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Children and Public Health in the House Ways & Means Budget

By Sarah Nolan, April 23, 2013

Public health programs ensure that children and adults are able to live healthy lives, both by protecting the public from the threat of diseases and other hazards, and by promoting healthy behavior and providing direct health services to at-risk populations. While many Department of Public Health (DPH) programs indirectly affect the well-being of children in some way, MassBudget's Children's Budget identifies a subset of 20 programs that provide direct services to children and adolescents, either exclusively or alongside adults. This group of programs, which are described below, accounts for nearly half of FY 2013 funding for DPH in the state budget. In recent years, overall funding for public health programs has declined sharply, and the decline for children's programs has also been steep—from FY 2001 to FY 2013 spending on the children's programs dropped by 29.8 percent, after adjusting for inflation.

The House Ways and Means (HWM) budget proposal does not reverse this trend, proposing a slight decrease of $1.2 million to children's programs, in contrast to the Governor, whose budget included a $13.6 million increase in funding for these programs. Underlying this net change are changes to individual line items, including increases to some and decreases to others. For example, the HWM budget includes an increase for the main Substance Abuse Services line item (which chiefly funds adult services, although it also supports important services for children), but it cuts a smaller substance abuse program aimed at adolescents, and it also proposes to decrease funding for a range of other programs, from Early Intervention to Youth Violence Prevention Grants.

This budget brief compares the funding proposed by the HWM and Governor's budgets for children's public health programs to current FY 2013 spending, and provides some basic background on each spending item. More detailed descriptions of each of these programs and funding history is available on the MassBudget Children's Budget website. Click on individual line item numbers to go directly to a description for that line item.

Line Item

Program

FY 2013 Current

FY 2014 Governor

FY 2014 HWM

HWM-FY13

% change

Maternal & Child Health

4513-1002

Women, Infants, and Children's (WIC)

12,366,617

12,748,383

12,748,384

381,767

3%

4513-1012

WIC Program (Manufacturer Rebates Retained Revenue)

26,355,000

27,060,000

27,060,000

705,000

3%

The WIC program is a nutrition program that serves low- and moderate-income pregnant women and small children. The HWM budget includes a slight increase for WIC programs that is identical to the increase included in the Governor's House 1 budget. [Note that both line items support the same activities; the second is a retained revenue account that allows DPH to spend revenue from rebates that manufacturers of infant formula pay as a condition of distributing their products through the program.]

4513-1020

Early Intervention

28,025,263

26,241,537

25,241,573

(2,783,689)

-10%

The Early Intervention program serves infants and toddlers who exhibit cognitive, motor, language, and other developmental delays. The House budget cuts an additional $1.0 million beyond the $1.8 million decrease included in the Governor's H1 budget. The H1 decrease is related to the end of funding for a one-time rate increase included in the FY 2013 budget. The additional $1.0 million decrease proposed in the HWM budget would likely lead to tightened eligibility standards (for instance, an increase in the level of cognitive development delay required for eligibility) that would reduce access to EI services for children.

4513-1023

Newborn Hearing Screening Program

70,193

74,036

74,061

3,868

6%

This program ensures that newborn children in Massachusetts are screened for hearing problems and receive access to services for problems that are diagnosed. The HWM and Governor's budgets both propose a 6 percent increase in funding for this program.

Violence Treatment & Prevention

4510-0810

Sexual Assault Nurse Examiner (SANE) & Pediatric SANE Programs

3,160,740

3,165,124

3,160,740

0

0%

4513-1130

Domestic Violence and Sexual Assault Prevention and Treatment

5,514,340

5,518,935

5,518,990

4,650

0%

The SANE programs provide medical care and expert forensic evidence collection, along with other support, for victims of sexual assault, and a separate line item funds programs to prevent domestic violence and sexual assault, and to provide services for victims. The HWM budget proposes level funding (a slight cut relative to inflation) for both these sets of programs, as did the Governor's budget.

