Health programs endangered by declining federal support

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By Rebecca Lessner

As the Maryland Department of Health and Mental Hygiene discussed Gov. Larry Hogan’s 2% across-the-board budget cuts on Friday, Sen. Adelaide Eckardt of the Senate Budget and Tax committee questioned the future of 68 mental health program facilities DHMH has created the past two years through aid provided by the Affordable Care Act.

Eckardt, a psychiatric nurse from the Eastern Shore,  described DHMHs’ growth of mental health programs in the past two years as “pretty remarkable,” but voiced concerns that if the department doesn’t locate state funds to cover reducing federal funds, Maryland will begin backtracking.

The state had a premier public health system in the early nineties, but then began to go downhill, she said.

“We put it (Maryland) on a road to restoring some of that and now it’s downhill again,” Eckardt said.

“If you start making reductions in the core funding then sometimes that puts you in a situation where you don’t have really enough staff,” Eckardt said to the DHMH panel at the committee briefing. “So, will you be at the place where you’ll have to close programs, because there won’t be enough people to do what is expected?”

New health secretary concerned

New Health Secretary Van Mitchell said he is concerned and believes that the foundation of the health department is community-based public health programs. Maryland will be heavily affected with cuts to programs that are mostly situated in rural areas.

Right now, the health department is receiving feedback from several counties to determine what effect projected reductions will have.

“So yes, is the answer to your question,” said Dr. Laura Herrera, deputy secretary of public health. “And there are implications to programs and the cutting of those programs at the local level. I think that with the last few years and the decline in core funding, the counties have generously overmatched the core funds, but that seems to be going away.”

Cuts to mental health programs

DHMH is looking at an estimated $7 million in projected cuts to mental health funding, adding to that is looming decrease of federal funding, as funding for the expansion of health care under the Affordable Care Act begins to become the responsibility of the state.

According to DHMH, since the enactment of the Affordable Care Act (Obamacare), full Medicaid benefits have been given to an additional 100,000 people at the start, equaling $200 million infederal funds. Now enrollment has grown to 1.3 million people included in the full Medicaid benefits. The full cost has been covered by federal funding, but in fiscal year 2017 the federal funding will drop to 95%, and then by 1% every following year.

Dr. Herrera has been working with health departments over the last two years to figure how to diversify the way the public health department funds itself. “Because not only are we seeing declines in our state general funds, but we’re certainly seeing declines in our categorical federal funds.”

Categorical funds go toward state programs dedicated to chronic diseases like hypertension and diabetes.

Dr. Herrera hopes to reorganize programs and regionalize, something Sen. Eckardt has seen success with in the Eastern Shore. It would involve regional partnerships among programs and hospitals, and funding through partnering with private sector agencies.

Looking for more cooperation among departments

Secretary Mitchell believes funding can come from other departments within the state. “The state has a lot of assets, whether it’s DHR, DHMH, MSDE, or everything else,” referring to Human Resources, Health and Education departments.

Mitchell told the committee that if they help him to “break down the silos” and get departments to do a “better job working together and reaching out to one another” then maybe they will all come together to find a solution.

“We got a lot of assets still, it’s tough times, but there’s no reason that we cannot help each other out,” Mitchell said.

Eckardt agreed, “We’ll all certainly work with you as we shape where we are going to be.”

Health Budget Subcommittee Chair Richard Madaleno also agreed, saying together the DHMH department and the committee “Will try to do more, with even less” moving forward.