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Archived Story
Area services worry about proposed cuts
Published 9:31am Wednesday, July 29, 2009By JESSICA SIEFF
Niles Daily Star
While the debate surrounding health care reform rages on the nation’s capital, all eyes are on how to care for America’s uninsured and how to best take care of those who are insured – including those at the local level.
Last week, House Republicans presented the state with their plan to balance Michigan’s budget.
And that, representatives Matt Lori (Cass), Sharon Tyler (Niles) and John Proos (St. Joseph) said - means tough decisions.
In their plan, on the list of immediate cost saving measures that take aim at several state departments including general government, agriculture, human services, environmental quality and labor and economic growth – the largest department to see proposed cuts, to the tune of $361.7 million, is community health.
“You’re always struggling to maximize the dollars that you have,” Proos said Monday, on his way back from a meeting with the Job Task Force in Traverse City.
“The big challenge that we had in balancing this budget without raising taxes or fees,” while remaining realistic, Proos said, was finding ways to cut the strings attached to state dollars through the American Recovery and Reinvestment Act.
“Community health has a significant amount of those dollars,” he said.
The proposed budget includes cuts to state psychiatric hospitals and centers and non-Medicaid special health services – but its biggest withdrawal is a $150 million reduction in funding “available to mental health services for non-Medicaid persons and substance abuse services.”
During the unveiling of the proposed budget plan, the idea of tough decisions, not unlike those being made at the kitchen tables of Michigan state residents, was emphasized by each of the area representatives.
That mindset continues.
The amount, Proos said is 65 to 70 percent of dollars which could have been cut.
So are area services worried?
Colleen Lerret, with the Berrien County Health Department’s Substance Abuse and Prevention division said the threat of cuts to programs and services are something the organization faces every year and that it’s “too soon to tell” should the proposed cuts make it through Lansing, just what kind of affect they would have on her department.
“The program will still be here,” Lerret said. “The program will still be offering services.”
The Substance Abuse and Prevention division of the Berrien County Health Department operates under funding that comes from a block grant through the state as well as Medicaid and drug court.
“It’s not an elimination of the program,” Proos assured. “It’s a savings within the program.”
Lawmakers, in drafting the plan, he added, “fought to maintain” as much as they could while putting together the proposals.
Now, it seems another fight is brewing on behalf of those who stand to possibly be affected by those cuts.
“It’s really a recipe for community disaster,” said Sally Reames CEO of Community Healing Center, the only other substance abuse treatment center in the county besides the health department.
Reames worries that a “great divide” is only getting bigger between the need for the “services we believe in” and the resources available for them.
The Community Healing Center is funded through a state block grant as well, along with Medicaid reimbursement, V.A. Contract reimbursement, self pay and private insurance.
Cutting funding to the programs could cost the state more money in the long run, she said. As more and more people in need of help find themselves unable to get it, hospitals and law enforcement find themselves forced to handle the cleanup.
Reames estimates “16 percent of the state budget (is spent) cleaning up after the problems associated with it (substance abuse). For every dollar spent cleaning up,” she said, “one penny is spent on treatment.”
Still, Reames said she understands the challenge facing lawmakers and the need for alternative solutions as advocates for those affected by the cuts fight against the proposed cuts. “But these people are going to end up in the emergency rooms. They’re going to flood them.
“These people are already on the brink,” Reames continued. Though, at press time, no studies could be found linking a bad economy to an increase in substance abuse – Reames said that she and the counselors at Community Healing Center have seen the stress of financial hardship and job loss taking its toll.
“Absolutely,” she said. Looking at substance abuse as a “chronic progressive disease,” she said the circumstances for those suffering have been “compounded” by unemployment and homelessness and now face a lack of treatment available.
While programs would continue to exist, less people might be able to be taken care of through them, Proos did say. However, he added, lawmakers felt it important to focus on areas where the state is most vulnerable. In shaving off funding to the areas on the budget’s list, those dollars can be invested in areas such as agriculture and tourism and infrastructure in an effort to address the question on every public official’s desk at the moment, “how do we get Michigan residents back to work?”
“The tough choices need to be made and the debate about which choices we make has to be on the table,” he said.
It’s a debate those such as Reames are willing to have for the benefit of those in need of help in this particular area of community health. Those in need of help for substance abuse or mental health services, “are the least likely to speak up for themselves,” she said. “We have to become the advocates and encourage them to advocate for themselves. We were really stunned by the depth of that cut.”
Reames estimates that the Community Healing Center in Niles helps over 200 people each month through various services in mental health, substance abuse and support for veterans.
She hopes that legislators could find a way to streamline services, cut bureaucracy and seek out other solutions in order to save services like hers from facing a severe cut in funding.
The state government has manipulated the legislators into this thinking, that hard budget cuts have to be taken in the human service areas, i.e. community health. In actuality, the monies to balance the state budget to this point, has already come from those most in need…those on Medicaid. The budget has already been on the backs of those most neediest; those elderly, disabled and children on Medicaid.
For just this budget year, $866 million of enhanced Medicaid dollars from the stimulus were funneled away from Medicaid recipients. It will be over $1B next year. The state took this $866 million of “enhanced FMAP”–which is the extra money the feds are paying for existing Medicaid dollars in lowering the amount states have to pay for their share of Medicaid through the stimulus– and they added around $250 million of monies the stimulus gave the state to balance the budget. These combined Medicaid monies and state stabilization funds were put into the state’s general fund and labeled “flexible stimulus monies”. The feds knew they were going to do this, and “detarget the stimulus”, and did nothing about it. Google “Detargeting the Stimulus” which was written by the U.S. House of Representatives Committee on Oversight and Government Reform on April 15th, 2009.
