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Contact Your Representative - HCFA's House Budget Amendments

Contact Your Representative - HCFA's House Budget Amendments

April 13, 2017

The state House of Representatives released their draft budget this week. The budget funds the state's MassHealth and other health programs, and includes many provision supported by HCFA. Our friends at the Massachusetts Law Reform Institute released an outstanding summary of the provisions affecting low income residents, including MassHealth and other health concerns. House budget debate starts on April 24.

Net state spending for MassHealth is just 14% of state budget

We want to offer an important correction to a misleading fact often cited in the press. It is claimed that MassHealth, our Medicaid program, consumes 40% or more of the total state budget, leading policymakers to decry out of control spending for Medicaid. Yet this statistic ignores the fact that that the vast majority of that spending comes from the federal government, and doesn't come out of state revenue. It's just a pass-through.

The real numbers are that Medicaid costs make up just 14% of state spending from state revenue. The rest is all federal money, that comes into Massachusetts, and is then spent in our economy, benefiting Mass residents. See the graphs on this presentation from the Blue Cross Foundation, chart 5, reproduced above. So, claiming that Medicaid costs us 40% of the budget is very misleading

HCFA is pleased that the House budget proposal includes a reinstatment of the state's employer responsibilty law. This will assess a fee on large employers who do not provide health insurance coverage to their workers. A similar fee was included in chapter 58, the 2006 health reform passed under Governor Romney, and was also part of the Affordable Care Act. The state fee was repealed several years ago, and with the ACA fee in danger of being repealed, or nor enforced, it's important for the state to step in and make sure that employers are prompted to provide coverage.

HCFA is supporting a number of important amendments to improve the budget. Please, call your state Representative, and urge him or her to support HCFA's budget priorities. Here's our list:

Improve Children's Health Coverage

Thousands of children who are not eligible for MassHealth and do not have access to private health insurance through their parents can get basic coverage through the Children's Medical Security Plan (CMSP). However, CMSP benefits have strict limits on coverage that are inadequate to keep a child healthy; for example, a $200 limit on prescription drugs and a 13-visit limit on mental health services. The FY2018 budgets proposed thus far cut funding for CMSP from $17.4 million to $12.4 million. Please support Rep. Barber's amendment to restore $5 million in funding for CMSP and to direct EOHHS to develop a plan to improve the scope of benefits (adding language and $5 million to line item 4000-0990).

Ensure Access to Transportation for Medical Appointments

Non-emergency medical transportation provides access to and from medical appointments for MassHealth enrollees who do not have other means of transportation. EOHHS has indicated it plans to seek a waiver to eliminate this benefit except for travel to substance use disorder (SUD) treatment services for MassHealth CarePlus (Medicaid expansion) enrollees. About 13,000 MassHealth CarePlus enrollees used non-emergency medical transportation for non-substance use disorders (SUD) services last year. Please support Rep. Gentile's amendment (#100) to ensure that MassHealth CarePlus enrollees continue to receive appropriate transportation to all necessary medical appointments (adding language to line item 4000-0940).

Restore Periodontal Treatment Coverage for Adult MassHealth Enrollees

Periodontal disease is a chronic bacterial infection of the gums and bone that surround teeth. When left untreated, this disease causes irreversible gum and bone loss leading to eventual tooth loss and also directly impacts chronic disease outcomes including those of diabetes, heart disease, and stroke. Periodontal disease can also lead to low birth weight and premature birth. Therefore, coverage for the treatment of periodontal disease is critical to improving the oral and general health of the adult population. Please support Rep. Scibak’s amendment to restore coverage for periodontal services for adult MassHealth enrollees (adding language and $10 million to line item 4000-0700).

Plan for Full Restoration of MassHealth Adult Dental Benefits

More than 1 million people, including 149,000 seniors and 245,000 people with disabilities, are without access to dental care beyond cleanings, fillings, extractions, and full dentures. Without access to appropriate dental care, many people living with chronic illnesses such as diabetes or hypertension see their conditions worsen. Those with oral health issues that may have been easily resolved with a simple procedure may require far more invasive and costly treatments. Please support Rep. Pignatelli’s amendment directing EOHHS to develop a plan to fully restore dental benefits for adult MassHealth enrollees (adding language to line item 4000-0700).

