A budget proposal is like a map, showing you where an agency wants to invest more money, and where it plans to cut. It reveals an administration’s priorities for the future– and holds them accountable for what they did or didn’t accomplish in the past. I’ll be your tour guide for this year’s health and human services proposal.
The headline this year is that the governor isn’t asking for more money than last year. That’s significant because health and human services account for more than a third of all state spending. Since 2008, that spending has grown by more than a billion dollars. Executive Office of Health and Human Services secretary Elizabeth Roberts.
“And actually it’s a few million dollars even an actual decrease," says Roberts, "which, in that size budget, is de minimus almost. “
De minimus: in other words, barely noticeable in a state that spends three-point-eight billion dollars a year on health and human services. Still, Roberts says it’s a sign that the governor’s push for savings from Medicaid is paying off. According to her numbers, the effort has already saved more than $70 million.
“What you’re seeing is against what it would have been," says Roberts, "we’re actually looking almost closer to $80 million.”
But a state project to unite a bunch of ailing health and human service information technologies (known as UHIP) has gone over-budget. And Medicaid head Anya Rader Wallack says her expenses have gone up.
“In the larger context, we’ve had an expansion in coverage through Medicaid," says Wallack, "so we’ve seen increased costs through our caseload increases," which means more people enrolled in Medicaid over the past year than anticipated. Nearly 10,000 more, as of December 2015.
There are some new proposals in this budget, including more than four million dollars to help prevent drug overdose deaths. One chunk of that would go to pay for addiction treatment for people behind bars.
Another new investment: pay raises for home health care workers and people who work with the developmentally disabled.
A couple of agencies could see funding cuts. Those include the Department of Children, Youth, and Families, which famously went over budget several times but left questions about the benefits for kids in its care. DCYF has been working to overhaul many programs.
State Health and Human Services Secretary Elizabeth Roberts says the department canceled contracts with two outside agencies, and has achieved some savings “…largely attributable to bringing the coordination of services back inside the agency and no longer having the network contracts, that were multi-million dollar contracts," Roberts says.
And more savings have come from another institution undergoing a major reform: the Eleanor Slater state hospital system. Medicaid head Anya Rader Wallack says she hopes to find additional savings from the many initiatives launched last year to quote “reinvent Medicaid.” But she says the full extent of the savings may not emerge until the following budget year.
“This is the year where I think we fully implement our initiatives, stabilize them, get throw the growing pains that we might have had this year in putting these programs in place," says Wallack, "and really start to reap the benefits of them.”
Advocates have concerns that savings in Medicaid will mean cutting services for enrollees. Again, Health and Human Services Secretary Elizabeth Roberts.
“The governor made it really clear that she did not want to balance this budget by denying access to services, denying coverage.”
Still, Medicaid is one of the biggest expenditures in the state’s health and human services budget. And the governor will be looking for $35 million dollars in additional savings from it in the coming fiscal year.