Co-chairs’ Budget Concerns Human Services Stakeholders

Keeping the deep cuts proposed by the Governor will “severely fray the [social services] safety net,” advocates say
March 30, 2011 -- The human services slice of the Joint Ways and Means co-chairs’ budget, released Tuesday, is striking in its dependence on cost savings from healthcare transformation efforts outlined by Governor John Kitzhaber and the Health System Transformation Team.
“The co-chairs [Rep. Dennis Richardson, R-Central Point, Sen. Richard Devlin, D-Tualatin, and Rep. Peter Buckley, D-Ashland] support the efforts of the governor, the legislature and the medical community to transform our Medicaid healthcare delivery system,” the co-chairs said in their budget document. “Success of these efforts is crucial to balancing the 2011-13 budget.”
At the final Transformation Team meeting last week, Oregon Health Authority staff outlined projected savings from eliminating ineffective treatments from the Oregon Health Plan’s prioritized list of services, instituting payment reform, and creating a healthcare system that integrates physical, oral and mental health. The net savings estimate of the proposed changes, not including what’s already in the governor’s balanced budget, is $34 million.
The co-chairs’ budget assumes savings not just from those efforts, but also from 19 percent cuts to Medicaid reimbursement for healthcare providers called for by the governor.
But those cuts, in addition to budget cuts for the Department of Human Services and Oregon Health Authority programs, are exactly what have human services stakeholders concerned.
The cuts proposed by the governor and upheld in the co-chairs’ budget “will severely fray the [social services] safety net, and in some cases, eliminate it completely,” said Christopher J. Krenk, MSW, president and CEO of Albertina Kerr Centers, which provides services to people with developmental disabilities.
The reductions, he added, would make it “likely that a number of smaller providers will no longer be able to remain in business. … Larger providers may find that they need to turn business back to the state because they can no longer afford to provide the service.” If that happens, said Krenk, it’s unclear how Oregon could fulfill its federal mandate to cover all citizens eligible for services.
 “Given the escalating need in services for our vulnerable citizens and repeated decreases in funding for staff who work directly with these clients to facilitate safe care in the least restrictive care setting possible, our state must not only invest in services but also the structure necessary to keep independence, dignity, choice and safety at the forefront of our long-term care system," said Kay Metzger, chair of the Oregon Association of Area Agencies on Aging and Disabilities.
A recent Oregonian investigation documenting incidents of elder abuse by DHS employees has made clearer the existing holes in the state’s safety net for seniors and people with disabilities. The co-chairs’ budget specifically highlights this as an area of concern.
“We are particularly concerned about the governor’s recommended budget for Seniors and People with Disabilities,” the co-chairs stated. “We will focus and direct our Subcommittee on Human Services to focus on resolving issues within this budget.”
Hearings on this budget in the Ways and Means Subcommittee on Human Services have been dire, as the program’s increasing caseload – currently growing by 6.6 percent – and the disappearance of one-time federal stimulus money collide with the governor’s proposed budget and Medicaid reimbursement reductions.
“We’re facing difficult choices,” Erinn Kelley-Siel, DHS’s new director, told the subcommittee earlier this month. “If we weren't in this situation financially, the department would not want to be having this conversation.”
The Human Services Coalition of Oregon, comprised of various community health and human services organizations around the state, submitted a letter to the legislature Wednesday offering cautionary recommendations to lawmakers preparing to slash services.
Among the coalition's suggestions: “less costly and more effective approaches to public safety; further innovations to improve service delivery”; and “the powerful employment implications that federal matching dollars bring to the state.”
Their suggestions won’t be falling on deaf ears, but they may be facing tied hands as Ways and Means subcommittees grapple to build budgets with fewer resources.
“I have a sense we're not even cutting flesh anymore, we're cutting bone,” said Rep. Mitch Greenlick (D-Portland) at a hearing earlier this month. “I don't like coming away from any of these hearings in tears.”
2011-13 co-chairs’ budget here.


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The OHA leadership consists of some of the same individuals who implemented a " failed over the budget" MMIS system; who refuse to require some providers to manage -triage care; who pay more for some DME than commercial Carriers; who did not provide proper oversight of Federal Grant dollars under the "Money follow the People" program. It's DHS that requires first & foremost requires transformation not the HC delivery system. Many of us have provided good, cost effective & quality care inspite of them not because they've (DHS) been helpful, effective or collaborative. This is not a "business plan" a rationale financial institution would approve a loan for. Legislators must be vigilant & demand robust programmatic savings analysis.