This article first appeared in the St. Louis Beacon, May 14, 2010 - As proponents of services for children and families watched another legislative session end with more budget cuts and no consideration of raising revenue, many wanted to offer lawmakers this message: This is not a responsible way to run state government.
"This year, we really had to cut into the meat of our budget," says Ruth Ehresman, director of health and budget policy for the Missouri Budget Project.
Cutting to the meat, she says, means sharply reducing or eliminating programs. For example, the income qualification for Medicaid is so low that many in need don't qualify. To be eligible for Medicaid in Missouri, a family of three can earn no more than $292 a month, Ehresman says. That's an annual income of $3,504.
About 2,600 adults, mostly seniors but also the disabled, no longer will get home health care for basic tasks, like bathing, because that service is being eliminated for all except those meeting Medicaid guidelines, added Ehresman.
Kit Wagar, spokesman for the Department of Health and Senior Services, says the agency received about $75 million in general revenue during the previous fiscal year. It expects $61 million in the next. The $14 million difference, he says, includes about $5 million from the elimination of help for the 2,600 adults mentioned by Ehresman.
"We just don't have the money," he says. "From our department's perspective" elimination of the program "was certainly the most significant reduction in services for seniors."
Children hurt by budget cuts
There's bad news even in some of the good news. Ehresman points to what she says was a welcome development: requiring insurers to cover certain treatment for autism.
"I'm sure legislators will say they did a great a job on that bill, and it is good," she says. But lawmakers excluded Medicaid-eligible kids from autism coverage.
"The service won't be required for them. That's about 271,000 kids who won't have the same rights, the same benefits."
She acknowledged that a small number of Medicaid-eligible kids get coverage for autism under a Medicaid waiver program. But efforts to expand the coverage to include all Medicaid-eligible kids didn't succeed.
Ehresman is pleased that the Department of Social Services will be required to work with public schools to enroll children who are eligible for Medicaid-paid health coverage but aren't getting it.
Meanwhile, the national Parents as Teachers office is still reeling from the state's decision to cut the budget for its program by about 60 percent, leaving $13 million for local PAT programs to reach families.
"There just won't be enough service providers, parent educators, to serve families," says Pat Simpson, director of communications for the national center for PAT.
This means they won't reach some children, early in their lives, who have developmental and other needs, she says. Early detection helps the state save money, Simpson says. She notes that Missouri's PAT program has never had to absorb a cut of this magnitude.
"I just want to remind the legislators -- and everyone -- how crucially important this program is. It's too important to fail."
Fewer cuts, more revenue
Joe Pierle, head of the Missouri Primary Care Association of Missouri, says the one thing that struck him about the session was the level of bipartisan cooperation on some issues.
"The untold story of this session really was the bipartisan approach to balancing the budget between the Democrat governor and Republicans," he says. "There was more of a bipartisan approach to making tough decisions. There's no doubt that everybody got hit."
Pierle said federally qualified health centers took a $1.4 million hit but adds: "That's the best outcome we could have hoped for. At one point in the House, we were at zero funding, early on in the process. So we went from zero funding to about $7.8 million."
He says working with their legislators made a difference in the final allocation for health centers. State funding makes up about 10 percent of money for the centers.
F. Scott Gee, executive director of Citizens for Missouri's Children, applauded the decision to require Social Services to make more of an effort to enroll Medicaid-eligible children. But he bemoaned the cuts in programs ranging from child abuse and neglect to adoption services.
"We've had so many reductions that I think the pressing need now is to get more revenue. Everybody is hurt. It's time for leaders to address that, not just cut, cut, cut, but bring in more funds."
Ehresman agrees, saying, "We paid a lot of attention to balancing the budget by cutting services. We now need to look at common-sense solutions to enhancing revenue. The Legislature is just failing miserably to look at that issue."
She repeated the Budget Project's idea of taxing internet sales as Missouri taxes purchases in stores. She also called for closing loopholes that she said allowed corporations not to pay some taxes in Missouri.
"It is a no-brainer to increase taxes on tobacco products. South Carolina is the only state that's lower than we are in taxes on tobacco products. And I think they're thinking of raising theirs. Ours is ridiculously low," Ehresman says.
Pierle says lawmakers should look at the issue as a user fee rather than a tax.
"We don't see it as a tax because at the end of the day as a state we pay for a lot of folks who have tobacco-related illnesses," Pierle says. "Why not require the user to pay for the health care we end up providing? I believe that's a nonpolitical issue. Otherwise, we are going to face significant cuts to social services, human services, education, and transportation."
The other issue Missouri needs to face up to, Pierle says, is its shortage of primary-care providers.
"If we as a state don't own up to this shortage, all the new health (reform) provisions will be for naught. What good is it if somebody has coverage but can't find a provider?"
Funding for health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization whose vision is to improve the health of the people in the communities it serves.
