PORTLAND — The compromise budget that the state Senate passed last week for the Department of Health and Human Services preserves some of the services city officials were most concerned about losing.
But with lawmakers set to cut another $85 million in time for the 2013 budget that begins July 1, the agreement was less a sigh of relief than a long gasp in the midst of a fit of hyperventilation.
“Some of the key things that we were worried about had to do with funding for Healthy Maine,” a program that provides preventive care for substance abuse and obesity and related health problems, “and none of those things have been touched,” Mayor Michael Brennan said.
The changes include a lower income threshold for parents of children covered by MaineCare and a cap on the number of “noncategoricals” – usually adults with no children – eligible for coverage. They will have an impact on hospitals and city service centers, the city’s Health and Human Services director, Doug Gardner, said.
Gardner said he is particularly concerned about impact at the city’s Healthcare for the Homeless clinic, a federally qualified health center that serves about 2,300 patients a year.
“We don’t know exactly how many patients fall into the noncategoricals, but it’s reasonable to guess that many are,” he said. “It is very reasonable to assume this this is going to have an impact on the center.”
About 40 percent of the center’s operating budget comes from MaineCare reimbursements, Gardner said.
Because DHHS expects to reach through attrition its goal of $40 million for noncategoricals, down from $80 million, the center has begun auditing its patients “to try and get a sense of the scale” of the issue, he said.
The city’s second federally qualified health center, Portland Community Health Center at 180 Park Ave., will feel the effects as parents whose children are covered by MaineCare lose their own eligibility, Gardner said. Previously, the income threshold was 200 percent of the federal poverty level, but that has been reduced to 133 percent.
It makes it more challenging for both Healthcare for the Homeless and PCHC to be financially viable as more people come seeking care without the ability to pay or have it covered, Gardner said.
Local hospitals will face the same difficulty, said Katie Fullam Harris, the senior director of government and employer relations for Maine Health, which operates Maine Medical Center and about a dozen other member and associate hospitals.
Maine Medical Center escaped $11 million in direct cuts included in Gov. Paul LePage’s original DHHS budget proposal, she said. But many people in line to lose MaineCare coverage “will go to the hospital, they will continue to need health care, they will continue to receive health care, and that adds to the burden of the hospital,” she said.
With fiscal year 2013 “just around the corner,” Healthy Maine, targeted case management, and changes to general assistance eligibility and reimbursement rates from the state are likely to be up for discussion again, Gardner said.
Those potential losses are just as devastating as the cuts to the 2012 budget, he said.
“There are changes that are made, eligiblities are curtailed,” Gardner said. “But the need doesn’t go away.”