FY13 BUDGET ADJUSTMENT DETAIL 

PUBLIC HEARINGS SCHEDULED ON BUDGET

We will forward the full list of public hearings on the budget when they become available.  These are the hearing dates for budgets relating to DSS, DCF, DPH, DDS and DMHAS.

Friday, February 17, 2012	Human Services:  DSS, DCF budgets	4:00 start time, LOB. 2C
Wednesday, February 22, 2012	Public Health:  DPH, DDS, DMHAS	Most likely date for hearing, probable start time 4:00, LOB 2C

VOLUNTEER TO TESTIFY

Volunteer to testify at one or more public hearings.  CCPA will be glad to coordinate sign ups and testimony with you.  We want to be sure that we are well represented at these budget hearings.  Please email tedelstein@ccpa-inc.org if you are willing to testify. 

 

GOVERNOR MALLOY SPEAKS OF SAFETY NET SERVICES IN BUDGET ADDRESS

Governor Malloy made reference to the safety net several times in his State of the State speech today:

“There are other examples of the change we brought to Hartford that benefit the entire state.  We changed state government by making it smaller and leaner, while preserving the safety net – those services that define us as a compassionate and decent people.”

And later:  “Finally, I am proposing we spend the rest – 103 million dollars – to maintain the safety net and other critical services that help define us as a compassionate and decent people.

“That money is necessary because the national economic recovery has been slow, and the people who depend on the safety net, and their caregivers, have suffered enough.”

OPM BUDGET INCLUDES 1% INCREASE FOR PRIVATE PROVIDERS (1/1/13 START)

In this morning’s presentation to the media, OPM Secretary Ben Barnes described a 1% COLA for private providers:

$8.5 M to provide a 1% cost of living adjustment effective January 1, 2013

• Funds to be targeted to private provider employee wages and benefits
• Applies to:
  • Human service providers funded through POS contracts with state funds as well as under the federal Social Services and Substance Abuse Block Grants
  • Rate-based providers and families paid by the Department of Children and Families
  • Providers of boarding homes for the Aged, Blind, and Disabled

The budget bill to be issued February 9 includes the following language describing the $8.5 M in funding.  We expect to see additional language clarifying funding for accounts not referenced in the sections below.

Sec. 2. (Effective January 1, 2013) (a) Funds appropriated to the Office of Policy and Management in section 1 of this act, for Private Providers, shall be transferred to the following agencies that contract with private providers to reflect a one per cent cost-of-living adjustment to wages and benefits effective January 1, 2013: Departments of Developmental Services, Mental Health and Addiction Services, Children and Families, Social Services, Public Health, Correction and Economic and Community Development and the Judicial Department. Such funds shall be used to provide an increase in private provider employee wages and benefits.

(b) Notwithstanding the provisions of section 17a-17 of the general statutes and section 28 of public act 11-6, rates or allowable per diem payments to private residential treatment centers licensed pursuant to section 17a-145 of the general statutes for residential care shall be increased by one per cent effective January 1, 2013. The provisions of said section 17a-17 shall not otherwise be considered in any increases or decreases to said rates or allowable per diem payments for the fiscal year ending June 30, 2013.

Malloy to add funds to private human service providers, nursing home "right-sizing"

Arielle Levin Becker, CTMirror.org 

February 8, 2012

Excerpt:  Private provider funding boost

Human service providers have not seen an increase in state funding in the past four years and weren't slated to get one for the upcoming fiscal year, but Malloy's proposal would give many a 1 percent cost-of-living adjustment, effective next Jan. 1. It would cost the state $8.5 million. The money would be targeted to the wages and benefits of employees of the providers. Many agencies have frozen wages and cut back benefits to make up for rising costs as their state funding remained flat in recent years.

The increase would go to human service providers funded with state money and through federal social service and substance abuse block grants, rate-based providers and families paid by the Department of Children and Families, and providers of boarding homes for the aged, blind and disabled.

