April 5, 2013- Health and Human Services

Additional Testimony

Below you will find links to additional public testimony from yesterday’s public hearings with HHS.

Public Testimony Part 7- April 4, 2013

Public Testimony Part 8- April 4, 2013

Social Services, Children, Developmental Disabilities, Brain Injury, & Hospitals

The Appropriations Committee, in conjunction with the Committee on Health and Human Services, held a joint hearing on the Governor’s Budget.   Specifically, the Committee heard testimony on the:

 

  • Bureaus of Child & Family Services                                           Developmental services Programs
  • Child Care Food Program                                                              Consumer directed Services
  • Child Care Services                                                                          Residential Treatment Assessment
  • Child Support                                                                                     Brain Injury Programs
  • Head Start                                                                                           Payments to Hospitals
  • Homeless Youth Program
  • Foster Care/Adoption Assistance Programs                         Division of Purchased Services
  • Special Children’s Services                                                           Purchased Social Services
  • Children’s Mental Health Services                                            Multicultural Services

 

General Fund Support

Program    FY 2012          FY 2013      FY 2014    FY 2015
Child/Family Services Bur. Central

$1,782,473

$3,661,615

$4,377,016

$4,511,808

Child/Family Services Regional

$29,893,205

$25,635,937

$28,004,256

$29,194,425

Child Care Services

$300,000

$297,048

$297,048

$297,048

Child Support

$3,023,071

$3,303,028

$3,573,512

$3,697,990

Head Start

$2,448,875

$444,458

$444,458

$444,458

Homeless Youth

$401,760

$397,807

$397,807

$397,807

Title IV-E Foster Care/Adoption

$11,237,468

$12,587,763

$12,588,106

$12,588,106

State Funded Foster Care

$37,333,711

$32,416,174

$38,746,364

$38,765,273

Medical Care-School-based Serv

$12,000,000

$12,000,000

Mental Health Services-Children

$16,766,006

$15,732,516

$16,266,709

$16,422,927

Mental Health Serv-Child Medicaid

$38,141,916

$37,502,261

$35,066,023

$35,325,248

Consumer Directed Services

$2,220,803

$2,198,909

$2,214,262

$2,218,387

Crisis Outreach

$472,085

$1,602,714

$1,760,817

$1,820,578

Developmental Service Community

$23,410,416

$19,805,327

$21,230,471

$21,766,991

Develop. Serv.-MaineCare Waiver

$88,751,235

$87,637,244

$93,977,282

$94,202,470

Develop. Serv -Waiver Support

$8,227,939

$12,533,142

$12,905,311

$12,978,175

Medicaid – Development. Services

$23,033,483

$24,898,720

$26,142,316

$26,426,727

Brain Injury Program

$108,282

$107,293

$115,599

$118,318

Traumatic Brain Injury Seed

$116,330

$118,430

$123,759

$124,585

Medicaid Waiver-Brain Injury
   Residential/Community Serv

$0

$0

$0

$20,000,000

 

   Funding transferred from MAP
Program    FY 2012          FY 2013      FY 2014    FY 2015
Medicaid Waiver-Other Related Conditions

$0

$0

$1,514,573

$2,097,250

 

Programs Funded from All Other Sources of Funding
Child Care Food Program

$15,650,776

$15,568,268

$12,240,794

$12,253,655

Child Care Services

$16,705,401

$16,625,087

$16,561,695

$16,600,277

Child/Family Services Bur. Central

$9,006,081

$3,444,641

$3,725,221

$3,810,707

Child/Family Services Regional

$21,941

$8,298,226

$8,587,267

$8,942,386

Child Support

$21,699,485

$22,221,966

$22,678,720

$23,197,860

Head Start

$109,152

$109,122

$1,462,217

$1,462,217

Title IV-E Foster Care/Adoption

$38,225,072

$22,965,023

$22,965,164

$22,965,164

Special Children’s Services

$1,770,370

$1,837,776

$1,988,368

$2,038,524

State Funded Foster Care

$8,723,417

$4,363,826

$4,346,521

$4,364,685

Mental Health Services-Children

$3,883,720

$3,882,300

$3,843,198

$3,815,015

Crisis Outreach

$428,840

$1,468,371

$1,602,690

$1,657,001

Developmental Service Community

$450,747

$457,747

$457,747

$457,747

Develop. Serv -Waiver Support

$53,584

$106,948

$106,948

$106,947

Medicaid – Development. Services

$16,438,323

$16,458,059

$16,458,059

$16,458,059

Brain Injury Program

$150,000

$150,000

$150,000

$150,000

 

Major Issues

 

Hospitals.   The Governor’s Budget contains several initiatives that reduces state reimbursement to hospitals as follows:

 

    FY 2014      FY 2015
Critical Access Hospitals- reduction from 109% to 101% of allowable costs
 General Fund

($2,448,000)

($2,448,000)

Critical Access Hospitals- reduction from 109% to 101% of allowable costs
Federal Funds

($3,962,055)

($3,918,710)

10% Reduction-Hospital outpatient Rates
   General Fund

($4,900,000)

($4,900,000)

10% Reduction-Hospital Outpatient Rates
   Federal Funds

($7,930,584)

($7,843,823)

 

The Governor’s Budget updates the hospital tax base year from 2008 to 2011 which provides savings in the General Fund – Medical Care Payments to Provider Program of $13.17 million in FY 2014 and $17.87 million in FY 2015.    The offset comes from Other Special Revenues in the same amount as saved in the General Fund in each year of the Biennium.

