Massachusetts Developmental Disabilities Council

Executive Summary

People First: Disability Analysis of the State Budget

An Analysis of the Governor's House 1 Budget Recommendations for Fiscal Year 2006

Report #1 of 4 on the FY06 state budget debate

In this Executive Summary, we present snapshots of the governor's House 1 for FY06 budget proposals in each of the agencies and areas that People First covers. The overall story for disabilities services in this budget can be summarized as one of level funding. Some programs and agencies are proposed to receive their first maintenance budgets in years and others are proposed for modest increases. Still, the capacity of the state to meet the needs of persons with disabilities would be little altered by H1. Hence, both in this Executive Summary and in the full report that follows, we highlight advocacy priorities that, if achieved, would allow Massachusetts to carry out a comprehensive system of disability service provision.

1.     Department of Early Education and Care (DEE&C)

H1 for FY06 keeps pace with the planned reorganization of child care and early education services into a new Department of Early Education and Care. The programming itself, however, is essentially level-funded across the board.

(For FY06 needs, advocacy priorities, and budget history on the DEE&C, see page 15 for details.)

2.     Department of Education (DOE) / Special Education / The Circuit Breaker

A Circuit Breaker law was implemented at the beginning of FY04 to help address soaring special education cost for cities and towns across the state. This law created a new reimbursement formula to provide state aid to help local school districts cope with extraordinary special education costs. The formula, subject to appropriation, is supposed to pay for 75% of special education expenses that are above 4 times the average per pupil budget. This means that if a special education student's annual education expenses exceed $29,328, than 75% of the excess will be reimbursed by the state. Under the Circuit Breaker, up to 12,000 students will trigger some form of state reimbursement to their school districts.

The Circuit Breaker for special education receives level funding in H1 for FY06, maintaining the $80 million increase that had been approved by the legislature for FY05. At present, the Circuit Breaker is reimbursing at a rate of 72%.

(For FY06 needs, advocacy priorities, and budget history on DOE's special education circuit breaker, see page 21 for details.)

3.     Department of Elder Affairs (DEA)

The H1 for FY06 budget proposal for elders basically represents level-funding. There is an $86 million increase for Senior Care Plans (line item 4000-0600), the account which pays MassHealth costs of all eligible seniors and some persons with disabilities who receive care in the community or in a nursing home.

H1 for FY06 does not address nursing home bed-holds, which have been regulated in the past through budget language. Needs for staff training and higher pay to support quality care are also unaddressed in H1. Funding for the Home Health Workforce Initiative (line item 4000-0625) is discontinued. Home care services are level funded, as is the agency's nutrition program. A long-awaited increase is proposed for Protective Services.

(For FY06 needs, advocacy priorities, and budget history on DEA, see page 25 for details.)

4.     Department of Housing and Community Development (DHCD)

H1 for FY06 recommends level funding of $2.3 million for the Alternative Housing Voucher Program (AHVP, line item 7004-9030) and would rename it Transitional Rental Assistance. To fully fund the program, $5.5 million is needed.

(For FY06 needs, advocacy priorities, and budget history on DHCD, see page 35 for details.)

5.     Department of Mental Health (DMH)

The governor's budget for FY06 is the first maintenance budget DMH has received in years. H1 recommends $24.3 million more than the FY05 allocation, a 3.4% increase. The budget covers contractual rate increases and annualized costs, and will prevent further program closures. However, no one new will be served from the long waiting lists for services. Only 15 additional community-based placements will be created by this budget (to move adults who are stuck in acute hospital units).

H1 also revives last year's proposal to cut $1.9 million from research programs at Harvard and UMass (line item 5046-0000). These funds leverage federal dollars and help to serve hundreds of people with mental illness.

Advocates are pleased to see that the EOHHS operations account (line item 4000-0300) maintains language that gives the DMH commissioner authority to approve or disapprove restrictions on medications to treat mental illness (including prior authorization requirements).

(For FY06 needs, advocacy priorities, and budget history on DMH, see page 39 for details.)

6.     Department of Mental Retardation (DMR)

H1 for FY06 recommends $58,292,652 more than the FY05 funding level for DMR, a 5.5% increase. The funds provide for the requirements of the Boulet (waiting list) and Rolland (nursing home diversion) class action settlement agreements. The funds also provide for Turning 22 services (for young people graduating or aging out of special education, line item 5920-5000). Each year, as costs increase, level funding for Turning 22 becomes less adequate to meet the needs of the program. Nearly $8.3 million of the increase is for annualizing pay increases for the lowest paid direct care workers funded in FY05 through the salary reserve (line item 1599-6901), and nearly $8.8 million is for Unit 2 collective bargaining increases to the salaries of unionized workers.

