Missouri Department of Health and Senior Services

Overall impact

The filed HB 1010 appropriations bill cuts $15,525,322 general revenue from the Governor’s FY 2005 budget recommendations.

• The filed HB 1010 reduces the FY 2005 budget of the Department of Health and Senior Services by $4,753,801 general revenue from the approved budget for FY 2004, a 5.8% decrease.
• If approved, the result would be a 27.4 percent general revenue budget cut since FY 2001.
• Critical programs affecting the health, safety, and welfare of Missourians will be stripped from the budget.

Core Public Health Functions – A 10% reduction was included in the House filed appropriations bill. All contracts would be pro-rated down by this percentage.

• This funding supports the 114 local public health agencies throughout the state that are the frontline defense on health issues for Missouri citizens.
• A funding reduction of this magnitude could result in layoffs at public health agencies and would reduce local surveillance and monitoring of disease incidence; response to disease outbreaks, public health emergencies due to natural disasters, or bioterrorism events; local food and water safety; and regulation of licensed establishments such as restaurant inspections.
• Public information on threats and prevention measures would be reduced.
• Rural areas with less available in local funds would be particularly affected.
• Would also result in an estimated loss of $1.1 million in federal matching funds for tobacco use prevention, cancer registry, FDA NEP food stamp program, and maternal child health programs. The exact amount of the federal loss would depend upon which deliverables were to be deleted from the contract, since specific deliverables are tied to different federal grants with different match ratios.

Vaccines

• The cut would eliminate influenza vaccinations for approximately 16,603 adults every year to protect against influenza disease. As of January 31, 2004, over 16,000 cases of flu have been reported in Missouri this season, with 1,308 deaths.

TB medications

• The cut would eliminate the purchase of TB medications. Currently, DHSS purchases medications for approximately 3,000 individuals identified with TB infection and over 100 individuals with TB disease. The result would be that these persons, who place themselves and other citizens at risk for tuberculosis, would either have to find a way to purchase the medications on their own or would not be treated for their conditions, which would result in increased incidence of TB in Missouri.

HIV/AIDS Medications - A 10% reduction was included in the House filed appropriations bill.

• Approximately 43 low-income, uninsured, non-Medicaid-eligible HIV+ clients would lose access to HIV medications, resulting in accelerated disease progression, increased incidence of opportunistic infections, increased overall health care costs, and increase in AIDS-related deaths.

Children with Special Health Care Needs A 9.4% reduction was included in the House filed appropriations bill.

• The cut would result in 145 fewer children with a special health care need receiving treatment services. The program would establish a waiting list.

Genetics Program – A 9.8% reduction was included in the House filed appropriations bill.

Services and interventions that assist Missourians deal with genetic diseases would be cut including:

• Sickle Cell Program – funding for the six resource centers (St. Louis Children’s Hospital, Children’s Mercy Hospital, University of Missouri Hospital and Clinics, Truman Medical Center and Barnes Hospital) serving approximately 1,000 of the estimated 1,500 individuals with sickle cell disease would be would be reduced. Specific services which would be impacted include:
• Confirmation of diagnosis and tracking of infants to ensure that those with clinically significant results are retested and entered into a system of medical care. In the past five years 199 infants have been identified through the state screening program with test results indicating sickle cell disease. All of these infants received follow up through the resource centers, resulting in early diagnosis and a program of life prolonging care in the first few months of life;
• Medical management (continuing medical follow-up and health maintenance following diagnosis);
• Education for health professionals and other agencies that provide care for individuals with sickle cell disease. At least 12 education sessions per year are provided by each center for more than 1,400 physicians, nurses, scientists, therapists and other allied health professionals.
• Adult Genetic Disease Treatment Program – Reduce funding for 60 clients at an average cost of $1,500 per individual who need medical services to maintain a healthy life.
• Cystic Fibrosis Outreach Clinic – Would terminate the Cystic Fibrosis Outreach Clinic contract with the University of Missouri. In FY 2004, 104 client visits were held in the Springfield and the Cape Girardeau satellite locations.

Head injury program A 10% reduction was included in the House filed appropriations bill.

• Based upon the projected cost per person receiving rehabilitation services ($6,418), 23 fewer clients could be served by the Adult Head Injury Program. Clients needing services would be added to the current waiting list which averages 40 to 45 clients monthly.

Comprehensive Health Services – The entire $4,988,565 recommended for the program by the Governor was cut from the House filed appropriations bill.

• The department will not be able to implement the program to serve 26,710 individuals to enhance the general health of men and women through screening/assessment, education/treatment/referral for diabetes, anemia, thyroid problems, certain cancers, sexually transmitted disease, substance abuse, sexual abuse, domestic violence, mental health needs, immunization needs, obesity and other eating disorders and reproductive health services.

Community Health Programs

• 54% reduction in general revenue funding to St. Louis and Kansas City for racial and ethnic minorities at highest risk of heart disease and stroke initiatives. This funding supports screening, early detection and referral, and community supports for decreasing risk for chronic diseases, the leading causes of death in the state.
• Services and interventions that improve healthy pregnancy outcomes and healthy baby outcomes will be cut including:
• Breastfeeding training to obstetricians, pediatricians, nurses, and nurse practitioners that work in obstetric and pediatric clinics and hospitals;
• “Train the trainer” training to 112 Child Care Consultants in the state on Back to Sleep so that they can then train both licensed and unlicensed day care centers;
• “Baby your Baby” books that help parents assure early and regular health screenings, immunizations and well-child check-ups.

