Governor Healey’s budget includes some good news despite ominous budget news over the past several weeks. At a briefing late Wednesday afternoon, the Executive Office of Health and Human Services (EOHHS) reviewed the budget proposal: Finance Deputy Secretary Dan Shark was joined by Secretary Kate Walsh and Assistant Secretary Mike Levine (MassHealth/Medicaid).
The Arc, combined with your strong advocacy, made a difference in several key line items.
Workforce: Chapter 257 reflects a historic $390 million investment. This is $160 million higher than any previous investment. Additionally, we were told that $95 million from the FY23 economic development reserve will ensure that median direct care salaries will be no less than $20 per hour. Several community programs benefit from this proposal. Day and Employment, Turning 22, Autism Omnibus, Family Support, and Transportation have significant increases. We hope that these increases, combined with recent workforce improvements, will result in more access for constituents/families waiting for services. The chart below documents the significant increases.
The budget does provide $2.5 million to expand the initiative that the Department of Developmental Services (DDS) begins this year for more robust in-home residential. This should help address the plight of those waiting for residential services. Both DDS administration (up nearly 29%) and state operated services (up 5%) received boosts. The latter line item funds residential services to approximately 1/7 of DDS residential participants. The community line item growth is essential as we estimate over 3,000 have not been able to start or return to day services or supports. We believe that the investments reflect a strong start to addressing the crisis.
To summarize our chart, the percentages of increases include:
- Day and Employment: 26%
- Turning 22: 17%
- Autism Omnibus: 18%
- Family Support: 22%
- Transportation: 19%
$10 million is allocated to address youth with complex medical or behavioral conditions who are in hospital or emergency room boarding situations. But this amount also may be directed to those primarily served by the Department of Mental Health.
MassHealth budget faces fiscal challenges in the range of $1 billion to address changes in federal revenue. MassHealth’s gross budget is $20.3 billion and there are two million MassHealth members. Focus on increasing revenue in health care delivery is one strategy. MassHealth is prioritizing increases in skilled nursing provided in individuals’ homes and wheelchair repair rates given community feedback on these needs. We also were told that decreases in day habilitation and adult family or foster care will be a last resort strategy to address its fiscal challenge.
The major impact on service delivery is regarding the Personal Care Attendant (PCA) program. MassHealth has stated adjustments are needed to ensure sustainability given its growth in recipients and cost. Policymakers plan to raise the eligibility threshold, namely 10 or more hours of Activities of Daily Living (ADL) support will be required by participants to remain in the program. They also plan to decrease hours for meal preparation. These do reflect major changes. We hope to work with disability advocates to revise these strategies, especially the 10-hour minimum threshold.
Given MassHealth news, we will have an uphill fight to obtain additional rate increase for day habilitation this year to add to the major 2024 increase.
The EOHHS FY25 budget is set at $32.08 billion by Governor Healey, which reflects an increase of $1.29 billion.
Only time will tell if these investments will be sufficient to provide the outcomes needed for our community and constituents. In the meantime, we will work with other disability advocates on the challenges facing long term support services such as the PCA program.
But our combined advocacy has made a difference. We can’t stop now!