DHHS budget: Nearly there

Would you choose to reduce services for children with mental illnesses or cut funding for Head Start, which serves low-income children? Or perhaps you would choose to eliminate Medicaid coverage for people of a certain eligibility status?

These are some of the difficult questions facing lawmakers when they reconvene on Tuesday to vote on the Maine Department of Health and Human Services 2013 supplemental budget. There is nothing to envy about the decision they’ll have to make. But they would do well to look carefully at the proposal, particularly the items that would affect Maine’s neediest.

To get you up to speed: Republicans on the Legislature’s Appropriations Committee have pushed through a proposed budget that outlines cuts and revenues that will close a projected $78.5 million shortfall at DHHS. All Democrats on the committee voted against the proposal and later presented their own budget that relies on projected revenues; it makes no cuts to programs.

Republicans have done a couple things that are important to note: First, they want structural changes and have appropriately suggested cutting some services. We don’t agree with all of their suggestions for cuts, but at least they are trying to reduce costs. The Democrats, meanwhile, are relying mainly on surplus and promising revenue forecasts and want to preserve every program. That’s not a realistic approach.

Second, Republicans have not fallen into lockstep with Gov. Paul LePage. Take the case of general assistance. As you will remember, LePage used his line-item veto power to reject a general assistance plan passed by the Legislature, and legislators opted not to return to override the veto. Now, however, the Appropriations Committee has ignored LePage and included the original general assistance reimbursement rates in its current budget proposal. Good for them for not passing the cost on to municipalities.

You may have heard about some of the thornier parts of the Republicans’ proposal: namely, eliminating the optional Medicaid coverage for 19- and 20-year-olds and reducing medical coverage for parents of children in the State Children’s Health Insurance Program. Together the propositions would save $7.74 million.

Don’t be fooled, though. It’s unlikely the state legally will be able to make these cuts because federal law prohibits states from reducing Medicaid programs to balance the budget. To make changes, states must apply for a waiver, and the director of the federal Centers for Medicare and Medicaid Services has said that waiver requests are unlikely to be approved. If the feds don’t approve the cuts, the funding problem is handed off to next year’s Legislature.

As is often the case with budgets, the most difficult parts come down to single line items. Consider the case of Head Start. Making sure children are ready for kindergarten, and providing child care services for working parents is, in the short- and long-term, a good investment. Would you really choose to cut $2 million (which is nearly half of Head Start’s state funding and 6 percent of its overall funding) to make it more difficult for moms and dads to be able to work because they can’t afford day care? People who run Head Start have said some programs will close if the cuts happen.

To put the dollar figure in perspective, consider the Republicans’ plan to cut taxes on retiree pensions. The cuts will cost the state $7 million in fiscal year 2014 and $20.8 million in fiscal year 2015. Some tax relief for retirees is fine, but should it be done at the expense of programs for children and working families?

Consider another plan: cutting $400,000 from the Family Planning Association, which provides health care services for people — mainly women — who have low incomes or are uninsured. The state should be trying to expand access to contraceptives and family planning services. The amount of $400,000 could instead be taken from the budget’s ending balance of $6.5 million.

The Republicans get credit for not falling in line with the governor’s sometimes extreme proposals. And we welcome a budget that proposes some cuts instead of maintaining the status quo. The House and Senate likely have enough votes to pass the budget along party lines, but hopefully legislators will reconsider a few of the line items. Otherwise we worry harm will come to those who need the assistance the most and that costs will simply be passed on to hospitals and local taxpayers.