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Thread: Health programs may take big hit in Md. budget

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    Health programs may take big hit in Md. budget

    Health programs may take big hit in Md. budget
    Ehrlich weighing list of $160 million, file says
    By Michael Dresser
    Sun Staff

    May 6, 2003



    The Ehrlich administration is considering a list of almost $160 million in possible cuts to health programs, including Medicaid and mental-health services, as part of its effort to deal with a mounting revenue shortfall.

    Critics say some of the possible cuts could hurt vulnerable patients and, in the long term, cost the state more money than they would save.

    But state Health Secretary Nelson J. Sabatini said yesterday that he has to assume that about $150 million to $160 million of the $500 million in cuts Gov. Robert L. Ehrlich Jr. is seeking in the budget that takes effect July 1 will come from his department's programs.

    "I have yet to figure out how to make budget cuts everybody applauds," Sabatini said.

    The potential spending reductions are detailed in a confidential administration document obtained by The Sun.

    The administration said last week that it is looking for hundreds of millions of dollars in immediate spending reductions to the $22.4 billion budget, in addition to the $135 million it will have to cut as a result of its planned veto of a business tax bill passed by the General Assembly.

    Ehrlich aides said the additional cuts must be made in the upcoming budget to prepare for a projected $1 billion shortfall in the fiscal year beginning July 1, 2004.

    In all, the cuts on the list prepared by the Department of Health and Mental Hygiene come to $93 million in state funds and $66 million in federal money.


    'Nothing out of play'

    In some cases, the proposed cuts have an "OK" scrawled next to them.

    But Sabatini said none of the proposed cuts has been approved or ruled out.

    "Right now, there's nothing out of play," he said.

    The possible cuts prompted protests from some Ehrlich critics who have opposed his plans to veto the revenue bill, which, among other things, closes a so-called "loophole" that allows companies to avoid Maryland taxation by shifting assets to Delaware shell corporations.

    "At a time when great national companies like Toys R Us are cheating Maryland out of hundreds of millions of dollars in state tax loopholes, it looks like the Ehrlich administration would rather cut health care for poor kids and public health measures," said Sean Dobson, deputy director of Progressive Maryland.


    Medicaid

    The bulk of the contemplated cuts, $123 million in state and federal money combined, are in the Medicaid program.

    The single largest possible cut - $30 million each from state and federal sources - would eliminate retroactive coverage of services for "medically needy" patients. The document notes that the cut would increase uncompensated care and make it more difficult for Maryland to keep a federal waiver that brings the state about $500 million a year.

    That proposal alarmed Pegeen Townsend, lobbyist for the Maryland Hospital Association.

    "When you load up on uncompensated care, you add to the cost of hospital care in this state," she said.

    Townsend said a cut that large could put the state's Medicaid waiver in jeopardy. She said that risking the federal waiver, which Maryland receives for maintaining its "all-payer" system to control hospital costs, is akin to risking the state's Triple A bond rating.

    Sabatini vowed to protect the waiver. "I would never do anything that would put the all-payer system in jeopardy. That is something that is absolutely essential," he said.


    Other proposals

    Among the other suggested cuts were:


    $5 million from the Cigarette Restitution Fund financed by the national tobacco settlement.
    That money would come out of anti-smoking advertising and cancer research and treatment programs.


    A $1.6 million reduction in money for the School-Based Mental Health-Violence Prevention Initiative.
    The document said the cut, which was marked with an OK, could result in the layoff of mental health counselors in schools.


    Almost $1 million to care for uninsured adults with chronic diseases - a cut that would require community providers to shoulder the burden of treating 1,000 more people.

    $1.2 million for the expansion of drug treatment programs in Baltimore.

    $1 million the legislature allocated for spinal cord injury research.

    Shifting expense

    Del. Samuel I. Rosenberg, a legislative leader on health-care issues, said several of the potential cuts in Medicaid funds would increase the uncompensated care costs of hospitals, shifting the expense to insurers.

    Such a move, Rosenberg said, would undermine the effect of Ehrlich's pledge to veto a 2 percent tax on health maintenance organization policies approved by the legislature.

    "It is a hidden tax," the Baltimore Democrat said. "There will be a rate increase eventually to compensate for this, and people will be paying the difference."


    Anti-smoking

    Stephen Peregoy, president of the American Lung Association of Maryland, expressed concern about the money that might be shifted from the tobacco fund - especially the funds for anti-smoking campaigns.

    "If they start going any deeper, I think you're going to jeopardize the overall credibility of the program," he said.

    Sen. Paula C. Hollinger, chairman of the Education, Health and Environmental Affairs Committee, said the potential reduction in mental-health services in the schools is one of the worst cuts Ehrlich could make.

    "Children's mental-health care is one of the hottest issues nationally," the Baltimore County Democrat said.

    Townsend said care providers are unlikely to pick up the slack if the administration tries to push the burden of 1,000 chronically ill adults onto them.

    "What is more likely is that they would end up in a hospital emergency room," she said.


    Youths

    Carol Fanconi, health-policy director for Advocates for Children and Youth, said that a proposed $1 million to $4 million cut for case management services for very ill youngsters has the potential to tear families apart.

    "In extreme cases, what could happen is that parents would not be able to care for these children at home," Fanconi said.


    Big portion

    Sabatini said the health department, which spends about 25 percent of the state budget, will have to take a hefty proportion of the needed cuts.

    "For every one of these cuts, I will find somebody that will tell you that doing it would be disastrous," he said.

    Sun staff writer David Nitkin contributed to this article.



    Copyright © 2003, The Baltimore Sun
    http://www.sunspot.net/news/health/b...alth-headlines

  2. #2
    The cuts are an understatement. Child day care vouchers have been abolished but under the "law" parents receiving AFDC/Foodstamps, etc must be employeed or in school. Then they axe the funding.

    SueP What can I do to help with the proposed SCI research fund cut? Shoot me a message or post here.

    The costs in life as well as the increase in secondary conditions will be staggering!

    "Don't worry about the world coming to an end today.
    It's already tomorrow in Australia!"----- Charles Schultz


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