governor cuts $4.9 million (3.6 percent) from the elder home care program to $132.5 million, level-funding the case management account at $35.7 million, and cutting the home care purchased services account from $101.7 million to $96.8 million. These community-based long term care services are crucial for helping frail elders remain in their homes in the community, and avoid nursing home placement.
• The Governor level-funds the enhanced home care program at $45.8 million, but this is a slight cut below what it might cost to maintain current FY 2011 levels of service.
• The Governor level funds the elder protective services program at $15.3 million, which is a 2 percent cut from what it might cost to keep the program at its current service levels. As it is, the program is challenged in keeping up with the demand for full investigation of accusations of abuse or neglect of elders in the community.
• The Governor level funds services in housing sites, including $1.5 million for congregate housing programs, and $4.0 million for services in elder housing complexes. The Governor also level funds meals on wheels and congregate lunch programs at $6.3 million, and level funds local councils on aging at $7.9 million.
• The Governor proposes $750,000 for a new program funded by the federal government for elderly veterans called the Veterans Independence Plus Initiative.

Housing

The Governor’s FY 2012 budget proposal reduces funding for assistance to homeless families living at or below 115 percent of poverty by $23.0 million.

According to documents accompanying the Governor’s budget proposal, the state expects to serve the same number of families (7,000) in FY 2012 as it did in FY 2011 with this lower level of funding because under the Governor’s plan, many families will no longer be eligible to stay in family shelters, which cost on average $30,000 per year. Instead, these families will receive assistance up to $8,000 per year to stay in their current housing or to find new, permanent housing.

• $38.6 million for the new Massachusetts Short Term Housing Transition Program (Home Base). Families, living at or below 115 percent of poverty, who are homeless or at risk of becoming homeless and are not eligible for EA shelter and services, would be provided assistance through the Home Base program. Working through a network of regional housing agencies, Home Base would provide transitional assistance to try and help these families find and stay in permanent housing. Home Base would provide these families with up to three years of temporary assistance of no more than $8,000 per year (or $667 per month) per family for the first year, and 5 percent less for each of the next two years. The funding would be used to help with rent or to cover arearages, utility bills or security deposits. It is unclear whether the monthly allowance for rent of $667 under the Home Base program will be sufficient to help low-income families who live in Greater Boston find adequate housing.
• Level-funding the program that provides Residential Assistance to Families in Transition (RAFT) at $260,000.
• Immigrant Access to Shelter Threatened - In early February advocates discovered that Governor Patrick's budget contains language which would require "disclosure of social security numbers of all members of a family" before housing could be provided. This runs counter to decades of state policy that recognizes that many families have mixed status, and that this status is often in flux. MIRA believes the new language could potentially result in the permanent homelessness of some immigrants.

-From MassBudget.org, http://www.massbudget.org/documentsearch/findDocument?doc_id=775, retrieved 2/4/11.

 

 

2/11