Major Changes for HHS in Governor's Budget

HHS makes up more than half of all state spending.

So it’s hardly surprising that the governor would look to the department for millions of dollars in savings it needs to close its estimated $500 million shortfall in the next biennium.

The 2010 budget funds HHS at $721 million dollars.

That’s an $85 million cut off of the department’s original request.

Almost $30 million comes from the payroll.

The governor says HHS would need to lay off 125 to 150 workers – about half of all state employee layoffs – and that it would leave 200 positions vacant.

Dick Cohen is executive director of the Disabilities Rights Center.

He says HHS is already understaffed and that further cuts will compromise the department’s ability to provide safe and high-quality services.

Cohen1.wav: We’re going to want to take a strong look at that. We think they’re probably cutting into the bone, here.

EG: A sober Nick Toumpas, the HHS Commissioner, said operating with fewer employees will be challenging.

Toumpas1.wav: We’re potentially reducing some of our staffing or more importantly maintaining a higher level of vacancy rate at a time when we’re seeing very increased levels of need from the people that we serve.

EG: Rather than cut jobs across the entire department, the governor is proposing eliminating certain programs altogether.

Gov1.wav: We faced the fundamental question of breadth versus depth. If we attempt to do everything, we risk doing nothing well.

EG: So he would close the Tobey School, a facility for children with special needs.

He would also eliminate a catastrophic illness program; end reimbursement for chiropractic and podiatry services; and cut state assistance for medical training.

But the governor’s proposed HHS budget is just as notable for what it does do as for the cuts it imposes.

Despite early rumors to the contrary, it does not cut Medicaid reimbursements to hospitals and providers.

And rather than house mentally ill patients in a new million-dollar facility on state hospital grounds, Governor Lynch proposes building community residences.

Louis Josephson is president of Riverbend Community Mental Health Center in Concord.

Josephson1.wav: It’s a lot cheaper to care for people in the community than in the state hospital so it’s a win-win for everyone.

EG: But Josephson cautions that such a plan won’t work without enough money to pay community health care workers.

For example, he says, Riverbend is in the midst of closing a 13-bed community residence because Medicaid reimbursements are too low to maintain it.

Josephson2.wav: We were losing about $150,000 a year on that care.

EG: For months, Commissioner Toumpas has been saying publicly that the state’s health care system is unsustainable and needs radical transformation.

This budget kicks off an 18-month transformation plan designed to make delivery of health care more efficient.
HHS plans to establish so-called medical homes for Medicaid patients.

Finally, the governor is looking to the health care system for some unexpected revenue.

The state maintains its own malpractice insurance fund, through which some 500 doctors – or about 10 percent of the state’s physicians – are covered.

The governor estimates that the fund has a $110 million surplus, which he would use to fill budget gaps this year and in the 2010-2011 budget.

The governor says the funds can’t be returned to the doctors and nurses who contributed to the plan.

New Hampshire Medical Society president Charles Blitzer says its members just learned about the idea Wednesday.

Blitzer says although the society hasn’t determined its position on the plan, its members don’t see eye to eye with the governor.

Blitzer1.wav: Probably the people who paid into it are the ones who are responsible for a surplus and therefore they would be the ones appropriately entitled.

The budget now moves to lawmakers for what will likely be lengthy debate and many changes.

For NHPR News, I’m Elaine Grant.