Updated at 6:40 a.m.
The budget deal between Democratic legislators and Gov. Dannel P. Malloy's administration calls for millions of dollars in cuts to health care and social service programs that serve seniors, poor families, and people with developmental disabilities and mental illnesses. But compared to the deep reductions the governor proposed in February, many of the cuts agreed to between the governor’s office and legislative Democrats are relatively modest.
The House of Representatives began debate on the bill early Wednesday morning following lengthy delays while legislative leaders tried to ensure they had enough votes to pass the package, which includes several controversial tax hikes.
Among the cuts: An estimated 20,000 to 25,000 low-income parents would lose Medicaid coverage. Seniors who receive state-funded home care would have to pay more toward that care, and fewer would qualify for the program. Health care providers would receive lower payments for treating Medicaid patients, and mental health providers would see a reduction in state grant funding.
Sen. Beth Bye, co-chair of the budget-writing committee, said many areas of the budget will see cuts, but she and her co-chair “fought like heck to hold onto what we think were critical safety net services.”
Services for people with developmental disabilities
The budget avoids many of the huge cuts Malloy proposed to services for people with intellectual or developmental disabilities, although many programs would face some funding reductions. The governor’s cuts caused outrage and worry among families of people who rely on the services.
The $33 million voluntary services program – which helps families of young people with a mental health diagnosis in addition to autism or an intellectual disability — would have faced a 60 percent cut under the governor’s proposal. The final budget would also cut the program, but by 10 percent in the next fiscal year.
The budget also includes money for day programs for the 626 young people with intellectual or developmental disabilities scheduled to age out of the school system in the next two years, although less funding than would be required to provide the level of services graduates currently get. Malloy’s proposal called for eliminating the funding entirely, leaving parents worried that they would have to stop working to stay home with their young adult children or pay someone to do so.
Some of that spending would be offset by about $5 million per year in reduced overtime costs the budget requires from the Department of Developmental Services. The department’s reliance on overtime, particularly at state-run institutions, came under scrutiny after parents of young adults served by DDS identified millions of dollars in overtime at Southbury Training School and suggested it could be better spent providing community residential services to people currently waiting for them. But DDS officials said overtime has been used to avoid hiring new state employees, and that the department did not have millions of dollars that could be cut or spent for other purposes.
The budget does not include any new money to provide residential services — such as placement in a group home — for adults with intellectual or developmental disabilities, something parents and advocates have been seeking. There are close to 2,000 people waiting for those services, and many families worry their loved ones will not receive any residential services until their parents die.
Bye said she and other legislators were disappointed there was not money to put toward serving those on the waiting list for residential services.
“It wasn’t a year we were adding,” she said.
But Bye said the Department of Developmental Services’ budget was one of the most protected in a year of cuts, a reflection in part of the advocacy by families of people the department serves.
Medicaid and social services
An estimated 20,000 to 25,000 low-income parents would lose Medicaid coverage under the budget, which calls for lowering the income limit for the program. Malloy proposed a larger cut that would have also affected pregnant women, while legislators sought to avoid any eligibility changes. The final deal would lower eligibility from 185 percent of the poverty level — currently the second-highest in the nation — to 150 percent, and would not affect pregnant women.
Parents who are no longer eligible for Medicaid would be able to buy deeply subsidized insurance through the state’s health insurance exchange. But advocates and some legislators have warned that many would be unable to afford even modest premiums and could end up uninsured or unable to afford the copayments for medical care.
Because of federal rules, many of those parents would not lose Medicaid coverage for 12 months after the change goes into effect. Those who do would be able to enroll in exchange plans beginning Aug. 1, Human Services Co-Chair Rep. Cathy Abercrombie, D-Meriden, said.
“That was a compromise, but one that we felt like people are not left without affordable health insurance,” Bye, D-West Hartford, said.
Health care providers who treat Medicaid patients would face payment reductions, although by far less than the $90 million over two years the governor initially proposed.
Malloy and legislators split the difference on the governor’s plan to reduce the amount of money the state provides for funeral and burial expenses for those who die without the ability to pay. It’s currently $1,800 per person; under the budget deal, it would drop to $1,400.
Other cuts the governor sought are not included in the final budget.
- Nursing home residents won’t have to give up an extra $10 per month from their Social Security checks or other income. Malloy proposed reducing the spending money nursing home residents are allowed to keep — if their care is funded by Medicaid — from $60 per month to $50, but legislators rejected it.
- The Department of Social Services’ Torrington regional office will remain open.
But the final budget includes other cuts.
Seniors would have to pay more for services provided through the Connecticut Home Care Program for Elders, which is intended to help people stay out of nursing homes. Participants currently pay 7 percent of the cost of their care each month; on average, people pay $66 per month. The budget calls for raising that to 9 percent. Advocates for seniors warn that any increase in the copay could make it harder for clients to stay in the program and get the help they need to continue living in the community.
The plan also calls for a two-year moratorium on admissions to a portion of the home care program that serves people who don’t require nursing home-level, long-term care, but who are at risk of hospitalization or short-term placement in a nursing home if they don’t receive services at home.
Mental health funding
The budget deal replaces many of the governor’s proposed deep funding reductions to mental health services with more modest cuts.
State grants to mental health and substance abuse treatment programs, which Malloy proposed cutting by $25.5 million, would be reduced, but by a smaller amount. Providers have historically relied on the grants to help cover the cost of treating people who are uninsured or underinsured, and agency leaders had said Malloy’s plan could lead to program closures or other significant service cutbacks.
In April, legislators proposed cutting the grants by $7.5 million, based in part on an analysis by the state Department of Mental Health and Addiction Services that suggested that providers could earn about $7.3 million in increased Medicaid payments as clients gain coverage under the federal health law. The final budget deal would cut $8.5 million, Bye said. Mental health agency leaders have said even the smaller proposed cut would leave them with less than would be needed to fully fund the 230 agencies that rely on the money.
The budget adds money for a new grant program to provide care coordination and other services for people with mental illness. It’s based on a program at Middlesex Hospital that works to improve care and other services for people who frequently used the emergency room. The budget includes $4.5 million for the grants over two years.
Public health programs funded by insurance industry
Under the plan, the insurance industry would become responsible for funding several public health programs: needle exchanges, AIDS services, a breast and cervical cancer detection and treatment program for uninsured women, X-ray screening and tuberculosis care and a venereal disease control program.
The industry pays through an assessment, which is typically passed on to customers through higher premiums. That assessment already pays for the Connecticut Insurance Department and the Office of the Healthcare Advocate. The industry already pays for the Connecticut Insurance Department and the Office of the Healthcare Advocate. Adding the other programs would bring the fee on the industry to nearly $80 million next year and $81.4 million the year after.
Legislators said the budget is expected to include $12 million for nursing home workers. Unionized workers at 27 nursing homes voted to authorize a strike in April — a move meant to send a message both to their employers and state officials, since about 70 percent of nursing home residents have their care paid for by Medicaid. They called off the strike at the request of Malloy.
Correction: This story has been updated to correct the new cost-sharing level for people in the Connecticut Home Care Program for Elders. Under the budget, program participants would have to pay 9 percent of the cost of care, up from 7 percent.