This budget does not fund any new service coordinator positions despite the expanding caseload of the agency, and it fails to restore the 18-20 service coordinator positions cut in FY05. The Flexible Family Supports account receives level funding only (outside of Turning 22 annualization and salary reserve-related increases). There are no new funds to pay for the new autism division at the department.

(For FY06 needs, advocacy priorities, and budget history on DMR, see page 51 for details.)

7.     Department of Social Services (DSS)

H1 for FY06 proposes a slight increase to the Services for Children and Families account. It funds the gamut of programs needed by families in which abuse and neglect is occurring and the foster families that take in children removed from their homes. Funding cuts going back a decade, and level funding in recent years, have placed great strain on the ability of such programs to meet the needs of their clients, particularly for mental health and substance abuse services.

(For FY06 needs, advocacy priorities, and budget history on DSS, see page 65 for details.)

8.     Department of Transitional Assistance (DTA)

H1 for FY06 proposes increases for the Employment Services Program (ESP) and decreases for the Transitional Aid to Families with Dependent Children (TAFDC) and Emergency Aid to Elderly, Disabled, and Children (EAEDC) programs. While more ESP funds are greatly needed to repair significant cuts suffered in the FY02-FY04 period, the new money won't come close to satisfying the need. Under a proposed new phase of welfare reform, parents with disabilities and other families facing serious barriers to employment would be subject to new and steeper work requirements. H1 essentially puts forward a plan to offer employment assistance to some people and save money when others drop off the rolls.

(For FY06 needs, advocacy priorities, and budget history on DTA, see page 67 for details.)

9.     Department of Youth Services (DYS)

H1 for FY06 funds DYS services with increases of between 3-14.5%. While the increased allocations are needed, and the news that some of the money will be marked for suicide prevention has been welcomed, the agency is not supported to the extent needed. Major DYS concerns include the increased mental health needs of its clients. The agency serves by default as a provider of last resort for youth with mental health issues, but does not have the resources to provide the needed treatment.

(For FY06 needs, advocacy priorities, and budget history on DYS, see page 75 for details.)

10.  Massachusetts Commission for the Blind (MCB)

H1 for FY06 fails to provide a maintenance budget for programs and services at MCB. MCB is a small agency that already has been cut $900,000 from its Turning 22 and Community Services programs during the fiscal crisis and has yet to regain those resources. H1 for FY06 recommends just $563,092 more than the FY05 level, a 2.1% increase. The increase provides most of the funding needed for new and annualized "Turning 22" program participants (students who age out of coverage under special education programs when they turn 22 years old and responsibility for their cases is transferred to a disability agency such as MCB). Community Services and Ferguson Industries face cuts.

(For FY06 needs, advocacy priorities, and budget history on the MCB, see page 81 for details.)

11.  Massachusetts Commission for the Deaf and Hard of Hearing (MCDHH)

H1 for FY06 recommends an increase of $108,903 (just 2%) for MCDHH. The budget would maintain services at the FY05 level only. No help is provided for the case management waiting list, the need for more assistive technology, community interpreter service gaps, the inadequate numbers of children's specialists (just 3 statewide), or the under-funded Deaf and Hard of Hearing Independent Living Services (DHHILS) programs (that were cut by 8% in FY02 and level-funded since).

(For FY06 needs, advocacy priorities, and budget history on the MCDHH, see page 89 for details.)

12.  Massachusetts Department of Public Health (MDPH)

Near level funding will mean more program erosion if the H1 for FY06 MDPH recommendations prevail. H1 proposes a 1% increase to MDPH, from $409.5 million in FY05 to $416.1 million. Most programs would receive level or near level-not maintenance-funding. These include programs for immunizations, school health services, community health centers, and dental health services. Under-funding of the HIV Drug Assistance program would mean that new enrollees in FY06 would be placed on a waiting list for life sustaining drugs.

(For FY06 needs, advocacy priorities, and budget history on MDPH, see page 95 for details.)

13.  Massachusetts Rehabilitation Commission (MRC)

H1 for FY06 recommends continued progress on the Turning 22 (T22) funding problem at MRC. Through T22, adult services are provided to students who graduate or age out of special education. Unfortunately there is no help in this budget for the Independent Living Centers (ILCs) or for the Home Care crisis. The ILCs have had level funding for 5 years and Home Care has a 4 month processing list for services, although Home Care is supposed to be an entitlement under the state Medicaid plan and not carry waiting lists. Vocational Rehabilitation (VR) and its long waiting list will also make no progress under this budget.