4590-1506

Youth Violence Prevention Grants

1,501,178

1,501,178

1,000,000

(501,178)

-33%

4590-1507

Youth-At-Risk Matching Grants

2,700,000

2,700,000

1,800,000

(900,000)

-33%

4000-0005

Safe and Successful Youth Initiative

4,000,000

10,000,000

0

(4,000,000)

-100%

Two DPH programs provide grants to communities and organizations for anti-violence activities and a third program, the Safe and Successful Youth program located within the Office of Health and Human Services, also funds grants aimed at preventing youth violence and promoting positive youth development. The HWM budget would reduce funding for the first two programs by a third and eliminate the Safe and Successful Youth program-a total cut of $5.4 million for these programs. The Governor's House 1 budget plan included level funding for the two DPH programs, and proposed to more than double funding for the Safe and Successful Youth program.

Public Health Care Access

4510-0025

SEAL Dental Program (Retained Revenue)

889,889

889,889

889,889

0

0%

4512-0500

Dental Health Services

1,403,897

1,414,980

1,415,040

11,143

1%

The SEAL program provides dental sealants and other dental care to low income children, and a second budget line item funds dental health services for both children and adults, including people with developmental disabilities. The HWM budget proposes level funding for these programs, as did the Governor's budget. Funding for the second dental health services program has been cut in half since FY 2008.

4513-1000

Family Planning (Family Health Services)

4,666,697

4,671,059

4,466,697

(200,000)

-4%

4530-9000

Teenage Pregnancy Prevention Services

2,378,411

2,382,583

2,265,015

(113,396)

-5%

These line items fund comprehensive family planning services for low-income women, men, and adolescents, as well as community-based programs designed to prevent teen pregnancy and encourage young people to develop healthy relationships. The HWM budget proposes small reductions for these programs, both of which have been cut substantially in recent years. The Governor's House 1 budget plan proposed level funding for these programs.

4590-0250

School-Based Health Programs

11,714,634

11,623,167

11,397,967

(316,667)

-3%

School-based health programs help support health services to children and adolescents in a school setting and help reduce barriers to care, especially for children in low-income communities. The HWM budget proposes a small cut in funding for these programs in FY 2014. Since FY2008, funding for the programs has declined ay about one-third.

4590-1503

Pediatric Palliative Care

821,051

825,183

825,184

4,133

1%

This program provides supportive services to Massachusetts children with life-limiting illnesses and to their families. Both the HWM budget and the Governor's budget propose level funding for this program.

Prevention & Wellness

4512-0200

Bureau of Substance Abuse Services

77,029,178

83,858,094

83,696,690

6,667,513

9%

The majority of funding from this line item supports treatment and services for adults, but funding also goes to a smaller set of crucial services for adolescents and young adults. The HWM budget follows the Governor's H1 budget in proposing a $6.7 million increase that is largely the result of a shift of funding from an off-budget trust to this line item.

4512-0203

Family Intervention Program

1,500,000

1,500,000


(1,500,000)

-100%

The Family Intervention Program, which began in FY 2011, provides services for adolescents and young adults with substance abuse disorders, and supports for their families. The HWM budget appears to eliminate funding for this program.

4516-0263

Blood Lead Testing Fee (Retained Revenue)

1,117,101

1,117,101

1,117,101

0

0%

The state oversees the testing of pediatric blood specimens to identify children with elevated blood levels. This line item allows revenues (such as payments from insurers) derived from that program to be retained and used for the cost of the tests, and both the HWM budget and the Governor's budget authorizes the same level of retained revenue.

4580-1000

Universal Immunization Program

52,879,812

54,425,120

54,425,120

1,545,308

3%

This program funds the purchase and distribution of vaccines to children (and some adults).

4590-0300

Tobacco Cessation & Prevention Programs

4,151,958

4,172,622

3,972,621

(179,337)

-4%

These programs aim to prevent people from starting to smoke and help those who have started to quit. A number of activities funded by this line item are aimed at children and adolescents. Funding for these programs has been cut more than two-thirds since FY 2008.

This research was funded in part by the Annie E. Casey Foundation. We thank them for their support but acknowledge that the findings and conclusions presented in this report are those of MassBudget alone, and do not necessarily reflect the opinions of the Foundation.