The Legislature restored some $150 million of the $201 million in spending that Governor Mitt Romney had vetoed for the fiscal year that began July 1.

The legislature's overrides restored:

• $7.6 million in funding for Mass. Legal Assistance Corp.
• $2.8 million for breast and cervical cancer screening
• $2.4 million for home care for the elderly
• $4.8 million to DMR (this was an additional cut; the legislature previously cut $9 million)
• $1.1 million for language interpreters in hospital emergency departments
• $1 million for prostate cancer prevention
• funding for the Boston Municipal Court (which Romney wanted entirely eliminated)
• $2 million for school breakfasts
• $2.2 million for work force training
• $10 million in kindergarten expansion grants
• $7 million reserve fund for K-12 education

The legislature also:

• created exemptions to the new law requiring English immersion in lieu of bilingual education.
• voted to allow welfare parents whose children are between the ages of 2 and 5 to substitute education and training programs for the work requirement that the state is now imposing on them. Until this month, those 9,000 women were not subject to the 20-hour-per-week work requirement that applies to parents with older children, and lawmakers said letting them take classes instead is a fair means of transition.

BIG PICTURE

These restorations of vetoes though, can obscure the big picture. What does this budget mean for specific programs on which our patients rely? The impact on MassHealth, the Children's Medical Security Plan (CMSP), Healthy Start, Prescription Advantage, Public Health, Rape Crisis Centers, Education and Local Aid are noted below.

MASSHEALTH

Overview

• The budget restores health coverage to 36,000 long-term unemployed adults who were cut from Medicaid on April 1.
• At the same time, however, 10,000 legal immigrants are losing Medicaid coverage on August 1. There are advocacy efforts (in which Partners is participating) to get the legislature to pass a supplemental budget to fund ongoing MassHealth access to this group. Contact Ellen Forman if you'd like more information to use to advocate for this.
• An estimated 10,000 more will lose access to health care as well come fall, as a result of new asset tests for the under 65 population (see below and newsletter article).
• MassHealth will be instituting new program enrollment caps to the CommonHealth and Family Assistance (including HIV waiver) programs.
• MassHealth will be instituting premiums and co-pays for members.
• Other planned changes include stricter rules for income allowed to the community spouse of institutionalized patients.

Details for each of these changes follow.

• MassHealth Basic for the Long-Term Unemployed
  DMA will establish a one-year program to cover the 36,000 long-term unemployed who lost MassHealth Basic coverage on April 1st.
  • Program is slated to begin on October 1st.
  • Financial eligibility will be set at 100% FPL, and individuals who have some intermittent or non-regular employment may still be eligible.
  • Enrollment will be capped at 36,000 so it will be important to outreach to former Basic patients to enroll them in the new program.
  • DMA has not yet released details on the application process.

• Termination Of Legal Immigrants' Coverage
  The State is terminating coverage for 10,000 "special status" legal immigrants who are in the MassHealth Basic, CommonHealth, Family Assistance, and Basic/Buy-In programs. Children under age 19 are not affected by this cut. Also exempted are long-term care facility residents and "Protected" aliens ("non-qualified" or "special status" aliens who were receiving medical assistance as of 6/30/97).
  • Individuals losing coverage have a variety of INS classifications:
    • individuals fleeing persecution who have applied for political asylum.
    • individuals granted "temporary protected status" because conditions in their home countries are unsafe.
    • legal permanent residents who entered the US after the federal restrictions took effect in 1996, have been here for less than 5 years, and are not yet eligible for MassHealth Standard.
  • Notices from DMA: DMA sent notice on July 7th to these 10,000 individuals. A second notice of actual termination should also have been sent this month.
  • The advisory notices:
  • advise immigrants of the upcoming changes and allows them to update their information if they believe the cut should not apply to them
  • include an "immigration status update form" that can be used by the immigrant to report changes or inaccuracies to his/her immigration status that may mean the individual is still eligible for broader MassHealth benefits
  • spells out instances where an immigrant may be eligible to continue receiving coverage, including people who are refugees, asylees, victims of domestic violence, and certain Cuban, Haitian, Amerasians, Native Americans, Filipinos, and Hmong non-citizens.
  Most of these individuals should be eligible for MassHealth Limited. The advisory notice explains MassHealth Limited, and informs the immigrant that the State will decide if they are eligible for MassHealth Limited.
  
  For more detailed information, please contact the CRC.

  The legislature may pass a supplemental budget. If funding is included for this group, some form of coverage may be restored. Contact MIRA (617) 350-5480 or the CRC (Ellen x6-5807) if you'd like information about how to advocate for this inclusion.

• Asset Testing (see newsletter article for more information)
  Asset testing will be re-introduced for all adults under age 65 on MassHealth.
  • Expected implementation date: No earlier than February 2004.
  • Draft regulations have been released and public the comment period closed on 7/25.

• Enrollment Caps
  Enrollment caps will be placed on the Family Assistance and CommonHealth programs.
  • DMA intends to have caps in place for the Family Assistance program by August 11th.
  • For capped programs, DMA will continue taking applications and will put applicants on waiting lists.
  • Individuals who are terminated and who appeal the termination decision can be reenrolled through the appeal process without falling to the back of the waiting list.
  • Family Assistance Program: The program will be capped at 30,000 adults; the cap does not apply to children. Currently, 36,000 adults are on the Family Assistance Program. Once the cap is in place, DMA will wait for attrition to bring enrollment down to 30,000. So no one new will be able to enroll until more than 6,000 adults fall off the program.
  • CommonHealth: Again, the cap does not apply to children. The program will be capped at 15,000 adults. Currently, 14,750 adults are on CommonHealth. Once the cap is in place, DMA will be able to enroll 250 adults before the program reaches its capacity.
  • HIV Waiver Program: Currently, enrollment is at 1,018: one-third are CommonHealth and two-thirds are Family Assistance. 125 of the adults on Family Assistance have income above 133% FPL and will be terminated. CommonHealth HIV eligibles below 133% FPL will be protected.

