As debate on the Massachusetts Senate’s proposed FY 2020 state budget begins next Tuesday (May 21), hospitals are urging senators to provide some needed relief to hospitals serving large populations of Medicaid patients as well as shoring up support for the state’s Health Safety Net, among other budget requests.
The Senate budget proposal, released last week by its Ways & Means Committee, contains $42.7 billion in spending and, in the case of many MassHealth components, it hews very closely to the governor’s FY20 budget proposal he released in January. For example, the Senate and governor’s budget proposal (and the final budget the House released last month) all call for $13 million for disproportionate share hospitals (DSH). The DSH received $51 million in FY2015, $24 million the next year, zero in FY17, and then $13 million the next two years. The steadily decreasing funding has occurred even though the number of Medicaid patients has grown, as has the cost of caring for them, and the number of hospitals now designated as DSH. MHA asks through budget amendment #550 that the Senate increase DSH funding to $20 million with an additional supplemental payment of $10 million dedicated for behavioral health services provided at DSH.
Another amendment concerns the hundreds of thousands of Massachusetts residents who don’t have any comprehensive insurance. Their care is reimbursed through the Health Safety Net program, which is primarily funded by hospitals and insurance companies; each group is assessed $165 million annually. Recent state budgets, including this year’s Senate Ways & Means document, always include language requiring a state contribution to the safety net, but also always provides permissive language allowing the state to never make the payment – which Massachusetts hasn’t for the past four years. As occurred this year in the House, Senate Ways & Means, and Gov. Baker budgets, the state is directed to include “not more than” $15 million or “up to” $15 million to the Health Safety net. That language ultimately allows for a transfer of zero. MHA’s amendment (#612) includes more directive “shall transfer $15 million” language. MHA’s amendment also includes a prohibition against a proposed transfer of funds out of the Health Safety Net to fund other programs.
Other MHA priorities include: providing greater MassHealth “outlier payments” to hospitals treating very complex, very ill MassHealth patients; a directive that MassHealth offer coverage for tele-behavioral health services to fee-for-service patients; a requirement that health insurers provide payment for nasal naloxone rescue kits in hospital emergency departments and other settings; a directive that the state fund (by $500,000) the Massachusetts Consultation Service for Treatment of Addiction and Pain, which is an integral part of the opioid use disorder fight. Another MHA priority is Amendment #521, filed by Sen Harriette Chandler (D-Worcester), to ensure that MassHealth does not prevent safety net hospitals from getting the discounts to which they are entitled from pharmaceutical manufacturers under the federal 340B program.