HEALTH CARE

The Conference budget puts $12.793 billion into health care programs, including $10.213 billion for MassHealth (Medicaid) and health reform programs, $645.2 million for mental health services, $513.2 million for public health, and $1.422 billion for state employee health benefits. MassHealth and health reform spending is less than either the House or Senate budget totals, and is $177 million less than total funding in the FY 2009 GAA. Mental health funding in the Conference budget is also less than in either the House or Senate proposals, and is $40.3 million (6 percent) below funding in the FY 2009 GAA. Public health services receive $513.2 million in the Conference budget; although this amount is $39 million above the totals recommended by the Senate, public health programs will still be deeply cut: the Conference budget is 14 percent below funding in the FY 2009 GAA. The recommended funding for state employee health benefits falls just about half way between the House and Senate proposals, and also includes compromise language for costs to state employee for their health insurance.

Highlights of the Conference budget health care funding include:

• The Conference budget puts $9.162 billion into the MassHealth (Medicaid) program, an amount almost identical to the total recommended by the Senate, and just under the amount recommended by the House. While this is 6 percent more than funding in the FY 2009 GAA, because of rising health care costs and increasing caseloads due to the recession, this funding level will still require significant cuts in the MassHealth program – most likely in the form of reductions in reimbursements for providers. Included in this total is $68 million for the Children’s Behavioral Health Initiative (Rosie D.) which received $25 million at the beginning of FY 2009, $14.2 million for the Children’s Medical Security Plan, $17.2 million for Healthy Start, and $324.5 million for the MassHealth Essential Program. There is no funding for the Community First Initiative. In addition, the Prescription Advantage program is level funded at $40 million.

• The Commonwealth Care Trust fund receives only $591.7 million in the Conference budget, a level below the House recommendation and above the amount recommended by the Senate. This trust fund is the source of funding for the state’s Commonwealth Care Insurance program, and for the health safety net (formerly called uncompensated care.) There is also language in the budget that cuts approximately 28,000 legal immigrants out of the Commonwealth Care program. This restriction had been in the Senate budget proposal.

• The Conference budget follows the Senate’s lower funding recommendation for children’s mental health services, allocating $72.2 million. Funding in the FY 2009 GAA was $76.2 million, so this year’s budget is a 5 percent cut. The Conference budget funds adult mental health services at a level below both the House and Senate recommendations, including only $374.4 million in total. This is a 4 percent cut from funding in the FY 2009 GAA.

• Even though the Conference budget recommends funding public health services at a level between the House and Senate recommendations, the FY 2010 budget will still result in broad cuts in public health programs. There are still likely to be significant cuts in: youth violence prevention, which receives $3.5 million (63 percent below the FY 2009 GAA); smoking prevention, which receives $5 million (61 percent below the FY 2009 GAA); and family health services, which receives $4.8 million (38 percent below the FY 2009 GAA). Early intervention services are also cut deeply, although there is an important change in the funding for these services for developmentally delayed infants and toddlers. There is language that will require insurers (including MassHealth) to cover a larger portion of early intervention costs. Nevertheless, the $25.6 million included in the Conference budget will likely result in greater restrictions on eligibility for these services.

• The Conference Committee chose compromise language in the funding of state employee health benefits. The House had recommended that new retirees pay 20 percent of their health insurance, but the Conference budget keeps the current 15 percent share as recommended by the Senate. As for the costs borne by current employees, the House recommended increasing the cost-share for all workers to 20 percent. The Senate, on the other hand would have increased the share paid by state workers to 25 percent. The compromise language included in the Conference budget would have employees hired before July 1, 2003 pay 20 percent of their health care costs, and employees hired on or after July 1, 2003 pay 25 percent. This is a five percentage point increase for all current employees.