Budget director Benjamin Barnes called the boost "perhaps the piece of this that makes me most proud."

CCPA MEDIA RELEASE ON INITIAL VIEW OF GOVERNOR’S BUDGET

First COLA in Five Years - Community Provider Statement on Governor’s Midterm Budget Adjustments

For the first time in 5 years, community based nonprofit organizations will receive a cost of living increase which will help us continue to serve some of Connecticut’s most vulnerable populations.  A 1% adjustment over a half year is a great first step.  We are pleased Governor Malloy has taken this first step at modernizing the safety net in order for us to deliver high quality services in a cost efficient way. We look forward to working together with the Governor and the legislature as we continue to preserve and modernize the safety net.

FY 13 Midterm Budget Adjustments

Additional Detail by State Agency

SELECTED LINE ITEMS

negative numbers in ( )

Read the OPM budget summary document.  The Health and Human Services information is found in slides 33-40.

The FY 13 Midterm Budget Adjustments are available online.  Follow the link, then click on the “Section B:  Budget Summary” link to get to the full budget detail, which is searchable by state agency.  We have referenced page numbers below from the “budget book” (bottom of page) or a slightly different page sequence “PDF.” 

Note:  We have summarized certain budget line items using the language from the Governor’s official proposal.  Please refer to the individual budget section for each state agency for the complete list of line items.  We have rounded some figures for simplification purpose and enclosed negative numbers in parentheses. 

BONDING CHANGES

DCF – see budget book page D 12

$1 M added to support grants in aid to private nonprofit mental health clinics for children for fire, safety and environmental improvements, including expansion   (residential bonding of $5M remains in place)

BUREAU OF REHABILITATIVE SERVICES (newly constituted state entity) – see budget book pages B 98 - 99

Reductions:

• Reduce funding for independent living centers ($273,669) – 50% reduction

DPH- see PDF page 80

Reductions:

• Reduce Community Health Center Grants Due to Increased Medicaid Payments  - ($666,822)

Funding for community health centers will be reduced in recognition of increased Medicaid payments to federally qualified health centers.

• Maintain School Based Health Clinic Contract Commitments  ($412,592)

Reflects elimination of funds that have been uncommitted since FY 2009.

DDS – see budget book pages B 81 – 83

Reallocations or Transfers

• Close additional public residential programs ($2,291,562)

Technical Adjustments:

• Provide funding for additional Money Follows the Person placements for individual at Southbury - $3.2 M

DDS is required to educate clients residing at Southbury Training School (STS) and their families/guardians about community living options. Funds are provided to support 34 new placements beyond those in the adopted budget for individuals opting to leave STS in FY 2013 under the Money Follows the Person (MFP) program.

• Comprehensive waiver management system - $555,400
• Provide funding for additional high school graduate placements (48 beyond current budget) - $470,011
• Provide funding for court ordered placements (six individuals beyond current budget) - $468,144

Expansion Adjustments:

• Fund recommendations in autism study - $1 M

Revenue Adjustments:

• Increase revenue for employment and day services (to maximize federal revenue) - $2M

In order to maximize federal revenue, services previously funded through the Social Service Block Grant (SSBG) will be claimed under Medicaid. DSS will achieve offsetting General Fund savings by utilizing the freed‐up SSBG funds. The amount reflected in this option assumes an October 1, 2012 start date.

JUDICIAL – see budget book pages B 126-127

Technical Adjustments

• Annualize FY12 holdbacks (unspecified) ($28 M)

CORRECTION – see budget book pages B 121 – 122

Reallocations or Transfers

• Reallocate Mental Health Alternatives to Incarceration funds to DMHAS ($300,000) (money transferred to DMHAS)

DEPARTMENT OF COMMUNITY DEVELOPMENT (new name)– see budget book pages B 72 - 75

Reallocations or Transfers

• Restructure State Government $90,337,507

Housing programs from DSS, DCF and OPM will be consolidated within DECD. Programs include the Rental Assistance Program, Residences for Persons with AIDS, Emergency Shelters for Homeless, Special Projects for Homeless Shelters, Transitional Living, Housing Mediation Services, Shelter and Services for Victims of Domestic Violence, Rent Bank, Security Deposit Guarantee Program, and Renters Rebate Program. In addition, the rental assistance subsidies portion of the Supportive Housing for Families program will be included in the consolidation.