Funding for two MRC housing programs is being closely watched by the disabilities community this year: the Home Modification Loan Program and the new Community-Based Housing Program (authorized in FY05). Both are part of the capital budget, not the General Fund, and at the time of this writing, the Executive Office of Administration and Finance has yet to release the "bond cap" allocations for FY06 (the money dedicated to authorized programs out of the limited capital budget). Both programs are essential to enable people to live in their own homes and not in facility-based care.

(For FY06 needs, advocacy priorities, and budget history on the MRC, see page 107 for details.)

14.  Office of Medicaid (MassHealth)

In November 2004, the governor unveiled his vision for health care coverage expansion and health insurance reform. The stated goals are to slow the growth in health care costs, expand access to health care (i.e., insurance) to all Massachusetts residents, and not spend additional dollars. H1 for FY06 does not include language to implement these health care reforms, nor has legislation specifying the necessary details been introduced. H1 allocates additional MassHealth program expenditures of only $134 million-just 2% of FY05 costs-at a time when average annual increases in health costs have been in the 10-12% range.

(For FY06 needs, advocacy priorities, and budget history on the Office of Medicaid, see page 119 for details.)

There are other important MassHealth issues regulated through budget language that impacts the gamut of MassHealth programs. Of concern to advocates is that H1 includes no funding for restoring what are considered optional benefits-including dental and vision services-that were cut during the recent fiscal crisis. There are no changes to the new premiums that families of insured children now must pay. And the Office of Medicaid is again granted the authority to impose enrollment caps on certain programs at any time they deem necessary. Unresolved in H1 is whether an asset test will be required for adults ages 19-64 to qualify for MassHealth programs, or whether a waiver changing standards of eligibility for persons with disabilities will be approved or implemented in FY06.

More positively, H1 does retain language within the MassHealth administration account (line item 4000-0300) that requires the Department of Mental Health (DMH) commissioner to approve any prior authorization or other restriction on medication used to treat mental illness that is issued by MassHealth programs. Also, no changes in eligibility for or benefits of PCA services are recommended in H1.

(For FY06 needs, advocacy priorities, and budget history on these other important health issues, see the "Special Section: Key Issues in Health Care" on page 143 for details.)

15.  Other State Disabilities Agencies and Programs

H1 for FY06 recommends consolidating three civil legal services agencies-the Massachusetts Legal Assistance Corporation, the Mental Health Legal Advisors Committee, and Massachusetts Correctional Legal Services-into a single line item. The new consolidated line item would be cut by $67,491. The governor had recommended consolidation of these 3 agencies last year, but without a cut in funding.

The Governor's Commission on Mental Retardation doesn't have its own line item nor any earmark funding. The Commission has been moved to EOHHS, but its budget is now unknown. Staff have been reduced by one-third in recent years.

The Massachusetts Office on Disability has been cut $167,012 (22.5%) since FY01, unadjusted for inflation. Four full-time staff-2 policy positions and 2 advocate positions-have been cut. Client Services has lost 33% of its staff while attempting to respond to an 80% increase in demand for services. H1 for FY06 recommends just $13,498 above the FY05 funding level, a 2.4% increase.

The Disabled Persons Protection Commission has been struggling to catch up with an enormous backlog of cases due to staff cuts during the fiscal crisis and sharp increases in calls to its hotline. Oversight officers have caseloads in the hundreds. H1 for FY06 recommends only $45,295 above the FY05 funding level, a 2.65% increase.

The Massachusetts Commission Against Discrimination (MCAD) investigates allegations of discrimination based on disability (among other protected categories). H1 for FY06 recommends $94,424 above the FY05 funding level, an increase of 6.6%. MCAD needs the funds to support hiring for 2 investigator positions that are critical for reducing case backlog and investigator caseloads. The new staff would also generate revenue, because when MCAD closes more cases it can maximize its federal reimbursements.

The Architectural Access Board is responsible for ensuring that all public buildings are accessible to and safe for use by individuals with disabilities. It has been a part of a larger line item at the Office of Public Safety and Homeland Security. H1 for FY06 again provides no specific earmark or separate line item indicating a budget for the AAB.

(For FY06 needs, advocacy priorities, and budget history on these other disability agencies and programs see page 131 for details.)

16.  Salary Reserve

The governor's H1 for FY06 again includes no funding for raising salaries of the lowest paid direct care workers. There is a proposed $5 million for a Purchase of Service Rate Adjustment (line 1599-6902) for contracted service providers, but the money is earmarked for standardizing reimbursement rates and efficiency standards, not for increasing salaries.

(For FY06 needs, advocacy priorities, and budget history on the Salary Reserve, see page 141 for details.)