As for a general overhaul of human services, the House 1 budget contains the much-anticipated restructuring of the Executive Office of Health and Human Services (EOHHS). The reorganization plan consolidates the 15 state agencies that make up EOHHS into four new divisions: children, youth, and families; disability and community services; health; and elder affairs. It merges "back-office" operations like human resources, accounting, and legal support under the auspices of EOHHS secretary Ronald Preston. And it calls for shuttering 30 of the EOHHS’s 150 local offices, as well as the Fernald Center and Worcester State Hospital. Perhaps the biggest news is the plan’s dismantling of the DMA, which administers Medicaid. In many ways, the DMA has served as the glue that holds EOHHS together, since 94 percent of people who receive EOHHS benefits also receive Medicaid. But now, its functions will be divided among three departments — a set-up that advocates fear will widen the cracks through which folks can fall. Because the plan would break up Medicaid’s "continuum of care," aid recipients will still have to juggle bureaucracies. For instance, seniors who get elder services and long-term Medicaid benefits will have to deal with two departments. So will children who suffer from behavioral and mental-health problems. As Reynolds, the former DMA commissioner, says, "Officials have tried to come up with a proposal that brings greater coordination. But dangers occur when you split up people who’re currently working together."
All in all, the administration pegs savings from the restructuring at $60 million, with another $30 million in one-time revenues generated from the sale of EOHHS-owned land and facilities. But while the House 1 budget provides the most detailed picture yet of Romney’s intentions for reorganizing EOHHS, it leaves many questions unanswered. Advocates wonder how, exactly, the savings will materialize. Which of the 30 local offices will be shut down? What’s the timeline? Will "efficiencies" result in more money funneled back into programs for the state’s most vulnerable? Will EOHHS agencies live up to their missions to serve specific populations?
Ultimately, the thinly outlined plan — which the Romney administration is expected to flesh out by May 1, when it files a legislative package detailing how it wants to reform state government — gives advocates no way to verify whether the math is valid. And it leaves them with no way to allay fears that the reorganization will spell devastation for social services. Steve Collins, of the Massachusetts Human Services Coalition (MHSC), sums up the sentiment best: "There’s nothing to suggest that the administration’s primary motivation is to make a better system for recipients. We can’t help but believe it’s to squeeze out money to support Romney’s no-new-taxes pledge."
THIS WEEK, Romney’s budget plan makes its way to the House, where Ways and Means Committee members have begun poring over the fine print. It’s doubtful that the Massachusetts legislature will rubber-stamp the governor’s plan — indeed, members have already reacted to House 1 with mixed messages. While they’ve commended Romney for delivering a budget that closes the projected $3 billion deficit, legislators have balked at his contention that it saves $2 billion from streamlining and restructuring state government. On Monday, House Ways and Means chair John Rogers (D-Norwood) sent his House colleagues a letter warning that House 1 is based on questionable and unrealistic information. According to the March 3 letter, Rogers’s preliminary budget analysis indicates that the state can save no more than $100 million through reforms in the next fiscal year — a figure that the MTF’s Widmer echoes. Critics have gleefully pointed out that the tax-phobic Romney has gone wild with new fees to generate the revenues needed to solve the state’s fiscal crisis. And they charge that he’s slashed more in direct services than he’s let on to date. In a breakdown of Romney’s budget, Rogers calculates that more than $900 million would come from program and service cuts. "The savings we can expect through efficiencies and reforms will solve only a fraction of the enormous problem," the legislator wrote in his March 3 letter. "The true difficulty lies in the necessary task of cutting as much as $2 million in programs, services, and aid."
At the same time, the legislature faces enormous pressure to pass some version of the governor’s far-reaching House 1 proposal. After all, tossing out House 1 opens up legislators to accusations of being obstructionists who are perpetuating the mess on Beacon Hill. Besides, the massive $3 billion budget shortfall necessitates some sort of action. And Romney's made it hard to identify anything in his budget regarding health and human services that wouldn’t at least survive. Last week, Senator Susan Tucker (D-Andover), who heads the joint legislative committee on human services and elder affairs, tipped her hat toward Romney’s EOHHS reorganization when she wrote an op-ed in the Boston Globe praising the administration for its "important first step." Compared to Romney’s explosive bids to refashion higher education and recalculate local aid, his proposals on health and human services appear modest, to say the least. In the words of Widmer, "The human-services reorganization is mild. But who knows if legislators will go along with it? We can only wait and see."
Kristen Lombardi can be reached at firstname.lastname@example.org