Senior Rx Program – The entire $7.5 million in general revenue recommended for increasing participation to 25,000 members and program inflation was cut from the budget in the filed HB appropriations bill.

• The impact of this cut cannot be known until the enrollment period is completed at the end of February. However, news of this possible cut may hurt the Commission’s efforts to increase participation or result in higher costs to Missouri seniors in the program.

Expense and Equipment Cuts – A 10% expense and equipment cut was included in the House bill. The impacts of that reduction include:

Section for Long Term Care

• Over 500 licensed Residential Care Facility I and II will not receive a mandated interim or mid-year inspection, placing thousands of residents at a potential risk for receiving poor quality of care.
• Over 500 licensed Intermediate Care Facilities and Skilled Nursing Facilities will not receive a mandated interim or mid-year inspection, placing thousands of residents at a potential risk for receiving poor quality of care.
• Approximately 2,000 facility complaints will not be investigated until the annual inspection is complete - DHSS statistics indicated 20% of these complaint allegations are valid.
• All Adult Day Care Facilities will not receive a mandated interim or annual inspection.
• All sixteen Alzheimer's Demonstration Projects, created by statute, will not receive mandated inspections.

Section for Senior Services

• A substantial loss in federal funds which in combination with the general revenue loss would impact the section's policy regarding face-to-face contact with seniors and adults with disabilities to reduce travel expenditures.
• A 10% reduction in travel E&E would represent expenses associated with investigating the circumstances of approximately 1,155 adults reported to be at risk of abuse, neglect or financial exploitation; assessing approximately 5,000 seniors and adults with disabilities for the care planning process for home and community based care; and screening approximately 1,146 seniors and adults with disabilities to ensure that those considering long-term care placement had information sufficient to make informed choices about care and care settings.

Family Care Safety Registry:

• The document scanning process and equipment would not be updated resulting in the continuation of manual data entry procedures. Continuation of these manual processes will result in less time available for running background screening requests, thus continuing or increasing the backlog. Delays in receiving requested background screening results may result in employers delaying hiring decisions and individuals being unable to secure gainful employment.

Bureau of Child Care:

• A cut in travel costs, which is equivalent to eliminating travel for three child care inspectors for the entire year. This will result in 420 inspections of child care facilities not being completed and 75 complaints not being investigated. A reduction in child care facility inspection and complaint activities would put children’s health and safety at risk.

Facility Regulation Unit:

• A cut in travel costs, which is equivalent to eliminating travel for 8 health care facility inspectors for the entire year. This will result in 140 inspections of hospitals, rural health clinics, end stage renal disease dialysis facilities, and ambulatory surgical centers not being completed and 182 complaints at these facilities not being investigated. Since many of these inspections also involve the use of federal funds, the loss of federal funds in addition to the $42,000 GR reduction is estimated to be $68,500. Inspections of the state’s health care facilities commonly reveal inappropriate health care practices that are dangerous to the health of Missouri’s citizens of all ages. These inappropriate health care practices include patient rights issues (often related to use of restraints) and pharmacy issues such as unlocked drug supplies. Complaints are also received about all types of health care facilities related to such issues as patient elopements, medical errors, the death of a patient in a posey restraint who was found hanging from the bed rails, inadequate dialysis treatment provided in order to teach a lesson to a patient who had not been following their physician’s orders regarding the frequency of dialysis treatments, etc. Complaints are also received about all types of health care facilities about such issues as patient elopements and medical errors. Funding reductions could cause hazardous situations to go unnoticed, uninvestigated and/or uncorrected thus resulting in a decrease in the quality of Missouri’s health care.

• Funding for telecommunication costs, housekeeping and janitorial services, and utilities for the 110 facilities that are shared by the Department of Health and Senior Services and the Department of Social Services throughout the state was cut. These operational expenses are not discretionary expense and equipment expenditures. A reduction of this magnitude will likely result in the holding of invoices to vendors or the department may need to consider closing offices in various areas of the state.

• Loss of travel funds for CHART staff will result in the inability to provide on site assistance to health agencies to increase their capacity and skills to improve health status is their communities.

• Contracts in the St. Louis and Kansas City area for local initiatives to address new HIV infections will be reduced resulting in fewer community capacity building efforts and less community prevention coordination. A reduction of this magnitude will adversely effect over 100 community-based and 20 faith-based organizations, which serve over 10,000 persons in the target population.
  
• Software purchases that are critical to the operation of MOHSAIC (the DHSS integrated client information system) would be reduced.

• Loss of travel funds would reduce technical assistance for Local Public Health Agencies, contract monitoring, informational meetings with contractors, and professional development opportunities for the local public health workforce.

• The Missouri Health Facilities Review Committee would further curtail travel and replacing and upgrading computer equipment and software.

Pay plan – All of the Governor’s recommended pay plan for state workers was removed from the bill.

• No pay plan for state workers for third year of the last four years while some workers will not have received a pay increase in any of the past four years. Missouri ranks 49th in average state employee pay and 80% of state employees make below the market rate for their job. Filling vacancies and keeping employees in jobs critical to the department is becoming increasingly difficult. Morale of state employees wavers especially as budget cuts have reduced staff and the remaining employees are left with significantly increased workloads. At some point state employees need to be properly compensated.