Expansion Adjustments

• Fund 300 New Rental Assistance Program Vouchers $1,500,000

Funds are added for 150 housing affordability and 150 scattered site supportive housing program vouchers.

• Expand Congregate Housing Program $405,000

Funding is provided to support the operating costs related to the construction or rehabilitation of about 50 units of new congregate housing.

• Provide Positions for the Consolidation of Housing Programs $180,000

Two positions are added to support the consolidation of housing programs within the Department of Economic and Community Development. DECD will provide leadership on housing issues and will facilitate coordinated implementation of the state's housing agenda.

DSS- see PDF pages 93 – 98

• Restructure Medicaid for Low Income Adults (LIA) under a Waiver  ($16,900,000)
• Strengthen Rebalancing Efforts by Revising Rates for Medication Administration ($10,300,000)
• Expand Options for Medication Administration ($10,240,000)
• Reflect Decreased Costs for Community Living Arrangements and Intermediate Care Facilities ($5,219,000)

Last year, the mortgages for a significant number of the state's community living arrangements for the aged, blind and disabled and the state's private intermediate care facilities for the developmentally disabled were paid off. Because current legislation freezes rates through FY 2013, there is no mechanism to reduce rates in recognition of these reduced costs.  Under this proposal, any facility that has a significant decrease in land and building costs will receive a reduced rate to reflect the reduction in costs

CCPA note:  The DDS Trades Business Managers Forum met with DSS officials on February 7 to discuss DSS intent for reducing funding, with attention to the time period in which the anticipated reductions were slated to occur.  CCPA will be verifying that there is a sufficient allocation of funds to reimburse for the allowable costs incurred in previous rate years.

• Retain Funding for the Nurturing Families Network and the Help Me Grow Program ($2,341,402)

This proposal eliminates funding for the following programs in the Children's Trust Fund: Family Empowerment, Family School Connection, the Children's Law Center and General Fund support for the Kinship Fund. The Kinship Fund will continue to receive $1 million in FY 2013 from the Probate Court Administrative Fund. Funding for the Nurturing Families Network, which provides intensive home visiting for new parents who are at high risk of abusing or neglecting their child, and the Help Me Grow program, which provides services to identify children at risk for developmental or behavioral problems and to connect these children to existing community resources that can help, will be maintained.

• Delay Implementation of the HIV/AIDS Waiver ($1,800,000)
• Restructure Dental Benefits by Shifting to a Client Centered Benefit Model ($1,740,000)
• Reduce Funding for Various Non Entitlement Grant Accounts ($601,098)

This proposal reduces funding by 10% for the following non‐entitlement accounts: HUSKY Outreach, Healthy Start, Safety Net Services and Alzheimer's Respite.

• Freeze Rates for Certain Residential Service Providers ($149,000)

Since FY 2009, rates have been frozen for community living arrangements and intermediate care facilities for the developmentally disabled that submit annual cost reports to the department. This proposal freezes rates for community living arrangements, residential care homes and community training homes that do not submit cost reports.

• Remove Funds for Advocacy Agency ($126,362)

This proposal eliminates funds that support advocacy efforts of the Brain Injury Association of Connecticut. The association receives, on average, approximately $150,000 per year from speeding ticket revenues.

Reallocations or Transfers

• Restructure State Government ($57,768,658)

Housing programs will be consolidated within the Department of Economic and Community Development (DECD). (See full narrative in that agency section).

