Health care budget cuts affect children, poor

Mary Rivers attributes a local health safety net provider with saving her life when she had nowhere else to turn.

The dental assistant from Bassett hopes Virginia budget cuts won’t hurt the ability of providers like Piedmont Access to Health Services Inc. in Danville to help locals who are uninsured or underinsured.

“These people need help,” Rivers said. “I’ve been there. I would like legislators to know there are people who fall in between the cracks. What are you going to do for them?”

Before leaving office, Gov. Timothy M. Kaine submitted his proposal on how to cut about $2 billion. On Wednesday, Gov. Bob McDonnell listed his recommendations to legislators that would cut about another $2.2 billion. In total, state legislators need to cut about $4 billion to balance the state budget for two years.

Kaine’s proposed cuts and McDonnell’s recommendations for health care funding and services would affect some of the Dan River Region’s most vulnerable residents: children, the chronically ill and disabled. Yet, nothing is set in stone as legislators hammer out decisions to pass a budget through the General Assembly.

CEO Kay Crane of PATHS said current proposals would impact whether the nonprofit could add new patients to its medication assistance program or if the Health Centers of the Piedmont could provide ancillary services like mammograms or lumpectomies.

added budget recommendations would: 

- Reduce funding to the Virginia Health Care Foundation 15 percent the first year, 40 percent the second year
- Reduce funding for the Virginia Association of Free Clinics by 15 percent the first year, 40 percent the second year
- Reduce funding for the Virginia Community Healthcare Association by 15 percent the first year, 40 percent the second year
-  Reduce personal attendant services at the Department of Rehabilitative Services by 25 percent the first year and 50 percent the next year
-  Reduce funding for chore and companion services provided by local departments of social services by 25 percent the first year and 50 percent the second year
-  Reduces Community Services Boards funding by 10 percent, which also means a loss in federal mental health block grant funds
-  Reduces by 20 percent the general funds for the Comprehensive Services Act
Kaine’s introduced budget included eliminating inflationary increases for Medicaid reimbursement, reducing Medicaid reimbursement for home and community-based services, clinical laboratory services, durable medical equipment and children’s behavioral services.
That budget would reduce funding for indigent health care costs for the U.Va. and VCU health systems by 3 percent. It also proposed reducing service reductions on most Medicaid community-based waiver programs, including a freeze on new enrollments and reducing the hours available for respite care by two-thirds. It also reduces Medicaid eligibility for long-term care.
The Health and Human Resources spending in the introduced budget funds cost and caseload increases in Medicaid, offsets revenue to the Virginia Health Care Fund (state share of Medicaid spending) and funds increased costs in mandatory health care and social service programs.
McDonnell’s recommendations include eliminating Medicaid coverage for consumers hiring their own personal or companion home care, freezing enrollment in the Family Access to Medical Insurance Security program, reducing Medicaid reimbursement for community mental health services and for dental services.
McDonnell recommended reducing state mental health bed operational capacity statewide by 15 percent to provide funding for care through Community Services Boards and reducing reimbursement for community mental health services by 5 percent.
McDonnell’s recommendations include various administration and community service organization cuts.

Any reductions in Medicaid reimbursement would affect the nonprofit’s bottom line, which affects its ability to increase access to care or expand or add services. That would come at a time when demand is only increasing as locals lose their jobs or health insurance.

About 40 percent of the children the community health center sees are Medicaid recipients, Crane added.

“It’s not that we don’t want to do our part to help them balance the budget, we’re talking about people’s lives,” Crane said.

The Free Clinic of Danville receives funding from local contributions and also from the Virginia Association of Free Clinics, which provides funding to free clinics statewide according to patient numbers.

Reduction in that association’s funding will affect the local clinic, but it would not make a huge impact on the budget, Executive Director Denise Buckner said. The funding is about $10,000 and $20,000 a year.

Yet, as the number of insured in Danville and Pittsylvania County rise and donations decrease in a down economy, the Free Clinic needs any and all funding possible, she said. The clinic saw a 26 percent increase in patients from 2008 to 2009.

“The demand is just so great right now, every dollar that’s cut can certainly make an impact,” Buckner said. “I know things are tight. We’re remaining hopeful.”

PATHS and the Free Clinic, like the Virginia Health Care Foundation, make up Virginia’s health care safety net, said VHCF Executive Director Debbie Oswalt.

McDonnell’s recommendations would essentially eliminate half of the state’s support for that safety net, Oswalt said. That’s a loss of $5 million in funding the second year.

Yet, for every dollar the state invests in safety net providers, the return is $25, Oswalt said. According to that rate, a loss of $5 million in funding means a loss of $125 million returned.

Oswalt remains hopeful because these are still recommendations, not yet final decisions.

“We all understand that in order to live within our means, that cuts are going to have to be made,” Oswalt said. “We hope that members of the General Assembly will be smart and strategic about the cuts that they make.”

Home care and personal care providers saw significant cuts in Kaine’s introduced budget, said Executive Director Marcia Tetterton of the Virginia Association for Home Care and Hospice. McDonnell didn’t recommend significant budget cuts for home care, “but the Kaine cuts were pretty devastating,” she said.

That means less money for assistance with the activities of daily living like bathing, dressing or chores. The association anticipates the reduction could mean up to 7,000 jobs lost across the state and perhaps access problems for care, particularly in rural areas.

Tetterton said she is waiting to see what budget amendment recommendations the House of Delegates appropriations committee plans to release today.

“This is a terrible budget scenario,” she said.

Mary Ann Bergeron, executive director of the Virginia Association of Community Services Boards, said she also foresees job losses in the health care arena if the proposed cuts and recommendations go through.

“I think the cuts themselves to health in general are devastating,” Bergeron said.

The Virginia Association of Community Services Boards represents the state’s 40 community services boards, which provide mental health, intellectual disability and substance use disorder services. Community services boards on an ongoing basis serve about 200,000 Virginians.

The budget recommendations reduce all of the Community Services Boards funding streams, she said. That means a loss of $25 million in general funds, about another $7 million in waivers and possibly $9 to $10 million in community mental health rate reimbursement reductions, she estimated.

“We are talking about sizeable amounts of money being reduced from CSB budgets,” Bergeron said.

She said cuts will ultimately affect the consumers who because of these services are able to stay within their communities instead of nursing homes or state facilities.

She said she hopes legislators target reductions to minimize impact.

Chris Owens, director of programs for Mental Health America of Virginia, said it’s undetermined how individual localities would be affected by the recommended cuts, but Owens worries if people cannot get the care they need, there would be a rise in crisis intervention calls or emergency room visits. That would cost more in the long run.

“It’s pretty drastic,” Owens said.

Rivers, who now works for PATHS at the new dental clinic, knows how quickly a person’s life can change. She never anticipated losing health insurance after her husband’s heart attack and bypass surgery. When she finally did get Optima insurance through her husband’s new employer, PATHS’ Health Center of the Piedmont was the only local provider she found to take it.

She attributes PATHS to saving her life, when Dr. Robert Goodnight found out the cause of spikes in her blood pressure. Essentially, she is diabetic and needed lifesaving medication.

She hopes Virginia legislators continue to fund the health care safety net providers for those most in need.

“It can happen to any of us at any time,” Rivers said. “You never know.”