Helping Human Services

Health and Human Services Commissioner Jack Nicholas emphasized to lawmakers that of the cuts proposed to his agency “there is nothing so bad in these recommendations that couldn’t have been worse.” He could have been speaking for state human-service commissioners nationally; shortfalls exist in most states. But the legislative corollary to his observation is that the cuts could have been better, which is where providers and their clients come in.

Among the affected programs are child-protection services, foster care, programs for the mentally ill and substance abuse services. Each of these affected groups has anxious or unhappy advocates trying to prevent the reduction in expected growth of DHHS programs. Gov. Baldacci, having learned from the last round of Medicaid cuts, may surprise advocates when he says, “There’s nothing hard and fast in the budget. It isn’t going to be completed until we get input from the people who are affected by it.”

That is the most useful course in a time of disappearing funds. Rather than merely defend the numbers in his budget, he has appointed providers and department staff members to a task force to review the DHHS plans and look for better solutions. As the new federal budget makes clear, funding for Medicaid is not going to continue to rise as it has in the past. President Bush has proposed a $44 billion reduction in growth, which states will feel especially after cutting back their own Medicaid program over the past couple of years.

It’s not certain yet which of the president’s proposals will pass Congress, but Maine could lose a portion of its nursing home tax, its funding for targeted case management and administration costs in addition to seeing its reimbursement match fall. The federal proposal would also get tough with the transfer of assets to allow people to qualify for Medicaid.

These changed circumstances as well as the merger of the Department of Behavioral and Developmental Services and Human Services demand a changed response in the way Maine provides services, but the key is to provide the service, and that requires changes to happen carefully.

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One way to do this is through a bill suggested by Rep. Sean Faircloth to raise $90 million annually through user fees on cigarettes, alcohol, soda and lodging. Similar assessments are also being considered in such anti-tax states as Alabama and Mississippi; conservative Indiana is think-ing of boosting its income tax to pay for services.

Whether the Maine proposal is the right combination of goods and services can be determined by lawmakers – cigarette costs, given Internet and cross-border sales, may be at their peak; lodging doesn’t really belong with the others – but the idea of a user fee would be worth pursuing if as talks progress between the administration and agencies more money is needed.

You can hear the critics now: “It’s a tax! It’s a tax!” They can call it a tax if it makes them feel better, but if Maine is going to charge people for using its highways or its lakes through tolls or registration, why not recognize that consuming alcohol in Maine, on average, produces a public cost, if only to lift the drunken driver off the pavement and rush him to the hospital? That’s just the short-term cost – long-term medical costs for hospitalization and nursing care due to excess alcohol consumption are much higher.

Should the general public pay for the frill of someone’s drinking habit or should drinkers be expected to contribute a few pennies a pop? The absence of a user fee can be seen in the DHHS budget – the poor and sick may be taken care of through state Medicaid payments but other programs for other needy people are cut, including substance abuse prevention.

Another thing about user fees: They aren’t counted on those national lists measuring overall tax burden. Other states figured this out years ago and shifted some taxes to fees, dropping down on the list and leaving states such as Maine – which was busy arguing over what a tax was – high in the rankings. It’s about time Maine caught on.

This isn’t to suggest that the cutting DHHS has done is wrong or that raising fees should be taken lightly. But all states are searching for ways to raise revenue for human-service programs; user fees provide one realistic approach to turn to should the current budget prove inadequate.