• Transfer Various Child Care Programs and Quality Enhancement Funding to the State Department of Education ($3,159,757)

The State Department of Education (SDE) currently operates before and after school child care programs. In FY 2012, funding for the quality enhancement grant for the School Readiness program was transferred to SDE. This proposal will further align statewide child care programs and child care quality initiatives under one agency by transferring the remainder of quality enhancement funds in DSS as well as afterschool programs for adolescents and before and after school programs for school age children.

• Reallocate Service Funds for Supportive Housing to the Department of Mental Health and Addiction Services ($1,237,000)

Expansion Adjustments

• Strengthen Rebalancing Efforts under Money Follows the Person $3,950,000

This proposal supports several initiatives related to the rebalancing efforts under Money Follows the Person.

• Provide Funding for Nursing Home Services for High Need Individuals $2,299,500

Individuals who are transitioning from a correctional facility, have criminal justice involvement, or are transitioning from a higher level of care provided by DMHAS have been difficult to place in appropriate care settings. Partial year funding is provided to cover anticipated costs to the Medicaid program for nursing home services for this population. Funding is also included under DMHAS for this initiative.

• Expand Personal Care Assistance Services $600,000

Under this proposal, effective April 1, 2013, all participants age 65 and older will be required to transition to the CT Home Care Program for the Elderly waiver where they will continue to receive the same services. This policy change will reduce the waitlist for program services under the PCA waiver and allow additional clients to receive waiver services.

• Shift Housing/Homeless Programs to the Social Services Block Grant ($2,044,844)

Under this proposal, Social Services Block Grant funding will be redistributed from the Department of Developmental Services (DDS) to DSS, to allow DDS to seek Medicaid reimbursement for case management services. Emergency Shelters will be funded through the Social Services Block Grant, thereby reducing the state's expenditures by an equivalent amount.

DMHAS- see PDF pages 86 – 88

Reductions

• Restructure Medicaid for Low‐Income Adults (LIA) under a Waiver: ($5.6 M)

Savings of $5.6 million are anticipated from a waiver which will establish an asset limit of $25,000 and count family income when determining LIA eligibility for individuals who are under age 26 and either living with a parent or claimed as a dependent for tax purposes. Under this proposal, limits on certain medical services could be imposed. Additional savings of $16.9M are reflected in DSS.

• Reduce Funding for Uncompensated Care in Hospitals and FQHCs:  ($2.8 M)

The conversion of the SAGA population to the Medicaid Low‐Income Adult program has resulted in significant additional funding to hospitals and FQHCs. Funding is reduced in recognition of this shift of under‐ and uncompensated care to Medicaid LIA reimbursement.

CCPA note:  Grants for MH Services show a reduction of $704,791‐and Grants for SA Services show a reduction of $725,800.  Managed Service System shows a reduction of $852,343.  GA Managed Care shows a reduction of $16,350,000.  We will be seeking clarification about these reductions.

Reallocations or Transfers

• Restructure State Government: $280,497

The Psychiatric Security Review Board will be consolidated with the Department of Mental Health and Addiction Services.

• Reallocate Mental Health Alternatives to Incarceration Funding from DOC: $300,000
• Reallocate Service Funds for Supportive Housing from DSS: $1.2 M

This will eliminate the need for DSS to transfer funds to DMHAS and allow service funds to be more appropriately managed by DMHAS staff with disability expertise.

Technical Adjustments

• Adjust Funding to Reflect Current Expenditure and Caseload Trends for Medicaid for Low‐Income Adults:  ($10.7 M)
• Realign Psychiatric Disproportionate Share Hospital Funding:  ($2.2 M)

DSS makes Disproportionate Share Hospital (DSH) payments to DMHAS for the purposes of claiming federal reimbursement on state‐funded inpatient psychiatric hospitals. A portion of the DSH payments to DMHAS are used to offset certain fringe benefit accounts administered by the Comptroller. The DSS appropriation for DMHAS DSH will increased by $3.0 million to ensure revenue can be maximized in the event the federal cap for DMHAS DSH activities is increased in FFY 2013. This proposal does not result in any net costs; the DSS increase is offset by decreases in the Comptroller's fringe benefit accounts ($0.8 million) as well as DMHAS' budget ($2.2 million).

