On Wednesday, January 27, Governor Baker released his budget proposal for fiscal year 2017. Baker’s budget proposal provides for a 3.5% increase in overall state spending, with mainly level funding for public health programs.
Many areas with the Department of Public Health (DPH) have lost staff due to the 2015 early retirement incentive program. Across DPH, approximately 200 positions were lost, with a budgetary impact on community-based programs of approximately $8.5 million. These staff losses hit some areas especially hard, including environmental health, the State Laboratory and infectious disease control, and health care quality. The impact of these cuts on program capacity is not yet known, as initiatives to retool staffing and technology are underway in many areas. Notwithstanding the impact of early retirement, the Governor’s budget includes a few areas of investment in public health, including an additional $9.2 million for substance abuse treatment and prevention, funding for new inspectional and regulatory positions in environmental health and health care quality, and funding for a new Office of Population Health.
Several important programs outside of DPH that help Massachusetts residents stay healthy face funding cuts in the Governor’s budget. We are particularly alarmed by a proposal to eliminate or significantly reduce cash assistance benefits for 8,500 families in which a family member is disabled, a cut that is sure to lead to worse health outcome and increased health inequities.
Substance Abuse Funding Increased
The Governor’s proposal maintains the Administration’s commitment to addressing substance abuse by increasing funding for treatment and prevention by $9.2 million or about 7%. To learn more about proposed substance abuse funding, read the analysis from the Association for Behavioral Healthcare Analysis here.)
Most Programs Level Funded
Nearly all other DPH programs are level funded, including AIDS Prevention, Treatment and Services (4512-0103), WIC Nutritional Services (4513-1002), Youth Violence Program (4590-1506), Matching Grants to YMCAs and Boys and Girls Clubs (4590-1507), Early Intervention (4513-1020), and Smoking Prevention and Cessation Programs (4590-0300). The Domestic Violence and Sexual Assault Prevention and Treatment line item (4513-1130) is proposed to be consolidated with a line item currently within the Department of Children and Families (4800-1400). Consolidation increases DPH funding by $24 million, which, when consolidation is factored in, is level with FY16 funding.
Mixed News on Public Health Infrastructure
Public health emergencies are in news daily. The spread of the Zika Virus poses a serious threat to children’s health in Latin America and is raising concern worldwide. The Flint, Michigan water crisis has shed a harsh light on the impacts of environmental racism on health.
Against this backdrop, it’s vital that we continue to bring attention to the essential public health protections here at home that we all rely on- though most of us seldom pause think about. Among the protections provided by Department of Public Health are things like water and air quality testing, protection of our food supply, monitoring disease reporting, investigation of and response to disease outbreaks, and helping local health departments respond to communicable disease threats. It is this often-invisible infrastructure that has suffered the most from budget cuts since 2008.
In this area, the Governor’s budget proposal is mixed. In several areas, the Governor has proposed funding for new positions or functions that would bolster public health protections. These include nine new inspectional or regulatory positions within Environmental Health (4510-0600) and two new positions in Health Care Quality (4510-0710), as well as funding for a new Office of Population Health within the Critical Operations and Essential Services account (4510-0100).
However, numerous DPH line items that support basic public health protections see a net loss of funds compared to what the Legislature appropriated for FY16. These budget reductions are driven by early retirements, many of which were not backfilled. MPHA will be keeping careful track of the capacity in these areas to assess future staffing and budget needs.
Cash Assistance, Housing, and Health Care Access Threatened
MPHA is concerned with several areas of the state budget outside of DPH which impact access to services and social determinants of health, including:
- Transitional Aid to Families with Dependent Children (4403-2000) is cut by $39.5 million or 17% from FY16. Drastic cuts are proposed in benefits to families where a parent or child is severely disabled and receives federal disability benefits. 8,500 families would receive dramatically reduced benefits or lose benefits all together. Families losing benefits will not be able to pay rent and are at a high risk of becoming homeless. Click here to learn more about these cuts from the Massachusetts Law Reform Institute.
- Massachusetts Rental Voucher Program (MRVP) (7004-9024) is decreased by $8 million or 9% from FY16. MRVP is the state’s rental assistance program. It helps low income families, the elderly and persons with disabilities pay their rent in private apartments at a significantly lower cost than emergency shelter.
- MassHealth spending would be cut in a number of areas. The Governor’s proposal provides for a 5% growth rate for MassHealth spending, which is lower than projected expenditures due to increases in caseload and inflation. To reach the 5% goal, the budget proposal would remove benefits from MassHealth fee-for-service plans, lock members into managed care plans for 12 months, and reduce eligibility for the Health Safety Net program which reimburses for the care of low income patients that are uninsured or underinsured. Learn more from Health Care For All by clicking here.
Next Steps and Opportunities For Action
The budget process moves on now to the House of Representatives. The House Ways and Means Committee will be developing their budget proposal over the next six weeks, and the full House will debate the budget in late April. MPHA will be working hard to advocate for adequate funding for DPH and the programs that help Massachusetts residents stay healthy.
We need your voice! Stay tuned over the next few weeks as MPHA releases our complete list of funding priorities and learn more about how you can get involved to speak up for public health in the state budget
For more information, contact MPHA Director of Public Policy, Maddie Ribble, at firstname.lastname@example.org.