On Monday, Nebraska Appleseed’s Executive Director testified at the Appropriations Committee in response to the Nebraska Department of Health & Human Services’ appropriation request. Appleseed believes that DHHS’s budget must invest in and protect low-income children and families’ needs.[DDET Appleseed Testimony] Senator Lavon Heidemann
Chair, Appropriations Committee
State Capitol, Room 1004
Lincoln, NE 68509
Re: Agency 25, Department of Health and Human Services
Dear Senator Heidemann and Members of the Appropriations Committee,
My name is Becky Gould and I am the Executive Director at Nebraska Appleseed. Nebraska Appleseed is a non-partisan, non-profit, public interest law firm that works for equal justice and full opportunity for all Nebraskans. I am testifying today to share our support for some aspects of the appropriations request for Agency 25, the Department of Health and Human Services, and our serious concerns regarding others.
I want to touch on several appropriations that are critical to low-income families and children in foster care, specifically those related to ACCESSNebraska, child care, child welfare services, and Medicaid.
We are glad to see the Department request resources to slow down the timeline for laying off workers in the ACCESSNebraska system. We agree that current challenges are significant and require adjustment. Our organization in conjunction with a number of other partners, held listening sessions across the state where we heard from hundreds of Nebraskans difficulties including delays in receipt of essential benefits like Medicaid, confusion and inconsistency in responses to complex cases, and mishandled paperwork. However, the appropriations request will only alleviate some of these problems. We urge the Nebraska Legislature to approve this appropriations request, and to pass three pieces of legislation LB 825, LB 1016, and LB 1041, that will solve some of the underlying systemic problems. Not only will these solutions ensure Nebraskans can assess these critical programs, they will also protect the state from potential legal liability for failing to meet processing time lines, or meeting the needs of those with limited English proficiency or people with disabilities.
We support the proposed investment in child care assistance. This is necessary to respond to increased need and keep working parents on the job.
At this moment, our child welfare system is failing the more than 6000 children who find themselves under the care of the state. Investments that will build a strong and effective system to support children in foster care and their families are essential. The biennium request asks that an additional $5 million be transferred to cover the cost of child welfare case management services remaining with private lead agencies. Senator Campbell and the Health and Human Services Committee, after extensive study of the failures of the current child welfare system, have recommended that case management services be returned to the state and have pending legislation to make that change. We agree with that recommendation and think it makes more sense to invest these resources in returning case management to the state, reducing caseloads, improving training for case workers and other reforms that will improve and stabilize the child welfare system.
Additionally, while it is important to recognize that difficulty accessing behavioral health services is still resulting in children being relinquished into the child welfare system, simply adding additional staff to focus on these children will not address the problem. Our office has worked with a number of families who have faced this situation over the last year. The reason many high needs children living at home are entering the child welfare system is because the Medicaid program has narrowed its scope of services to the point that critical levels of care no longer exist. Coordinators cannot connect children and families to services that simply don’t exist. LB 1063 would clarify the scope of behavioral health services that are required under federal law and help close some of the current gaps in services. Rather than hiring coordinators, we need to make investments in the services array and covering needed services through Medicaid.
We agree with the concerns raised by many groups testifying today about the proposed cuts to the Medicaid program. First, reducing access to needed care does not decrease the need for the services but rather shifts the costs to another area of the budget. If people with disabilities are not able to continue living independently because of the loss of private duty nursing services, they may end up in much more expensive nursing home care, a mandatory service under Medicaid. Second it is unclear why these cuts are necessary at this time. The current biennium request envisions reducing the Medicaid appropriation by an additional $5 million “based on year to date analysis of funding requirements.” We question where this additional $5 million in savings comes from, particularly if enrollment is not expected to decrease. Additionally, if the program has already saved $5 million, why must it be cut by another $4 million? Lastly, a number of the proposed reductions in optional services are services that are mandatory under the Patient Protection and Affordable Care Act and will require the state to offer those benefits again in 2014. It is short sighted to eliminate these services only to reinstate them in 2014. We would encourage this Committee to reject these cuts and advance LB 952.
The Department of Health and Human Services oversees important programs that touch the lives of hundreds of thousands of Nebraskans each day. Ensuring that those programs work effectively is critically important and we greatly appreciate your consideration of our testimony as you review the Department’s appropriations requests.
Rebecca L. Gould