• Premiums and Co-Pays
  The budget authorizes DMA to charge premiums and co-pays to MassHealth recipients.
  • DMA will charge premiums based on a sliding scale to the extent permitted by federal law (for members over 133% FPL). Premiums will be applied to both children and adults on MassHealth.
  • DMA will charge up to $3 co-pays for MassHealth services (excluding mental health and substance abuse services) and up to $3 co-pays for prescription drugs. DMA has not yet decided whether co-pays will be applied to children on MassHealth.
  • The timetable for operationalizing these changes in co-pays and premiums is still unclear.

• LTC Community Spouse Protections
  As reported in the June MGH Community News, DMA was authorized to adopt the "income-first" rule, limiting assets the spouse of a nursing home resident may keep. They have released draft regulations, and the public comment period has ended. Under previous/current rules, if the "community spouse" (generally the wife) has an income below the DMA determined "minimum monthly maintenance needs allowance" (MMMNA), she can ask for a "fair hearing" and request that she be allowed to keep additional assets until the income these assets would generate would bring her income up to the MMMNA. If that is still insufficient, then she could keep a portion of the institutionalized spouse's income to bring her income up to the MMMNA. Under the proposed rules, she would take from his income first and would not be able to keep additional assets unless his income was insufficient to bring hers up to her minimum monthly needs allowance. In that case she still might be able to retain some assets, but it would be a lesser amount than if they started with the assets. This also puts her at risk if he dies first and no longer has an income to be turned over to her.
• General Reminders
  • 10 day retroactive period makes it crucial to get applications processed quickly so that date of service is covered.
  • Individuals have a 60-day window to return their verification documentation.
  • MassHealth members now only have 30 days to return their paperwork for redetermination, as opposed to 60 days. If an individual doesn't receive/pay attention to the redetermination notice, or doesn't return paperwork within 30 days, and he/she is in a program that is capped, then the individual loses coverage and falls to the back of the waiting list.
  • If an individual falls off a capped program because he/she fails to return verification on an asset test, or fails to pay a premium, then the individual loses coverage and falls to the back of the waiting list.

CHILDREN'S MEDICAL SECURITY PLAN (CMSP)
The Conference Committee approved a new premium structure for CMSP, but didn't change the benefits.

• Premiums are as follows:
  • For children at 150%-200% FPL: $10.50 per child with a family cap of $31.50
  • For children at 200%-400% FPL: $45.32 per child with no family cap
  • For children over 400% FPL: $52.50 per child with no family cap
• Premiums are expected to be implemented in the late Fall or early winter.
• Currently there are over 5,500 children on the waiting list, and the State stopped moving children from the waiting list onto the program as of July 1st, since the new funding will only support 21,000 - 22,000 children. There are currently 26,114 children on the program, so the state must wait until approximately 5,000 children drop off before they can start enrolling children from the waiting list. They expect it will only take a few months to get down to the 21,000 - 22,000 level.

HEALTHY START

• Financial eligibility was lowered from 225% to 200% FPL.
• Healthy Start retroactive coverage is now only 10 days rather than 30.
• Healthy Start is releasing a provider letter that will outline all changes to the program.

PRESCRIPTION ADVANTAGE
This program has been restored, but with limited open enrollment for some groups (see newsletter article).

PUBLIC HEALTH
Massachusetts has cut everything from domestic violence prevention to immunizations for adults against pneumonia and hepatitis A and B. The state's widely emulated tobacco control program saw its budget reduced 95 percent in just two years (from $50 million three years ago to $2.5 for this fiscal year). Money for school health programs, once among the most comprehensive in the nation, has dwindled from almost $38 million in the 2002 budget year to less than $13 million this year. In addition, several rounds of budget cuts have gutted disease prevention and screening programs. Overall, state dollars spent on public health have shrunk 30 percent in two years.

RAPE CRISIS CENTERS
As noted in the last newsletter, funding for rape crisis centers, including the 24-hour hotline for Spanish speaking victims, has been decimated. If the legislature passes a supplemental budget, funding for rape crisis centers might be included. For information on how to advocate for funding to be included in a supplemental budget go to the Jane Doe website: www.janedoe.org/involved/involved_rcc_flyer.htm or contact the CRC (Ellen x6-5807).

EDUCATION AND LOCAL AID
The budget contains the first K-12 education funding cuts in a decade. Education and other aid to cities and towns took the biggest hit, cut $327 million, or 6 percent, with some communities seeing their aid slashed by larger percentages. Higher education accounts have been sliced $156 million. Although the legislature restored nearly all of the $57 million in local aid vetoed by Romney, the cuts in aid to cities and towns are being felt across the state, with school districts eliminating teaching positions and laying off police officers and municipal workers.

-Information provided by Kim Simonian of MGH Community Benefits, DMA, and from Boston Globe stories that ran on 7/11/03, 7/18/03 and 7/29/03.