Health care officials frustrated with state budget: Fear hospitals will take big hit – and shift costs onto insured patients
DOVER – For social service and health care officials around the state, the recently passed state budget realizes some of their deepest concerns.
The $10.2 billion budget became law Friday without Gov. John Lynch’s signature. While the budget was hailed by Republicans as responsible and practicing sustainable spending in state government, Lynch said it wasn’t something he could endorse.
“This budget ... will drive up the cost of health care, and put health care at risk for too many of our most vulnerable families,” Lynch said in a statement Friday. “It undercuts some of the basic workings of state government, impacting the services expected by our citizens.”
Some agencies, such as Community Partners in Dover, are facing a better scenario under the final budget than they’d anticipated when House Republicans proposed their budget earlier this year.
“We did relatively well,” said Brian Collins, executive director at Community Partners. “We’re planning on losing $600,000. After the House budget, we’d anticipated losing $4.7 million.”
Collins said the cuts are in smaller categories and will result in “multiple impacts” they will try to manage internally.
Steve Ahnen, president of the New Hampshire Hospital Association, has been vocal in his disappointment in the budget deliberations, projecting cuts to hospitals will cause cost shifting onto patients with private insurance, so those premiums will increase.
He said hospitals would also face serious cuts to programs and staffing.
“Hospitals are extremely disappointed that Governor Lynch has chosen to allow the budget approved earlier this week by the Legislature to become law without his signature,” Ahnen said in a statement. “This budget will wreak havoc on the health care infrastructure and safety net in New Hampshire. It will increase the cost of health insurance for businesses and individuals, threaten the availability of essential health care services that our communities depend on and result in the loss of jobs and economic instability.”
Many health care officials have warned of a trickle-down effect that could be caused when patients unable to seek services at a community health center instead turn to an emergency room.
Now, the community health centers are also wary.
“We have no idea yet how we’ll be impacted by the cuts to hospitals,” said Jay Couture, executive director of Seacoast Mental Health in Portsmouth. “Anything that’s going to impede their (hospitals’) ability to provide access to care could impact us.”
Couture said this budget is “much better” than that proposed by House Republicans -- that budget reduced not just funding but the number of people who would be allowed to seek services at community health centers.
“It’s a much better outcome,” Couture said, but added she’s still not feeling relieved.
“We’re a system who’s had rate cuts in each of the last three years, and although we made out better, we still have more than $6 million in cuts so we had a system we knew wasn’t adequately funded and now it’s funded a little less,” she said.
While the budget’s impacts on the community mental health system are focused in the second year of the next biennium, Couture said it will take some time to see how they will be impacted by changes. One provision in the bill -- Medicaid capitation -- would set a rate for each person covered by Medicaid who seeks services at the center.
“We’re trying to figure out the risk corridor,” Couture said. “If they go above a certain percentage, that would be the responsibility of the center.”
Other agencies are looking at dramatic cuts as well.
Edwin W. Kelly, administrative judge of the new Circuit Court of the New Hampshire judicial branch said the Children in Need of Services program is essentially repealed under this budget.
“There are dramatic changes as a result of the budget,” he said. “The Legislature has completely repealed the definition of a child in need of services from what we’ve known it to be over the years.”
It had been defined as children who are regularly truant from school, habitually run away from home or commit offenses that would be criminal if committed by an adult.
Now, Kelly said, the definition is “severely restricted” so it requires a diagnosis of mental health disorder and applies only to young people who commit serious offenses.
Under this new definition, the number of children who qualify for CHINS will go from between 3,000 and 5,000 in one year to about 50.
“From my perspective, CHINS as we know it has been repealed,” Kelly said. “It’s a huge change.”
He said they will need to wait and see what the overall impact will be, but children will likely be brought under a delinquency case or abuse and neglect case instead, if CHINS is no longer an option.
He said it’s likely there will be cases that would have been brought before the court that will find services available in communities, but others will not move forward and those children will continue to be truant or commit crimes.
The budget goes into effect on Friday, July 1.
Copyright (c) 2011, Foster’s Daily Democrat, Dover, N.H. Distributed by McClatchy-Tribune Information Services.