Provide Unbiased Prescription Drug Information to Doctors

Drug companies market their drugs directly to doctors by providing biased information promoting their most expensive drugs. To counter this, trained educators can offer objective information to educate doctors on the cost-effective uses of prescriptions, lowering the cost of health care. Please support Rep. Benson’s amendment to fund a physician education program on cost-effective pain management medications, administered by the Health Policy Commission (adding language and $500,000 to line item 1450-1200).

Fund the Office of Oral Health

The Office of Oral Health within DPH provides critically important school-based prevention services, workforce development programs and surveillance and reporting on the state of oral health in Massachusetts. Unfortunately, the Office of Oral Health has had limited capacity to conduct regular data collection, surveillance and analysis due to staff positions that have remained vacant for several years. Please support Rep. Scibak’s amendment (#117) to increase funding for the Office or Oral Health (line item 4512-0500).

Ensure Children’s Access to Preventive Dental Care

The Forsyth Kids program serves 51 schools to provide school-based oral health care to approximately 1,700 underserved children annually in Boston, Cambridge, Lynn, Chelsea, Fitchburg, Randolph, Holyoke, Hull, Waltham and Cape Cod. For many of these children, regular oral health care in a dental setting may be difficult to access due to limited office hours, lack of transportation, or general lack of awareness of the importance of good oral hygiene. Please support Rep. Crighton’s amendment (#234) to fund the Forsyth Kids program at $300,000, level-funded from FY2017 (line item 4512-0500).

Sustain the Prevention and Wellness Trust Fund

The Prevention and Wellness Trust Fund (PWTF) has increased access to preventive services for nearly 1 million people across every region of the Commonwealth and will have an ever greater impact in the future. An independent evaluator found strong results and concluded that the program warrants further investment. PWTF does not rely on any state funding, but is supported through a small assessment on health insurers. Funding will sunset and the program will be dismantled in June 2017 without legislative action. Please support Rep. Vega and Rep. Chan’s amendment (#24) to make PWTF a permanent program (adding outside section language).

Expand Adolescent Substance Use Prevention

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a set of tools that helps identify alcohol or drug use and guides follow-up counseling and treatment if a problem exists. More than a third of school districts have received training and are in the process of implementing SBIRT. An additional $301,500 will help to support all school districts with the resources they need to be successful, including the hiring of a per diem nurse to cover the regular school nurse's office during screenings. Please support Rep. Khan’s amendment to provide an additional $301,500 in funding for SBIRT (line item 4590-0250).

Address Unmet Mental Health Needs for Youth

Mental Health Advocacy Program for Kids (MHAP) is a highly sought after service initially being piloted in the Lowell and Lynn Family Resource Centers. It is designed to be replicable in other FRCs. MHAP for Kids improves the mental health of youth who have been diverted from juvenile court or are already court-involved and have unmet mental health needs. It achieves this goal by providing these children with a legal advocate trained in removing barriers to treatment. Please support Rep. Golden’s amendment to provide $50,000 to fund and maintain MHAP for Kids from February-June 2018 (line item 4800-0200).

Close the SNAP Gap

The SNAP gap refers to the 680,000 people who are receiving MassHealth and likely eligible for SNAP, but are not receiving SNAP benefits. Rep. Livingstone has filed an amendment to give MassHealth applicants and enrollees the option of filing a SNAP application at the same time they apply or get a renewal of their MassHealth, and to provide the infrastructure funding needed to handle the anticipated growth in the SNAP caseload. Please support Rep. Livingstone's amendment (#31) to streamline the SNAP application process for MassHealth applicants (adding new line item language and $2 million in funding).

For additional information, please contact Suzanne Curry, Associate Director of Policy & Government Relations:  scurry@hcfama.org or (617) 275-2977.