 

Head Start.    The Governor’s Budget reduced General Fund support for Head Start by $2 million each Head S year in the budget for FY 2012 and FY 2013.   The cuts are continued for FY 2014 and FY 2015.  Head Start has been demonstrated to be very effective in raising the educational achievements among Head Start children.

 

Unmet Needs.    Testimony from over 70 members of the public demonstrated an extraordinary need for DHHS services for children, the elderly and disabled, and for other populations.   Another indicator of the need for these services is the number of Maine residents who are on waiting lists.

 

  • With respect to Section 21 and Section 29 Developmentally Disabled waiver programs, alone, there are more than 1,000 Maine residents on the waiting lists.    There are waiting lists for other DHHS programs, such as the Home-based Care program and other programs.   The MR Waiver program has a waiting list of more than 600 people, and a class-action suit has been filed against the Department.   There are a significant number of Maine residents on waiting lists for nursing homes and long-term care facilities.

 

Bed-hold Days.    Currently a Medicaid patient in a residential facility, such as a nursing home, PNMI, or other long-term care facility is allowed 4 hospital bed-hold days and one therapeutic bed-hold day.   Hospital bed-hold days enable a long-term care MaineCare resident who is in need of hospitalization to return to the same facility following discharge from the hospital.

 

  • A therapeutic bed-hold day enables a MaineCare resident to spend time with the member’s family for one day, only,   If the MaineCare patient has the opportunity to spend a week with family or needs more than 4 hospital bed-hold days, the long-term care facility must discharge the patient, and the patient must find a different facility to which he or she can return.   This policy creates many problems.

 

  • There are long waiting lists for many long-term care facilities that will result in medically unnecessary longer stays in hospitals while waiting for openings in long-term care facilities.
  • The discharge of a patient to a different long-term care facility can be very unsettling and create considerable anxiety and ,
  • Discharging a patient with dementia can create very serious problems.

 

Questionable legality of some of the budget proposals in the DHHS Budget.    A suit has been filed against the Federal Government on the basis that cutting off MaineCare for persons with incomes between 100% and 130% of FPL violates federal law and rules.

 

Cost of Care.    Residents of PNMIs, many of whom are disabled and receive Supplemental Security Income [SSI], pay a portion of their room and board from their monthly check or other sources of income  – known as “cost of care.”  “Cost of care” is paid by each resident to the PNMI provider.   DHHS, however, has also been paying “cost of care” to each provider, which has resulted in double payments to providers.   The providers are opposed to double payments, which have to be reimbursed back to DHHS.   The DHHS computer system, however, could not extract the State’s cost of care payments to providers following disclosure of the double payments.   This issue raises the following questions:

 

  • Has the double payment for cost of care been corrected?   If it hasn’t, when is it expected to be corrected?
  • Has the State extracted and been reimbursed for the State’s share of the double payments?   If not, when does the State expect to be reimbursed?
  • How much is owed the State for “cost of care?”

 

Medical Add-on.   The Governor’s budget eliminates the Medical Add-on, an additional stipend or rate that a provider receives for the care of a person who has serious developmental disabilities.   The “medical add-on” is in addition to the non-negotiable standardized rate provided to a PNMI provider or group home.   Many clients for whom a medical add-on is provided, would have been eligible under the Pineland Consent Decree if it were in effect today.   The cost of care for this population would be significantly greater in a nursing home.    This population includes people with developmental disabilities, autism, dementia, and brain-injured people.

 

————————————————————————–

 

Other Program Funding FY 2012 FY 2013 FY 2014 FY 2015
Community Block Grant
   Federal Block Grant

$4,925,262

$4,927,504

$4,928,740

$4,933,007

Purchased Social Services
   General Fund

$6,489,747

$6,441,547

$6,123,669

$6,123,669

Purchased Social Services
   All Other Funds

$16,143,458

$16,143,627

$14,465,669

$14,466,886

Health and Human Services

Budget documents for the HHS committee may be here.

Commissioner Mayhew joined both the HHS and AFA committees to present testimony on the final section of the Governor’s budget.

Members of the public presented testimony in opposition to the Governor’s proposals.  Some testified in support of the proposal to create a new Brain Injury Waiver.

Public Testimony Part 2- April 5, 2013

Public Testimony Part 3- April 5, 2013

In the afternoon Commissioner Mayhew continued her testimony in support of the Governor’s cuts to hospitals.

The public also presented testimony in opposition to these cuts.

Downeast Hospital- April 5, 2013

Public Testimony Part 4- April 5, 2013

Public Testimony Part 5- April 5, 2013

Schedule

Monday morning, April 8th the Appropriations committee will be joined by the Veterans and Legal Affairs committee to begin to weigh in on the competing plans to rebid Maine’s wholesale liquor business.  The meeting will begin at 10:00 AM.

At 1:00 PM AFA will hear a presentation of the latest Consensus Economic Forecasting Commission (CEFC) report.

Friday morning AFA will hold public hearings on proposals to change municipal revenue sharing.

The full schedule may be found here.

Report backs

Policy Committees will now hold budget work sessions in preparation for reporting recommendations to AFA.  The schedule for report backs is below.

Audio and more

Please feel free to join the committee as they do their work. You may also listen online using the following link: http://www.maine.gov/legis/ofpr/appropriations_committee/audio/index.htm

You also may watch broadcasts of these and other committee hearings on the Maine Capitol Connection pilot channel through Maine Public Broadcasting.  You may watch over the air or through your cable provider as well as online here: http://www.mpbn.net/News/MaineCapitolConnection.aspx

Thank you and please let me know if you have questions.

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