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DDS line items would get small increases while some MassHealth accounts would see cuts under governor’s FY ’27 budget
Governor Maura Healey has proposed relatively small increases in the Department of Developmental Services (DDS) budget for provider-run group homes, state-operated group homes, and for the Wrentham and Hogan Centers in the coming fiscal year, which starts July 1.
However, some of the state’s largest MassHealth accounts would face cuts under the governor’s budget proposal, raising the possibility of cuts in funding for Day Habilitation and Adult Foster Care programs and Personal Care Attendants for persons with intellectual and developmental disabilities (I/DD).
MassHealth is Massachusetts’ Medicaid program, through which the state administers and receives federal Medicaid reimbursement.
There appears to be no indication yet that the state’s 50% Medicaid reimbursement level from the federal government will be cut. But there have been proposals at the federal level to do so. At the same time, the Trump administration and Republicans in Congress have maintained the cuts won’t affect people with I/DD.
On January 28, Healey unveiled a $62.8 billion proposed budget for Massachusetts for the coming fiscal year. The governor’s budget legislation has been sent to the state Legislature’s House Ways and Means Committee; and from there it will proceed to votes in the full House and Senate.
Among the DDS line items we are concerned about are the following:
- The Wrentham and Hogan Intermediate Care Facilities (ICFs) (Line item 5930-1000):
Healey has proposed a $4.6 million, or 3.5%, increase in this line item, bringing it from $129.7 million to $134.3 million.
Despite that increase, we remain concerned that the Wrentham and Hogan Centers are being allowed to die by attrition, given that the administration routinely denies admission to them. Since Fiscal Year 2012, the ICF line item has been cut by more than $18 million, or more than 12%.
We visited the House Ways and Means and other key committees at the State House yesterday, asking them to support proposed language in the ICF line item that we think would open those facilities to new admissions. Our proposed language states that persons eligible for ICF-level care in Massachusetts have a right to that care.
- State-operated group homes (Line Item 5920-2010):
The governor has proposed a $25 million, or 7.2%, increase in this line item, which funds state-operated group homes. The increase would bring projected spending of $347.2 million in the current fiscal year to $372.3 million next year.
We believe the administration, while proposing modest increases in this line item, is also effectively allowing the state-run group home network to die by attrition. The data coming from DDS is inconsistent, however, regarding the trend in the total number of residents, or census, in those facilities.
The latest census data provided by DDS in September has produced confusion over whether the total census in state-operated group homes has been rising or falling. Data provided by DDS in previous years consistently showed the total census had been steadily falling. However, the new data set from DDS in September indicates that the census actually rose during the same fiscal years DDS had previously said it was falling – 2020 through 2023.
It seems most likely to us that the census in the state-operated homes has been steadily falling. We have heard that several homes have been closed in recent years, that staffing has been cut, and that it is difficult, if not impossible, to gain admission to those residences.
- Corporate provider-run group homes (Line Item 5920-2000)
The much larger corporate-provider-run group home system would receive a 2.4%, or $48.5 million, increase under the governor’s budget proposal, to $2.07 billion. While that increase is relatively modest, the provider line item has been on an entirely different funding trajectory for the past two decades than has the ICF line item. Since Fiscal 2012, the provider line item will have been increased by $1.3 billion, or 173 percent.
MassHealth programs would be cut
The Arc of Massachusetts, a key lobbying group for the corporate providers, is reporting that the MassHealth budget would see an across-the-board rate freeze, under Healey’s budget. According to the Arc, the proposed budget also includes significant cuts to Adult Foster Care, Personal Care Attendants, and Adult Day Health programs.
However, given that these programs are funded through large accounts, it’s not clear how much those specific services would be cut if the governor’s budget is adopted.
Healey has proposed cuts in the following MassHealth accounts:
- MassHealth Medicaid Administration (Line Item 4000-0300):
This account, which includes funding for Personal Care Attendants, would be cut by $3.2 million, or 2%, from $159.4 million to $156.2 million.
- MassHealth fee-for-Service (Line Item 4000-0700):
This account, which funds Adult Foster Care and Day Habilitation programs, would be cut by $268 million, or 6%, from $4.4 billion to $4.2 billion.
