A case in point concerns HB
375 by state Rep. Frank Hoffman.
It reconfigured to some extent the management of the Early Steps Program, which
to date without cost to clients provides assistance to families with children ages
0-3 who display developmental disabilities. The program’s early intervention is
designed to prevent later problems in these children integrating into society without
more expensive and extensive services provided. It may draw on federal money with
state money but is not required to be operated.
Last year, when the House of Representatives proposed deeper spending
cuts than budgeted, the Department of Health and Hospitals (which actually runs
the program despite its administrative housing current in the Department of
Education) maintained that it would have to eliminate
the program. However, budget negotiations that reversed most of the cuts saved
the program, where about half of its costs are paid through roughly $8 million from the general fund.
This year, DHH proposed that some limited cost sharing occur to
forestall more coming cuts to DHH in this year’s budget. DHH’s budget
is nearly $40 million lower and the area in it responsible for Early Steps, the
Office for Citizens with Developmental Disabilities, is facing an over $30
million reduction. Almost half
of families currently receiving services, or those making more than 250
percent of the Federal Poverty Line in income (for example, almost $56,000 for
a family of four), would pay no more than $1,500 annually to access services,
the per incident or hour costs of which
are much higher in value. Under this, about 10
percent of existing clients are forecasted to drop out, although some
significant portion is expected to access these services using private
insurance, and others who make the co-pay will use insurance to pay for it.
After this year (when the co-pays are phased in), the co-pay regime was
estimated to raise over $2 million annually. A number of other states also
employ a similar arrangement. OCDD officials noted that without this additional
revenue, the entire program could be at risk.
Despite this, yesterday
the House failed to advance the bill. A majority voted for it, but because this
required imposition of a fee, this requires a two-thirds majority to pass, which
ended up 20 votes short (and would not have passed even without this
supermajority requirement, being three votes short of that absolute majority of
the seated members requirement). The main concerns seemed to be about straining
family finances and those withdrawing from the program – even though the proposed
scale to be established was based on ability to pay for an optional program
that would require at most less than 2.7 percent of income and that many could
get insurance to pay either in or out of the program.
But if that was the goal of opponents, to make sure participation
remained the same, they may have cut their noses off despite their faces or
imposed that cost elsewhere. The budget did not include as part of expenditures
the extra revenue to be gathered this way (because of the Constitutional
prohibition on contingency expenditures), but in operating the program now OCDD
will have to adhere to the budgeted amount which cannot sustain current operations.
Assuming the whole program isn’t axed in favor of less drastic, possible
solutions, there are just two alternatives.
One would be restricting eligibility; for example, cutting off
participation at 400 percent FPL. This could result in some families not
receiving services at all. The other would be cutting other programs, such as
the Flexible Family Fund run by OCDD, budgeted at $1.4 million. This provides monthly
stipends to families needing to offset large expenses related to caring for
children with severe disabilities. Thus, these families suffer.
With passage of the bill, one way or the other – through insurance or
out of pocket – it seems that these services would have continued at their
present level without cutting services from other programs. After all, if a
child with a caring family can benefit from these services, these families, who,
contrary to statements made by rookie state Rep. Julie
Stokes, are not the “working poor” nor close to poverty, will sacrifice to
make the co-pays or out-of-pocket expenditures, or would choose not to if the
services aren’t that helpful. Failing to pass it means services for some will
be cut, either in this program or another.
Unless, now having made this latter choice, the House makes cuts
elsewhere, thereby reducing potentially other services, or in finding
efficiencies. If these are part of the policy mix, no indication has been given
as such, negating these as options. So, effectively by their action on this
bill, enough representatives actually have reduced services one way or the
other, which they asserted they were avoiding by turning it down, and/or passed
the cost off onto other recipients elsewhere. That seems neither rational nor
informed.
2 comments:
If anybody at LSU-Shreveport is reading this, please, please send the professor down the hall to sign up for an English class.
AMEN!!
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