A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

Budget Overrides Start Tuesday

Budget Overrides Start Tuesday

July 12, 2009

The legislature begins its consideration of budget overrides and amendments on Tuesday.

The top issue will be Governor Patrick's proposed compromise for the coverage of legal immigrants. The Governor has accepted the legislature's decision to find savings everywhere, even in the health care for low-income people who are fully eligible for assistance. His proposal reflects the fiscal reality the state is faced with, and includes funds from new federal enhanced reimbursements.

However, much of the savings claimed by the legislature are illusory.

The legislature’s proposal assumes a $130 million state financial savings. However, the Mass. Hospital Association estimates that the elimination of Commonwealth Coverage to 30,000 residents will add $87 million in costs to the Health Safety Net, bringing the total shortfall for FY10 to $125 million. These costs get passed on as higher premiums paid by the state and employers. The cost of Commonwealth Care will increase in the future, since bids by managed care carriers will be higher to take into account the reduced enrollment, and higher uncompensated care.

An example: when MassHealth Basic coverage was eliminated in 2003 for 47,000 enrollees at a projected savings of $115 million, hospitals and health centers spent $76 million providing uncompensated care for this population.

In addition there's some double counting in the assumptions, the Connector has already made cuts this year to reduce Commonwealth Care enrollment by around 18,000 people, saving around $63 million. Many of those who will lose coverage will be from this group of legal immigrants.

We also urge the legislature to override funding for the academic detailing program, line item 4510-0716, which was funded in the Conference Committee budget for $250,000. The Governor vetoed all funding for this program in the FY10 budget. The evidence-based prescription drug outreach and education program takes information learned through comparative effectiveness research on drugs and translates it into practice for health care practitioners. This program is designed to generate health care cost savings for the state. According to an economic model developed by Dr. Avorn and Dr. Soumerai at Harvard Medical School and Brigham and Women’s Hospital, every dollar spent on academic detailing returns, at a minimum, two dollars in drug costs. Given the ever-increasing cost of prescription drugs, this could amount to millions of dollars in savings annually.

GWe're also deeply troubled by Governor Patrick’s veto of $2.3 million for the Children’s Behavioral Health Initiative (CBHI).

Funding for the CBHI is necessary for Massachusetts to be in compliance with the verdict in the case of Rosie D. v. Romney. In this settlement, the court found that Massachusetts failed to provide required community-based mental health services for Medicaid-eligible children and youth with severe emotional disturbance.

Massachusetts cannot step back from full implementation of community-based services, even in light of the difficult economic climate. Failure to comply with the court settlement leaves the Commonwealth vulnerable to additional lawsuits and denies children in need of mental health services necessary and appropriate care.

The decision in the Rosie D. case was a sign of hope for thousands of long-suffering families of children with mental health needs. These families have been anticipating these services and have been counting on the commitment that came from the lawsuit.