In addition to these stolen Medicaid monies, they also made major cuts to Medicaid beneficiaries on July 1st. This has cost both the recipients (costing them to provide their own medical transportation to distant hospitals and wheelchair medical transportation have been cut, for example) and Medicaid providers, in lost jobs in services that are funded by Medicaid. The stimulus dollars were targeted to keep these health care jobs. The monies are now only being spent on Lansing, supporting every other area of state spending. And since no one has stopped them, they are planning on doing it again next budget year, with even more Medicaid monies.
But in the economic disaster we are in, the state is cutting the essential services needed for people to survive over cushy Lansing jobs. The Department of Human Services is overloaded…in Benton Harbor, each caseworker has 670 cases. The legislators have created a paperwork nightmare needed to get Medicaid. My initial Medicaid application was 140 pages of forms and information, and proofs, i.e. utility bills. Some poor person has to process these forms. A DHS supervisor today actually measured my file–it was 11 inches thick. Because of the legislated policies, they spend more time and money processing my Medicaid than they do paying for my health care (which is the costs after my COBRA health insurance).
The State of Michigan has major problems with fairness and equity of services. If you work while on Medicaid, and are on SSDI (the kind you get for having enough social security work credits), you will actually receive, after your spend-down deductible, half of what a person on SSI (not enough social security work credits) will receive in available monies for living expenses. And if you try to work while on Medicaid and SSDI, you will mess up your Medicaid for months. And you’ll only be able to keep $85 of the money you earn anyways. So there are disincentives to work. People on SSI have Freedom to Work Medicaid; those on SSDI do not in Michigan. This has lead to anybody who wants to work or has worked in their life, to be “penalized” for doing so with Medicaid.
There were bills to reform this introduced in the legislature earlier this year, so that people on SSDI and Medicaid would not be penalized for working, and would be able to keep most of their benefits in order to survive. But since the budget cuts in April, and the “detargeting” of the stimulus monies, there are no Medicaid monies left to reform and correct this travesty. The state rewards those that are not working, or never worked, and have the “entitlement” mindset, while those on SSDI and Medicaid who want to work are left with nothing to live on. The reform bills have been buried in committee since.
This has lead to a situation like mine. I worked for 25 years full-time until I became seriously ill two years ago. I qualified for SSDI 18 months ago. Because the feds have a two year wait for Medicare, I have had to qualify for Medicaid these past 18 months. I have a large spend-down, around $800 currently. $711 of this is my COBRA premiums. I am on the 150% of “regular” COBRA premiums on the disability extension to make it to Medicare. I am currently left with $335 in “living expenses” after my spend-down. It doesn’t matter what my actual expenses are, i.e. my rent is more than the $335. I have to meet the spend-down each month because I am oxygen and other medical equipment dependent at night, and a dozen or so prescriptions to keep me alive. Yet, the state of Michigan doesn’t leave me enough monies to pay my rent, never mind for electricity to power my medical equipment. I truly don’t know how the State of Michigan expects me to survive. Because I did work when I was well earlier this year, this has also caused problems with Medicaid since March, and only now, months later, is it being resolved. I have been paying many of the Medicaid portion of my current bills until Medicaid is resolved for these months.
I can honestly say every legislator in this state knows about my situation. I have met them in Lansing, as an example of what’s wrong with Medicaid and the need for Freedom to Work Medicaid. Fred Upton ignores me. Neal Nitz wrote to me, occasionally made a phone call, but did nothing to change my situation or lobby for change in my behalf. Sharon Tyler’s office has met me early this year, and have done nothing to help my situation despite constant pleas. Mr. Proos and Mr. Jalinek have never responded to any of many emails or calls.
This is all about politics and the conservative right having its way at the expense of people like me. By the way, I have a masters degree, have worked with the disabled since I was a teenager, and won human service and humanitarian awards. Yet when I need help, this society has decided that I am not worth saving. As one of my doctors recently pointed out…”the system is betting on you dying. They consider that the most cost effective thing you can do is die”. Brutal, but honest doctor…
I know this is long, and is not a plea for help. I need to let people know the reality of these policies and “tea party” rhetoric does to others. I have been told by these “tea party” people that maybe I should go out out and do to myself what they do to sick horses (shoot myself), so that I don’t have to steal money from them. People, please think about people like me, when you are making all these broad negative “tea party” statements and implementing budget cuts.
My Hat off to LOVEY! She has shown That No Matter how educated you are, The Local, Federal and State Politicians do not Pay any attention to the VOTERS needs. As long as the Tax Payers Pay for their Staffs and other extra to DEVIL with the Senior Citizens in the State of Michigan. It is Sad that the Tea Party People told Her to go out and Shoot herself. What Kind of Morons did we elect to make a Statement like that. Well, they are following their President, he feels the same way about Senior Citizens and Cancer Patients! And Lovey, your Message has been posted on my Twitter site all 13,000 plus words, for the whole country and some foreign countries to read. The Feed Line is; This is How State of Michigan Republicans Feel about Senior Citizens!