Having mandated health coverage for all Massachusetts residents, the state government now is preparing to remove funding from groups dedicated to ensuring it happens, including $50,000 from the Vineyard Health Care Access program.
The $27.4 billion budget proposed yesterday by state lawmakers makes no provision for ongoing funding for the MassHealth Outreach grant program, which previously provided some $3.5 million a year to aid the operations of organizations across the state, dedicated to steering people through the complexities of health insurance.
The $50,000 the Island received from the program made up the largest single part of the $275,000 budget for Vineyard Health Care Access, which program director Sarah Kuh said yesterday was “really critical” to its ongoing operations.
Already this year, said Ms. Kuh, the program has been forced to drop one full-time staff position, and had reduced the hours of two others.
“I let a full-time person go in January and have had to cut back the hours of two other formerly full-time people to 30 a week, so we’ve essentially lost about 50 hours a week in staff time,” she said, adding:
“It’s a real hit to us. We have less than three full-time equivalent positions left.”
Such programs are particularly important now, because the poor economy is affecting so many people’s employment and insurance arrangements, especially on the Island where major changes are afoot to coverage for low wage earners.
Last week the news surfaced that some 1,500 lower-income Vineyard residents face the prospect of having to find new health insurance because the Martha’s Vineyard Hospital is negotiating with a new insurance carrier. Although negotiations are ongoing, the likelihood is that after the end of June, the hospital will drop its contractual arrangement with the Boston Medical Center HealthNet program and enter into a new one with another insurer, meaning people will either have to change insurers or go off-Island for medical care.
Until a formal announcement is made, said Ms. Kuh, “we are in a kind of holding pattern.
“Once we know, we can start trying to help people and inform people. Presumably there will be attempts to help people, perhaps from the hospital, hopefully from the state, to let people know what their choices are,” she said.
Meanwhile the search is on for alternative funding. This week some of that funding came through, at the annual town meetings in Tisbury, West Tisbury, Oak Bluffs and Edgartown.
Similar articles will go to the up-Island towns in the weeks ahead.
Originally, there was to be just one warrant article in each town, but that changed as the program’s funding situation became more dire.
Ms. Kuh explained: “We had, starting last year, an agreement with the towns to share cost of the access program between the county and the towns.
“This was to cover about a third of our budget, or approximately $90,000. It started at 50-50 between the county and the towns, but went to 60-40 this year.
“But when I became aware that our grant funding was disappearing — at least $100,000, enough to mean we could be in real jeopardy of losing our program — I decided to seek additional funding from the towns,” she said.
The original amount sought was $53,318, divided proportionally among the six towns. The additional funding, contained in the added warrant articles, was $51,972.
In three of the four towns which held their meetings this week, it all went through, easily, in some cases accompanied by glowing testimonials to the services of Vineyard Health Care Access.
Edgartown was the only town that did not carry an additional article for the extra shared funding; the finance committee decided the town should not be asked to make up for lost grant income. (Edgartown did approve its main share for funding.)
Ms. Kuh said she intends to go back to Edgartown to see if they will reconsider, but for now the other towns will bear a disproportionate share of the added cost.
Another entity which derives a benefit from the access program but is not bearing any share of the cost, is the Martha’s Vineyard Hospital — a fact Ms. Kuh said was pointed out repeatedly to her during her talks with various selectmen.
“It came up in my meeting with Edgartown, and has come up in practically every discussion with the towns — shouldn’t we be getting some support from health care providers?” she said. “And it’s true, there are two levels of benefit to what we do. The first is to the people we help with insurance, and things beyond that, like if they can’t get a prescription or need to figure out how to get to see a doctor.
“The second is to the providers, because when people have insurance, providers can get reimbursed. They benefit from the fact that we get thousands of people insured every year.
“Most health care access programs — which tend to be in rural areas where there isn’t a lot of other social and health service support — are supported by their local hospitals,” she said.
Ms. Kuh described the funding regime for her organization as “like a patchwork quilt.
“We get bits and pieces from all over the place. I have $20,000 a year right now from a Blue Cross grant and dribs and drabs from United Way and Elder Services of Cape and the Islands.
“We do get some support from our partner organization, Island Health Care, in Edgartown. We partner with them in various programs and get a modest level of support through them.”
What she would like, naturally, is not to have to rely on grant funding, which is a hand-to-mouth form of financial management.
“I think we provide a service something like the Dukes County Regional Housing Authority, a community-wide service which benefits everybody. It would be great to have that kind of stable [Island] funding,” she said.
“In Oak Bluffs they’ve already decided to move it off the warrant into the town budget. That’s the direction I’m hoping it will move in.”
Likewise at the state level. If the state wants to make health insurance mandatory, she believes there should be a line item in the budget funding organizations like hers. It still would not be immune to cuts, but there would be some extra security.
That is not the case.
“The budget released on Wednesday by the House Ways and Means committee did not include funding for the MassHealth Outreach grant program,” she said. “Nor was it in the governor’s budget.
“Of course, it’s early in the budget process, so it could end up being written in, but we’re starting at a disadvantage,” she said.
And lobbying to get it included just means less energy to devote to the real mission of organizations like hers — helping people deal with their health care issues.
“Gosh,” Ms. Kuh said, “we get calls every day from people in all kinds of tough situations: having had tragic accidents, sudden illnesses and so on. It’s a minority of cases, but the most important cases, where you really want to get coverage going.”