HCFA's Budget Priorities - Fiscal Year 2017
The House-Senate conference committee on the Fiscal Year 2017 state budget held its first meeting last week to negotiate a final budget based on the House and Senate budgets passed in each branch. The new state fiscal year will begin on July 1.
HCFA is pleased that each budget proposal includes a number of provisions that fund MassHealth and other key health programs, and advance consumer health interests. However, there are important differences between the two versions, and HCFA distributed the following statement to the legislative leadership indicating our priorities for the budget process:
The challenges facing our Commonwealth are significant. Recent revenue declines mean difficult funding decisions. The budget proposals put forward by both the House and the Senate reflect the commitment by the Legislature to not retreat from effective, innovative government policies that promote the health of all Massachusetts’ residents, and we should collectively be proud of the many provisions that will benefit health care consumers.
As you work to develop the final FY 2017 budget, HCFA urges you to prioritize these goals:
- Protect the Health Safety Net Program;
- Expand access to dental care through Dental Hygiene Practitioners;
- Provide unbiased information about the cost and efficacy of prescription drugs;
- Streamline public benefit program applications to improve health and decrease health costs;
- Plan care improvement for infants exposed to substances;
- Complete the study on drug copay coupons before changing policy;
- Examine the impact of limited MassHealth dental coverage; and
- Adequately fund the statewide dental program for people with disabilities.
Protect the Health Safety Net Program
The Health Safety Net (HSN) lives up to it name. It is our last resort program to meet critical health needs of low income residents of the Commonwealth without any other source of assistance. Senate Section 77A (redrafted amendment 369) delays proposed eligibility reductions through April 1, 2017, giving the Legislature, Administration, and stakeholders the opportunity to better understand the impact of the cuts and develop appropriate policy responses. HCFA opposes the cuts proposed by the Executive Office of Health and Human Services (EOHHS), and urges reconsideration of their implementation. The eligibility cuts would shift costs to providers and leave many low-income people with substantial medical debt.
The HSN is primarily funded by an assessment on hospitals and payers, while the state customarily contributes $30 million of federal reimbursement it receives from revenue generated by the assessment. The Administration’s FY2017 budget did not include any state funds for the HSN. Both the House and Senate provide $15 million in funding, though the House budget includes “up to” language that could potentially result in less funding being transferred to the Health Safety Net (House Section 42). We urge the conference committee to support the Senate budget approach that specifies a firm $15 million for the program (Senate Section 72).
We urge the Conference Committee to include a provision delaying implementation of eligibility cuts in the Health Safety Net program until April 2017 and specify $15 million in state funding for the HSN.
Expand Access to Dental Care through Dental Hygiene Practitioners
One in ten Massachusetts residents does not have access to a regular dental provider. Only 35% of dental providers accept MassHealth, making it even harder for seniors, children, and other vulnerable populations to access basic dental care. Dental care must be more easily accessible.
A dental hygiene practitioner is similar to a nurse practitioner and would improve access to dental care. Dental hygiene practitioners could work in settings such as schools and nursing homes to make care accessible. They may also work directly with dentists, allowing practices greater financial flexibility to see more MassHealth patients. Sections 35A-35D and Section 77A of the Senate budget (redrafted amendment 479) authorize dental hygiene practitioners in Massachusetts.
We urge the Conference Committee to include provisions authorizing Dental Hygiene Practitioners to be licensed as a new midlevel dental provider.
Provide Unbiased Information about the Cost and Efficacy of Prescription Drugs
Health care providers are confronted with an overwhelming amount of new clinical research, making it difficult to stay current about which treatments are most effective and have the best patient outcomes. At the same time, the pharmaceutical industry spends billions on marketing directly to doctors to promote their products. This influence results in higher costs for patients and the Commonwealth as pharmaceutical representatives typically promote their newest, most expensive brand-name drugs, regardless of whether or not they offer improved outcomes.
Academic Detailing is an evidence-based prescriber education program on the therapeutic and cost-effective utilization of prescription drugs, which allows doctors to make decisions based on balanced research data rather than biased promotional information. The program both improves doctors’ clinical decision making and controls costs, countering the influence of drug companies that promote the most expensive new drugs.
We urge the Conference Committee to provide funding for the Academic Detailing program (line item 4510-0716) at $500,000 so that educators may reach as many providers as possible and have a measurable impact on cost-savings and medical care.
