Oklahoma, federal budget issues leave health agencies guessing
Oklahoma City — People with disabilities in Oklahoma, who breathed a sigh of relief that their services would be funded just one month ago, may start worrying again.
Budget uncertainty on both the state and federal levels has left state agencies and health care providers wondering whether their programs can continue — and people who rely on those programs potentially with little time to find alternatives.
The Department of Human Services, which administers programs that pay for in-home supports for people with disabilities, still faces a budget shortfall of about $42 million. The department has warned it could need to cut funding for the Advantage program, which offers alternatives for people who otherwise would need a nursing home, and a separate program for families that have an adult child with developmental disabilities.
Services could be terminated in March, and people with disabilities would start getting notices at the end of January, said Roseann Duplan, public policy specialist at the Disability Law Center. That would put families in the position of quickly trying to find a bed in a nursing home, which costs the state more and isn't what many people want, she said.
Sheree Powell, DHS spokeswoman, said reductions won't be necessary, at least for the next few months, if a House bill appropriating $25.5 million for the department becomes law. Officials still are determining if reductions would be necessary later, she said.
“That funding, at least for the time being, will prevent service-level cuts,” she said.
Gary Taylor, legal director at the Oklahoma Disability Law Center, said he is concerned services for people with disabilities could get lost in the budget shuffle. The Disability Law Center and the American Civil Liberties Union have filed a lawsuit arguing that cutting services would violate the right for people with disabilities to live in the least restrictive setting that can meet their needs.
“There's a lot of uncertainty in the community,” Taylor said. “We still don't know, as of today, what the Legislature will do, if anything.”
The department was one of three health agencies that lost a combined $150 million when the Oklahoma Supreme Court struck down a $1.50-per-pack cigarette fee. Gov. Mary Fallin called legislators back for a special session in the fall, but vetoed large portions of the bill they passed in November, saying it failed to provide long-term fiscal stability.
Fallin ordered lawmakers back to Oklahoma City for a second special session, which started Monday. She instructed lawmakers to focus on avoiding rate cuts to Medicaid providers. The Oklahoma Health Care Authority board voted to authorize those cuts earlier this month to balance its budget.
The authority would need an additional $17.7 million to avoid cutting state payments to health providers caring for SoonerCare patients, spokeswoman Jo Stainsby said. Nursing facilities would absorb a 1 percent cut, and most other medical providers would lose 6 percent.
The cuts are scheduled to start Jan. 1, though the board has scheduled a meeting to reverse them before the new year if the Legislature acts. Advocates have raised alarms that nursing homes could close or doctors could stop treating SoonerCare patients because of the reduced funding.
Mental health hit from multiple sides
The rate could be another hit to mental health providers, who are facing potential cuts from the Oklahoma Department of Mental Health and Substance Abuse Services' own budget shortfall.
The department warned earlier this year it might have to end state funding for almost all outpatient services without additional state money, but the Legislature appropriated enough to put off deep cuts to behavioral health services until April. It would need about $21.5 million to avoid any cuts this year.
Jeff Dismukes, spokesman for the mental health department, said additional cuts would be “devastating” to services after years of reductions, but said the department still is working out which programs would be affected.
“These services reduce costs to other state agencies and community programs, keep Oklahomans working and contributing to our economy, and save lives,” he said in a written statement. “It is important that we fix this.”
Federal programs in the balance
Other providers also face uncertainty from the federal level. Funding for the Children's Health Insurance Program, which covers children whose families earn too much to qualify for SoonerCare, lapsed Oct. 1, though Oklahoma has enough money to hold out until March. Grants for community health centers — which offer primary care, dental and mental health services on a sliding fee scale — lapsed at the same time. Senators have said they likely won't take up the issues until January.
Health centers get their federal grants at different times of the year, so not all will face a funding cliff at the same time. Two whose grants were due in January were told they would get a two-month extension, with possible one-month extensions if Congress hasn't come up with a solution by March, said Cassidy Heit, public policy and communications associate at the Oklahoma Primary Care Association.
While the extensions would keep the money flowing, they mean health centers can't guarantee they will be able to keep caring for their patients, and the uncertainty is taking a toll, Heit said. Health centers can't hire new employees, get loans to expand their facilities or make other long-term plans when they don't know if their funding will dry up, she said.
“It is not only burdensome and anxiety-inducing for health centers and their staff, but also for patients uncertain as to whether they will be able to continue receive care at their medical home,” she said in a written statement.
The same problem is happening on the state level, as agencies offering disability services adapt to the uncertainty, Duplan said. Some caregivers have decided to look for steadier work and some home health agencies may decide to close, leaving fewer choices for people with disabilities even if the state comes up with funding at some point, she said.
Recipients' “real fear is that one day, that care provider is not going to be there,” she said.