- MassHealth managed Care (Line Item 4000-0500):
This account, which also funds Adult Foster Care and Day Habilitation programs, would be cut by nearly $1 billion, or 14.2%, from $7 billion to $6 billion.
Many questions loom over the planned cuts in federal funding, particularly over the impact those cuts will have on people with intellectual and other disabilities. But over the long term, perhaps a more fundamental question is what will the Healey administration’s policy of promoting privatization of services mean for the future of Wrentham, Hogan, and other critically important state-run facilities and services for some of our most vulnerable citizens.
Even if Massachusetts is spared from devastating cuts in Medicaid reimbursement, the ongoing trend toward the closures of the ICFs and state-run group homes will still result in a race to the bottom of care for those persons in this state.
Do we really want managed care for the disabled?
Hang Lee struggled to get his words out in testifying on Wednesday morning before a packed public hearing in Boston on a proposal by the Patrick administration to introduce managed care into the delivery of services for the disabled.
Hang said he is concerned that under the proposal, he and thousands of other disabled people who are eligible for both Medicaid and Medicare, will see reduced funding for medical equipment and services they currently need and might need in the future.
Hang suffers from cerebral palsy and scoliosis, debilitating and progressively worsening diseases of the spine and nervous system that he anticipates will leave him completely immobilized in a few years. “I am in constant pain and emotional agony,” said Hang, his face contorted with the effort to speak each sentence.
He said he anticipates he will evenually need a body brace, which costs thousands of dollars. “A cut in services means a reduction in funding for the brace,” he said.
Hang was one of dozens of people, who are dually eligible for Medicaid and Medicare-funded services, who testified at the hearing held by the Executive Office of Health and Human Services. Under the EOHHS proposal, private vendors, known as Integrated Care Organizations (or ICOs) would be hired to manage medical, prescription drug, and disability services to thousands of those people.
Medicaid helps fund a range of residential, employment, and other services for persons with disabilities, while Medicare funds medical care and prescription drugs for many of those same people. The EOHHS maintains that their proposed system would cut costs of care by eliminating overlap, redundancies, and a lack of coordination between Medicaid and Medicare. Medicare and Medicaid will spend a projected $3.85 billion in 2011 on health care for dual eligible adults ages 21-64 in Massachusetts, according to EOHHS.
COFAR and the SEIU Local 509 state employee union called for exempting the management of residential care, day and transportation, service coordination and other services from the proposal. SEIU representative Stu Dickson maintained that while the union “agrees with the need to address needless costs of medical procedures, tests abuse, billing and administrative redundancies, etc., this is profoundly different than the care of human beings.” Dickson contended that in implementing the proposal, Massachusetts would compete with other states in a “race to the bottom” in care for the disabled.
“This proposal appears to be another step in this administration’s quest to privatize key services to the state’s most vulnerable people and to remove government from its responsibilities in that area,” I testified on behalf of COFAR.
Even the human service providers are not sold on further privatization in this area. In a December 16 email to members, the Association of Developmental Disabilities Providers stated that “the Arc (of Massachusetts) and ADDP do not believe there is current research available that validates significant cost savings attained by turning over large parts of State Medicaid programs to managed care companies.”
As did Hang, many in packed hearing on Wednesday said their main concerns were the retention of consumer choice and access once a corporate entity was making decisions on who gets what services.
Other speakers maintained that they had spent years, in some cases, in finding doctors and therapists for their conditions and might lose those specialists under a managed care system. “My doctors all work together,” one woman testified. “My concern is I’m enrolled in a managed care plan and my doctors are not enrolled in it, what do I do?”
“We have to make sure the big corporations don’t just look at the bottom line,” said one man who relies on Medicaid-funded personal care attendants for his disability.
Others called for more planning for oversight of the ICOs, and more accountability. Dale Mitchell of Ethos, a nonprofit provider of services to the elderly and disabled, called for an “independent care management entity” that would oversee the managed care system and prevent it from “chipping away at consumer control and input.”
Victoria Pulos of the Mass. Law Reform Institute said the involvement of consumer-based organizations is needed to establish “accountability systems” to oversee the ICOs. And Laurie Martinelli of the National Alliance on Mental Illness maintained that the “role of families needs to be spelled out” in the EOHHS proposal, in addition to more planning for issues such as transportation of clients.
Let’s hope the folks at EOHHS are listening to all this.
COFAR blog 