Deep State Cuts Mean Pain (Courant Commentary)
http://www.courant.com/news/opinion/hc-commentarycuts1213.artdec13,0,4362452.story
December 13, 2009
Red ink flowing across the state’s balance sheet requires a tight fiscal tourniquet. Gov. M. Jodi Rell’s plan to cut $337 million in spending drew howls, including those from 300 people at legislative hearings Wednesday. There are no easy cuts. It’s a Sophie’s choice between such things as keeping aid for nursing homes in favor of programs for children. Money to achieve worthy long-term goals is pitted against spending for critical immediate needs. There is no black ink in the forecast. How painful are the contemplated cuts? Here are four programs among the hundreds that have been targeted.
HELP FOR VULNERABLE FAMILIES
Taking funds from the state’s most vulnerable families — high-risk, first-time parents with young infants — is economically shortsighted at best and coldhearted at worst. On the chopping block is the Nurturing Families Network, a home visiting program of the Children’s Trust Fund. It provides weekly visits to more than 1,500 vulnerable families annually.
Home visitors aim to prevent child abuse and neglect, improve parenting skills and help the parents return to school or work. The families served are among the most challenged — teen parents and those with cognitive, social or emotional limitations, many of whom lack the most basic child care skills. A notable success is the low rate of substantiated cases of abuse and neglect — only 1 percent to 6 percent per year for children served by home visiting, compared with rates of 20 percent for similar high-risk populations.
Providing these preventive services to one family costs the state about $3,000 per year. Contrast this with $30,000 a year for a substantiated case of abuse or neglect through the Department of Children and Families or $44,000 a year for each adult in prison. Prevention saves the state money — nevertheless, the home visiting program will be cut by more than $5 million, and fewer than half of the current 1,500 families will be served.
John M. Leventhal, M.D., is a professor of pediatrics at Yale Medical School and medical director of the Child Abuse Prevention Programs at Yale- New Haven Children’s Hospital.
GENERAL ASSISTANCE
Gov. M. Jodi Rell’s budget mitigation plan would prohibit acceptance of new State Administered General Assistance clients, which, she says, would save the state $5.2 million. This is wrong and will not provide the projected savings.
Connecticut should not turn its back on a program that provides health care to about 44,000 of the state’s poorest residents. Many clients suffer from chronic illnesses and use the medical program to stabilize their health enough to go back to work. Others, too ill to return to work, use the aid as a bridge to Social Security disability and Medicaid, passing much or all of their costs on to the federal government.
As a primary care provider in a community health center in Bridgeport, I see patients daily using the General Assistance aid for treatment of diabetes, hypertension, heart disease or HIV. Denying them care will drive them to our overburdened hospital emergency rooms, a poor and costly alternative for primary care. In 2004 and with each subsequent budget, the General Assembly mandated that the state Department of Social Services apply to the federal Centers for Medicare and Medicaid for a waiver to move the General Assistance medical program into Medicaid. This would give the state a 50 percent federal match in funding and a substantial savings. No application has been made for a waiver. The governor should submit that application.
Gary F. Spinner is a physician’s assistant in New Haven.
CHILDREN’S TRUST FUND
The governor’s deficit mitigation plan includes a drastic reduction in support for the Children’s Trust Fund, which funds Help Me Grow, a statewide program of proven effectiveness that assists thousands of children and their families each year and has become a national model for promoting children’s healthy development.
At $650,000 a year, Connecticut’s Help Me Grow promotes the early detection of children at risk for adverse developmental and behavioral outcomes and, through Child Development Infoline operated by United Way of Connecticut, links such children and their families to community-based programs and services, typically at no cost to the state, family or managed care plan.
Annual evaluations by the University of Hartford Center for Social Research have documented the program’s effectiveness and contributions to the State’s Results-Based Accountability initiative.
While budget mitigation is admittedly necessary to ensure our state’s financial health, we should continue to support programs of proven effectiveness. Although the governor has not specifically targeted Help Me Grow for elimination, the budget rescission will adversely impact all of the Children’s Trust Fund’s programs. Help Me Grow, with its focus on early detection and intervention, is cost-effective from the standpoint of both its modest cost and ultimate cost savings by minimizing the need for later, far more expensive interventions.
Paul H. Dworkin, M.D., is chairman of the Department of Pediatrics of the University of Connecticut School of Medicine and the Physician-in-Chief of Connecticut Children’s Medical Center. He is also a member of the Children’s Trust Fund Council.
ELDERLY HOME CARE
This year’s state budget requires cost sharing for seniors using the Connecticut Homecare Program For Elders. Low-income seniors using the state-funded portion of the program will be required to pay 15 percent of the cost. Clients who require the most services could be charged more than $400 a month, which could be more than half of their income.
For most, the prospect of another bill, even for services so essential, is just too much to bear. Some plan to cut their care to limit their expenses. We have had diabetics in our offices saying they are dropping their nursing services. Others say they plan to drop their meals-on-wheels, though they admit they will not cook and eat properly without them. Under new rules, residents who do not pay their fees may have a nurse, a home health aide and meals-on-wheels on Friday and wake up to no services on Monday. Without a nurse monitoring them at home, many seniors will take their medications inappropriately. They will fall because they don’t have a home health aide to help them in and out of the tub. They will fail living independently and will be forced into nursing homes. As the state tries to shift costs from expensive nursing home care to less expensive home care, this does not make fiscal sense — and it does not make moral sense.
Mary D. Priestman is co-chairwoman of the Connecticut Association of Resident Service Coordinators in Housing.
Copyright © 2009, The Hartford Courant
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