Budget Conference: You Can Close The Bridge, But People Still Need To Cross The River

The House and Senate conferees reported their FY 2011 budget last night (full text; Globe coverage). Facing no good choices, the conference budget makes deep cuts in health programs, along with many other areas of state government we all rely on. The House and Senate are scheduled to vote on the budget this afternoon.

This post summarizes our initial read of the budget document; we’ll update it during the day as we better understand the implications of the budget.

[Update – the always authoritative Mass Budget and Policy Center analysis is here, and their health care discussion is here.]

Among the cuts is elimination of the Commonwealth Care Bridge program, which covers some 24,000 legal immigrants. Another 13,000 or so are currently on the waiting list. The program itself represents a budget cut, since it has reduced benefits and higher copays than the Commonwealth Care program that covered them before this year. Also, the budget imposes a further $68 million cut to MassHealth, and the already-planned elimination of most dental care for adults.

Many of these cuts would be reversed if Congress approves the 6-month extension of enhanced FMAP – the additional Medicaid reimbursements pending in Washington. The Bridge program and many of the Medicaid cuts would be reinstated if FMAP funds are approved.

HCFA is co-sponsoring, along with many other allies, including SEIU and other unions, GBIO, and other groups, a mass rally Monday at noon outside Senator Scott Brown’s Boston office, demanding that he support extending FMAP funding. Meet us outside the JFK Federal building, next to City Hall Plaza, Monday at noon. We’ll have more details on the blog later.

The budget is not all bad news. The conferees included some important initiatives and took some more steps on disparities, payment reform, kids coverage and other areas.

Here are some other budget highlights:

• Section 190 of the budget creates an “FMAP Budget Relief Fund.” That fund would receive the additional FMAP money if Congress extends our expanded Medicaid match rate. Numerous line items are partially funded from the General Fund, and part from this FMAP fund. Under section 190, for those line items the agency may only spend at the annual rate provided by the General Fund appropriation until the FMAP money is secured.

  So rather than a blunt, across the board cut, the budget provides for varying levels of cuts if the FMAP money is not approved.

  For example, in the MassHealth CommonHealth program for the disabled, .2776% is held back and funded by the FMAP fund, while in the DPH HIV treatment program’s budget, 4.98% can only be spent from the FMAP funds. Some programs, like the CommCare Bridge program, academic detailing and the Betsy Lehman center, are 100% dependent on FMAP funds.

• the MassHealth cuts are not specified beyond authorizing the administration to reduce adult dental benefits (section 145) and other optional benefits. Language directs EOHHS to provide a plan to cut $15 million in state costs from MassHealth, which would require about $33 million in total cuts, since the state would lose the federal reimbursements. The plan, due by October 15, “may include, but not be limited to, limiting, eliminating or otherwise restructuring services delivered to adult members of the MassHealth program;” but “shall make all reasonable efforts to avoid proposing elimination of any MassHealth services.” The language explicitly overrides the provision of chapter 58 restoring MassHealth benefits that had been cut earlier.
• The MassHealth restrictions on immigrants was amended to eliminate the unintended consequences of the original Senate language. The new provision (section 73) codifies current practice. All MassHealth applicants must verify their immigration status, and benefits may only be provided to those here lawfully except where federal rules permit otherwise.

  UPDATE: We are grateful that the Conference Committee found a rational and reasonable solution on this emotional issue. We also want to thank Rep. Provost who sent a letter to Speaker DeLeo (pdf) on this issue which was signed by 33 other Reps. Each of these Reps should be thanked and commended for their leadership and dedication to immigrant issues. Thank you!

• The Commonwealth Care Bridge program is authorized to continue through August 31, to give time to notify members about the future of the program (section 136). After that, the program would exist only if the additional FMAP funds were received. Most of the people losing Bridge would continue to be eligible for the Health Safety Net program. The HSN (formerly the Uncompensated Care Pool) is funded from a fixed pot, so adding thousand of newly eligible people would only drive up the shortfall, which must be absorbed by hospitals.
• The Health Connector would continue to provide $2.5 million for community-based outreach and enrollment assistance. (section 155)
• children on MassHealth would be eligible to remain on the program for up to 12 months even if their family has income fluctuations. (section 71)
• detailed language is included to guide the duties of the Office of Health Equity in DPH
• The MassHealth children’s integrated asthma care pilot project is authorized (section 154), along with other chronic disease management programs, as long as they can show positive financial returns within the first year (not easy).(section 133)
• The DHCFP is directed to post online all provider price information they receive (section 76).
• Update: The budget does not include the extra $4 million approved by the Senate for the Prescription Advantage program. The program will need to end all premium assistance for low-income seniors due to the cut.

-Brian Rosman