• Increase Funding for Specialized Discharge and Diversion Placements: $1.5 M

Funding will facilitate the discharge of approximately 25 difficult‐to‐place hospitalized clients into appropriate community settings and/or prevent unnecessary hospitalizations by providing "wrap around" housing and services tailored to the needs of individual patients.

• Increase Funding for Community Placements for Individuals with TBI/ABI:  $1.5 M

Funds six additional placements.

• Increase Funding for Medicaid Adult Rehabilitation Option:  $800,000

Funding is provided to support the costs of this program for non‐reimbursable services.

Expansion Adjustments

• Provide Funding for Nursing Home Services for High Need Individuals $300,000

Individuals who are transitioning from a correctional facility, have criminal justice involvement, or are transitioning from a higher level of care provided by DMHAS have been difficult to place in appropriate care settings. Partial year funding will be provided to support the development of a nursing home to serve this population, with DMHAS covering anticipated costs for individuals who are not Medicaid eligible. Funds are also included under DSS for this proposal.

• Provide Funding for the Military Support Program $293,461

One‐time funding that supports this program will be exhausted by the end of FY 2012. Funding is provided to continue this program.

DCF- see PDF pages 125 - 127

DCF experienced some of the largest cuts in this revised FY13 budget.  Much of the reduction is in a $23.7 M cut to the board and care / residential line.  Terry Edelstein spoke with DCF Deputy Commissioner Janice Gruendel on February 8 pointing out the large cuts to residential services, and seeking additional detail about the specifics of the $23.7 M residential cut as well as other cuts.  In addition, Ms. Edelstein noted that there didn’t seem to be a reallocation of funds from residential line items to other community services, just a cut and asked for clarification.  A reinvestment in funds has been a crucial part of the discussion at Continuum of Care Partnership meetings.

Adjustments

• Adjust Funding for Congregate Care: ($6.1 M)

Reduce funding for safe homes and therapeutic group homes to reflect reduced utilization.

• Implement USE Plans for At‐Home Services: ($2.1 M)

Achieve savings through implementation of a Unique Special Expenditure (USE) evaluation and approval process that will ensure at‐home service plans meet a child's specific needs in the most cost effective manner.

• Eliminate Funding for Low Priority Contracted Services (not specified): ($71,424)

Reallocations or Transfers

• Maximize Insurance Coverage for Voluntary Services Clients: ($60,000)

Transfer funding to support the Office of Healthcare Advocate's efforts to appeal denials of coverage by insurance companies.

(CCPA note – Office of the Healthcare Advocate budget includes a position to advocate for clients receiving voluntary services $101,400)

Technical Adjustments

• Re‐estimate Caseload Driven Expenditures: ($24.3 M)

Reflects updated expenditure projections for out‐of‐home care (adoption, subsidized guardianship, foster care, residential and no‐nexus special education) and individualized payments.

Cuts were not proposed for the following DCF budget lines:

• Health assessment and consultation
• Grants for outpatient psychiatric clinics for children
• Grants for day treatment centers for children
• JJ outreach services
• Community based prevention services
• Family violence outreach and counseling
• Family preservation services
• Substance abuse services
• Child welfare support services
• Community KidCare

The following DCF budget lines are slated to be cut by the corresponding amounts (rounded):

• Support for recovering families ($6.4 M)
• No nexus special education ($1.3 M)
• Board and care for children- adoption ($3.6 M)
• Board and care for children- foster ($2.1 M)
• Board and care for children- residential ($23.8 M)
• Individualized family supports ($1.6 M)

Other updates:

CCPA Analysis:  Compounded COLA vs Compounded CPI vs Compounded Medical CPI  FY1987 – 2013

Descriptions of Indices Used by CCPA

Compounded Provider COLA Compared with Compounded Consumer Price Index