$209 million slashed from HHS budget

Last modified: 3/15/2011 12:00:00 AM
The House Finance Committee yesterday took a carefully wielded ax to the Department of Health and Human Services budget.

After working through the weekend and going line by line through a series of potential budget cuts, the committee recommended reducing the governor's budget for the Department of Health and Human Services by an additional $209 million.

"We looked at them individually and made some judgments about what would good policy be, what kinds of reductions would cause the least harm to people," said Rep. Neal Kurk, a Weare Republican and chairman of the finance committee division dealing with Health and Human Services.

But Democrats and health care advocates say the additional cuts will cause serious harm to people in need. "I am extremely distressed that we seem to be sending our most vulnerable citizens - the elderly, our children, the mentally ill, the unemployed - a message that we have no sense of community, that we have no sense of responsibility for our fellow citizens, that we don't care if they don't get these services," said House Democratic Leader Terie Norelli.

The 2012-2013 budget proposed by Gov. John Lynch would have given Health and Human Services - the state's largest department - $621 million less than the agency calculated it would need to maintain current services. But Republican leaders who control the House say Lynch's revenue estimates are $300 million too high. They also object to the governor's cuts to local aid. House Finance Committee members have pledged to make up the difference through deeper spending cuts.

Last week, Health and Human Services Commissioner Nick Toumpas presented the House Finance Committee with a list of $346 million in potential cuts. Toumpas made clear that he did not support the cuts, which he believes would shift costs to cities and towns and dismantle the infrastructure the department has set up to maintain services for vulnerable citizens.

After his presentation, more than 500 people turned out for a public budget hearing, many pleading for social services - services for people with disabilities or with mental illness, or for people who are homeless.

In sessions on Sunday and yesterday, the Finance Committee division dealing with Health and Human Services tentatively decided to accept most of the governor's cuts, as well as a large number of the cuts on the list Toumpas provided. The committee did restore potential cuts in some of the most controversial areas, such as services for people with developmental disabilities.

 Children's services

One of the most drastic impacts could come from the elimination of the state's system for "Children in Need of Services," or CHINS, a category of children ordered by the courts to get treatment, guidance or counseling before they become delinquent. According to the Department of Health and Human Services, just over 1,000 children fell into this category in fiscal year 2010. Eliminating the system is expected to save more than $7 million over two years.

The Department of Health and Human Services estimated that 18 percent of these children will end up in the juvenile justice system. "Schools, communities, diversion, police would have to find another way to deal with it," Eric Borrin of the Department of Health and Human Services told the Finance Committee.

Democrats objected to the cut. "I don't know what would happen to these children in their communities," said Rep. Sharon Nordgren, a Hanover Democrat and Finance Committee member. "Some are violent. Parents can't deal with them. They're a danger to themselves and their community."

Norelli said eliminating treatment and counseling for these children would increase pressure on public schools and the courts. "It could result in our communities and certainly our families being less safe, and it puts the child at further risk for abuse and neglect," Norelli said.

But Kurk said the committee discussed whether the program was truly effective and whether services could be provided elsewhere more effectively. The committee also compared the CHINS program to other potential cuts.

"There was a sense that while it was not a good idea, it was the least harmful alternative," Kurk said.

Another big hit would be to hospitals, which are currently reimbursed by the state and federal governments for some of their costs for charitable care. The committee voted to cut those state reimbursements, which would also eliminate a federal match. The state would save $115 million. The committee would still make payments to critical access hospitals, small rural hospitals that receive additional Medicare money.

Kathy Bizarro, executive vice president of the New Hampshire Hospital Association, said it is "unprecedented" to tax hospitals to fund an uncompensated care pool, then not give the hospitals any of that money in return.

In some areas, the committee decided to eliminate funding entirely. It would eliminate subsidies for new families who adopt children; cut foster grandparents and senior volunteer programs; eliminate state funding for Service Link, which provides free information and referrals for seniors and adults with disabilities; and eliminate a program that provides meals, transportation, nursing and personal assistance to elderly housing residents.

The governor already proposed cutting about $4 million from community health centers; the committee added an additional $175,000 a year. Vanessa Santarelli, director of pubic policy for Bi-State Primary Care Association warned that more than 47 people would be laid off and 11,000 patients would lose primary care services.

In several cases, the committee took less money than it could have. Some of the most controversial proposed cuts were to services for people with developmental disabilities - including family caregiver pay, community support programs and day services. During the public hearing, recipients of these services testified that if community support programs were cut, more people could go into more expensive residential programs.

The committee ultimately voted to halve funding for most of these programs but not to eliminate them.

The committee would also cut in half funding for family planning, money that goes to community health centers and other clinics for preventive health care such as breast exams, cancer screenings and testing for sexually transmitted diseases. It would halve funding for domestic violence programs.

 Mental health services

The cuts were a mixed bag for individuals with mental illness, who were also a forceful presence at the public hearing. Two of the most extreme cuts would have stopped voluntary admissions to New Hampshire Hospital and restricted admissions to eight hours a day, five days a week. Rather than implementing those cuts, hospital officials came forward with a plan to save $1 million a year in general funds by moving a warehouse onto the hospital grounds and cutting back on maintenance, contracts and medication costs.

"We looked long and hard at what we could do," said hospital CEO Bob MacLeod. "Consolidating the warehouse we could meet our mandate and not impact admissions, which impacts communities and the emergency room."

At the same time, the committee voted to save the state more than $12 million a year by eliminating community mental health services entirely for a group of about 3,500 adults with severe mental disabilities and 3,400 children with serious emotional disturbances. The Department of Health and Human Services warned that cutting community services would increase the risk that these people would hurt themselves or others, and costs could be shifted to hospitals and law enforcement agencies.

Maggie Pritchard, executive director of Genesis Behavioral Health, said it is unclear whether community mental health agencies would stop treating these patients, or whether agencies would have to treat them for free - and risk going out of business because of the cost.

"If you cut access, you put the community at risk," Pritchard said.

One group of people that was spared was children in community shelters. The governor revived a controversial plan to move children - some of whom have been abused or neglected - from shelters to the Sununu Center, which houses juvenile delinquents. Without the CHINS program, fewer children would be sent to shelters. And Kurk said the committee did not want to move the shelter children to a locked facility.

The committee avoided cutting Temporary Assistance to Needy Families because of potential federal penalties.

The committee found a couple of new revenue sources and cost savings, in the form of some additional federal funding and a change in outpatient provider payments.

The committee rejected proposed tax or fee increases, including an increase of a tax on hospitals, and increased licensing fees for child care and health facilities.

Many cuts passed along party line, with Republicans supporting them and Democrats opposing them. Rep. Cindy Rosenwald, a Nashua Democrat and Finance Committee member, said she believes the results of the cuts will be devastating.

"We're going to see some catastrophic impacts on people, on families," she said. "We're going to see some downshifting of costs on school systems, local hospitals, local police departments and corrections facilities."

(Shira Schoenberg can be reached at 369-3319 or sschoenberg@cmonitor.com.)

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