A Healthy Blog

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

What's Not in the Senate Budget Proposal (UPDATED)

What's Not in the Senate Budget Proposal (UPDATED)

May 14, 2009

The Senate Ways and Means Committee released its version of the FY10 state budget today (text here), which even Committee Chair Panagiotakos described as "draconian.”

The key question will be whether the Senate joins the House in embracing new revenue provisions critical to maintaining vital services. With tax revenue declining, the Senate based its budget on a tax revenue estimates at $17.989 billion, $1.54 billion less than the estimate used by the House and the Governor. HCFA will be joining hundreds of other groups next Monday at noon to call for new revenues. Or join the ONE Massachusetts virtual rally.

Cuts were made throughout health accounts. Among the items we noticed were missing from the SWM budget:

1. Dental services for adults in MassHealth. See this earlier post for more details. Cutting these services causes the state to lose more federal reimbursement revenue than the amount saved by the cut, not to mention the damage that would be done to the health of 600,000 people.

2. Coverage for 28,000 legal immigrants in Commonwealth Care. Some 28,000 "special status" legal immigrant adults are enrolled in Commonwealth Care. They pay sliding-scale premiums, and are enrolled in private managed care plans. Coverage for this group, whose health needs was previously covered by episodic coverage via the Uncompensated Care Pool, was a provision of health reform. Reducing eligibility for special status immigrants will leave over 28,000 Massachusetts residents without the comprehensive health coverage they need, and increase costs in other programs.

3. Adequate Payment levels for providers. With reimbursement levels already below cost, many providers, particularly those that focus on serving MassHealth patients, will be forced to curtail access to services under the Senate budget. Key support for community health centers is eliminated in the budget.

3. Office of Health Equity. The House budget included (no cost) language for an Office of Health Equity within EOHHS. We hope the Senate follows.

4. Public Health. The Senate proposal makes dramatic reductions throughout the Department of Public Health. The Office of Oral Health was funded at $1.4 million, below the $2.1 million the House allocated for dental services. A $27 million cut in substance abuse reduces the program so much it may jeopardize federal reimbursement for substance abuse services. Violence prevention is eliminated, and deep cuts are made to smoking cessation programs.

5. Prescription Advantage benefits. Deep cuts will mean low-income seniors and disabled people will not get prescriptions they need to stay healthy. UPDATE: The cut would eliminate assistance for over 14,000 seniors and disabled, and also require increased copayments and premiums.

6. Academic Detailing Program. One of the cost saving ideas from Chapter 305, where a small investment but could save the state millions.

7. Adequate funding for Child and Adolescent Mental Health Services. Funding for children’s mental health programs was decreased by $3.4 million.

8. Early Education Mental Health Consultations. The entire line item was eliminated.

9. CMSP benefit flexibility. Both the Governor and the House included language allowing the Children Medical Security Program to provide more cost-effective benefits tailored to the needs of children.

One silver lining. The SWM budget directs HEFA and the Connector to continue their contributions to the MassHealth Outreach Grant program in FY2010, allowing community groups to provide this critical assistance.

Silver lining #2: The SWM budget includes non-payment for hospital–acquired infections (HAI) and serious reportable events (SRE). DPH has already passed regulations on SREs but the HAI non-payment is a great continuation of Senate President Murray’s Cost Containment and Quality Bill.

Budget amendments must be filed by noon on Friday. Budget debate is expected to begin on Tuesday, May 19th.
Mehreen Butt