Malloy’s budget cuts could hinge on his definition of the ‘safety net’

One of Gov. Dannel P. Malloy’s most familiar refrains on the campaign trail last fall was that while “everything is on the table,” his administration would not “shred the safety net” to close the state budget deficit.

But when Malloy unveils his plan Wednesday to close a $3 billion-plus shortfall for the coming fiscal year with nearly $2 billion in cuts, the governor’s definition of Connecticut’s social service and health care “safety net” may not match those of others.

Is it limited simply to Medicaid, a $4 billion component of this year’s $19.01 billion budget, which provides funding for nursing home and other long-term care and health services for poor families, childless adults on welfare, the aged, blind and disabled?

How about the more than $1 billion in contracts that state agencies will award to private, nonprofit social services to serve abused children, the developmentally disabled, drug addicts and the mentally ill and to provide counseling and job training to inmates leaving prison?

Does it also include Temporary Aid to Needy Families, the $230 million welfare and child care program for single mothers with children, which — like Medicaid — relies on a combination of federal and state dollars and must follow certain federal rules?

What about the $83 million Connecticut will send to its acute care hospitals this fiscal year to help them meet their mandate of treating all emergency room patients regardless of their ability to pay?

On top of all that are tens of millions in additional smaller health care and social service programs run almost entirely with state funding, such as the prescription drug subsidy program for seniors commonly known as ConnPACE. Is that part of the net?

“I don’t know if I envision that broad of a vision of the safety net,” Malloy told The Mirror during a late October interview, one week before Election Day, adding that while preserving the safety net remains a top priority, he might have to look to combine or streamline some smaller programs to reduce costs.

Malloy also conceded preserving services for those most in need  would not be easy–or inexpensive.

Human services comprise one of the single-largest shares of the overall budget. According to the legislature’s nonpartisan Office of Fiscal Analysis, this year it involves about $5.16 billion, or 27 percent of all spending.

Advocates for all of these programs can try to shield them from potential cuts in the Malloy budget by sending one of the governor’s favorite campaign rallying cries right back at him.

“The safety net is far bigger than just the programs that are federally funded,” Sen. Toni Harp, D-New Haven, co-chairwoman of the Appropriations Committee, said Monday. “Many of the programs we fund ourselves (with only state dollars) were set up because we recognized a need that the federal government isn’t meeting.”

Harp said Connecticut particularly needs to supplement federal programs with state-funded efforts because of the unique nature of its population.

Though Connecticut boasts the highest per capita wealth in the nation, its three largest cities — Hartford, New Haven and Bridgeport — rank as three of the country’s poorest. This combination of tremendous wealth and poverty sometimes means needy Connecticut families don’t qualify for certain types of federal aid because of the overall prosperity of the state, Harp said.

The New Haven lawmaker added that the problems stemming from this poverty stretch across many issues, including jobs, housing, child care and school readiness. “We know people need more than just medical programs in this state’s safety net.”

And though Connecticut’s safety net still surpasses those offered by most other states, most of its components have seen little or no funding increase — and in a few cases some cuts — over the last two fiscal years.

Shawn M. Lang, director of public policy for the Connecticut AIDS Resource Coalition, described the  safety net as what she called “the basics”: Food, shelter and access to health care.

“In the world of HIV and AIDS, we look at housing as really the linchpin around which everything else flows,” she said. If people aren’t in safe, affordable and adequate housing, they’re less likely to receive the care they need and stay on medication, and more likely to engage in high-risk behavior.

Lang also hopes the budget will avoid any erosion of food programs like school breakfast and Meals on Wheels for people who are elderly and homebound.

The state’s needle and syringe exchange program, which costs $455,072 this fiscal year, might not fit into the “safety net” definition of some, Lang said. But she added that it’s good public policy.

“We have some very profound concerns coming into this budget round,” said Patrick Johnson Jr., president of Oak Hill, which serves people with intellectual, developmental or physical disabilities at more than 100 sites.

Community providers like Oak Hill will have a hard time absorbing any cuts after three years of flat funding and two decades of what Johnson called chronic underfunding. Oak Hill has 184 vans on the road every day, and the cost of gasoline is rising. The agency’s health care costs go up by roughly $1 million a year, and next month, contracts for about 800 workers will expire. For the past three years, nobody in the organization has had a raise, Johnson said.

“If the funding is inadequate or if there’s a cut in funding to private agencies, I think the results will be devastating this year,” he added.

Heather Gates, president and CEO of Community Health Resources, which provides behavioral health and other services to about 10,000 people a year, said she’s confident Malloy understands the safety net’s value.

But with state budget deficit projections ranging from $3.2 billion to $3.7 billion, a gap ranging from 16 to 20 percent of current spending, there’s no hiding from fiscal reality, Gates said.

“He understands it on I think a pretty fundamental level,” she said. “And that’s sort of the beginning. That’s where you start.”

“But we’re also realistic about the kind of fiscal climate we’re in, and have to say in all honesty we are of course concerned about what’s going to come out,” she added.

Some advocates have looked for clues in Malloy’s actions since being elected.

Alicia Woodsby, public policy director for the National Alliance on Mental Illness Connecticut, said the group was encouraged that Malloy did not attempt to consolidate human service agencies in his proposal to restructure state government and announced plans to expand the Money Follows the Person program, which aligns with mental health advocates’ goals of having more people receive services outside of institutions.

“The governor just made it really clear on multiple occasions that he really understands the concerns of people with mental illness, that they see it as a very vulnerable population, that it costs more when you cut off services,” she said.

Johnson said he’s encouraged by Malloy’s decisions to create a cabinet-level position to represent nonprofits, and by the governor’s sensitivity to the needs of people with disabilities. He noted that Malloy spoke frequently during the campaign about his own experience with dyslexia.

For Connecticut Voices for Children Executive Director Jamey Bell, the nervousness also comes from the size of the budget gap and Malloy’s pledge not to resort to gimmicks to close it.

“He has to deal with it incredibly honestly and that means that it’s going to be very, very difficult for a lot of things that my organization cares about and has worked to preserve and expand if possible for many years,” she said.