Streamline Public Benefit Program Applications to Improve Health and Decrease Health Costs
Both the House and Senate budgets recognize the need to streamline the complex system for applying for public benefits (House section 42A and Senate line items 4000-0100 and 4400-1000). Using common eligibility information can be particularly helpful in closing the “SNAP Gap” – the over 550,000 state residents who are enrolled in MassHealth and likely eligible for federally-funded SNAP (food stamp) benefits. Improving nutrition though SNAP enrollment benefits overall health, lowering health care costs. Moreover, the additional federal funds are spent in the local economy, stimulating employment.
We urge the Conference Committee to support a provision to direct EOHHS to allow MassHealth applicants and recipients the option of also applying for federal SNAP benefits, and to electronically share relevant MassHealth eligibility data and documents for SNAP eligibility purposes; and to include an additional appropriation in DTA’s line item 4400-1000 to support caseworkers needed to process an increased SNAP caseload.
We also recommend a provision directing EOHHS, Executive Office of Communities and Development (EOCD) and other agencies to explore creating a simplified common application for low income households to also seek income-eligible child care, housing subsidies and other services for which they may qualify.
Plan Care Improvements for Newborns Exposed to Substances
Prenatal exposure to alcohol, tobacco, and illicit drugs has the potential to cause a wide spectrum of physical, emotional, and developmental problems for these infants. The harm caused to the child can be significant and long-lasting, especially if the exposure is not detected and the effects are not treated as soon as possible. These impacts are particularly severe for a newborn who was exposed to addictive opiate drugs (NAS – neonatal abstinence syndrome) while in the mother’s womb. In Massachusetts, the rate of babies born with NAS is greater than three times the national average, according to 2014 estimates based on hospital admission data.
Senate Section 77A (redrafted amendment 500) establishes an interagency taskforce on newborns with neonatal abstinence syndrome as well as substance-exposed newborns. The existing systems of care for these babies are often disconnected and difficult to navigate. The group will develop a unified statewide plan to coordinate care and services and achieve data, quality, and outcome goals for newborns and young children impacted by exposure to substances.
We urge the Conference Committee to include a provision establishing a task force to improve care for neonatal abstinence syndrome and substance-exposed newborns.
Complete the Study on Drug Copay Coupons before Changing Policy
Prescription drug copay discount coupons are a deceptive marketing tool used to entice consumers to select expensive name brand drugs which often have cheaper and equally effective alternatives. After the savings expire, the consumer is left to purchase this more expensive drug at the full cost share. These coupons increase the use of more expensive prescription drugs, which significantly increases the overall cost of health care for individuals, and public and private employers.
In 2012, when coupons were first permitted in Massachusetts, the legislature wisely placed a sunset on the policy and directed the state to conduct a study on the effect this policy would have on consumers and on overall health care costs. However, the study was never completed. Section 22 of the House budget would strike the sunset provision before the state is able to complete the study.
We urge the Conference Committee preserve the existing sunset provision on the drug coupon law and direct the state to complete the policy impact study before making a decision about the continued role of drug coupons in Massachusetts.
Examine the Impact of Limited MassHealth Dental Coverage
Oral disease is the most common chronic disease among children and adults, causing significant pain and suffering. The MassHealth dental program provides the opportunity for low-income adults and children to access crucial oral health care. However, MassHealth does not currently cover all dental services. Full dental services were last covered in 2010. A Senate MassHealth line item (4000-0700) includes a provision calling for a report of the impact and cost-effectiveness of dental coverage. Understanding the impact of this cut in available care will assist the legislature in making policy decisions about the program.
We urge the Conference Committee to include language in line item 4000-0700 directing EOHHS to report on MassHealth dental coverage.
Adequately Fund the Statewide Dental Program for People with Disabilities
Individuals living with disabilities have particular oral health needs, including adaptive facilities and equipment, as well as providers with specialized training. Massachusetts is the home of a nationally recognized statewide program for persons with special needs. The Department of Public Health (DPH) and The Department of Developmental Services (DDS) partner with the Tufts University School of Dental Medicine to provide specialized care at seven clinical sites across the Commonwealth.
Known collectively as the Tufts Dental Facilities (TDF), the program provides dental care to more than 7,000 individuals living with disabilities such as autism, cerebral palsy, epilepsy, cystic fibrosis, muscular dystrophy, closed head trauma, spinal cord injury, spina bifida, multiple sclerosis, congenital blindness, and congenital deafness. People with developmental and acquired disabilities have an increased risk of oral health problems, and face many challenges to dental care. Most people served by TDF are enrolled in MassHealth and have no other alternative for dental care.
Due to cost increases for this vital program, we urge the Conference Committee to increase funding by $250,000 for the dental program for adults with intellectual and developmental disabilities (line item 4512-0500).