Stormy Weather: Facing the Reality of State and Local Cuts to MCH Program Budgets
By Michelle Alletto, MPP
Program Manager, Public Policy & Government Affairs, AMCHP
Chad J. Abresch, M.Ed
Program and Policy Manager, CityMatCH
State Budget Crisis
According to the Center on Budget and Policy Priorities, 48 states are facing fiscal stress in their fiscal year 2010 budgets with initial estimates of these shortfalls totaling $166 billion. Since the beginning of the current recession, states have begun making cuts and felt increased pressure as the economy has continued to weaken. Although fiscal relief from the American Recovery and Reinvestment Act has minimized the impact of some of these cuts, many states still face severe fiscal challenges. To help close budget gaps at least 39 states report making cuts that will impact services to vulnerable residents.[i]
Impact on State Public Health
According to a recent survey of health agencies conducted by the Association of State and Territorial Health Officials (ASTHO), shrinking state health department budgets brought on by the current economic downturn are forcing cuts in critical public health programs. [ii] According to the ASTHO survey, nearly 30% of states’ fiscal year 2008 health department budgets were cut below their fiscal year 2007 level and almost two thirds of state health departments expect this trend to continue in 2009.[iii]
Nearly half of all states implemented cuts to public health programs that will affect low-income children’s or families’ eligibility for health insurance or reduce their access to health services, including maternal and child health services. In addition to reducing services, eroded funding impacts state public health departments’ capacity to coordinate efforts across communities. If state funding continues to decline, communities may turn to categorical funding streams to fill gaps, resulting in divergence of priorities and possible duplication of effort among agencies and programs.
States have also been forced to cut back on their workforce to help balance fiscal pressures. Hiring freezes and furloughs place additional pressure on an already limited workforce to meet the increasing demands for public services during tough economic times. At least 27 states have instituted hiring freezes, 10 have announced lay-offs, 15 have reduced state worker wages, and several have delayed scheduled pay increases (including cost of living adjustments). Based on media reports, 21 states were either already implementing or considering furloughs.
States have reported cuts or complete elimination for several key maternal and child health programs including home visiting, newborn screening, family planning, transition assistance for children with special needs, care coordination for underinsured women, vaccinations and school-based health. While the reality of each state and local agencies’ budget cuts vary, the impact on programs that keep mothers, children and families healthy is critical. Cuts mean less funding from states to support local government programs and services. In one state, for example, more than $20 million in cuts to the state's maternal child and adolescent health program have been proposed, and a county health program for at-risk pregnant women and teenagers may be eliminated. The program, operated by county public health departments, provides services to women and teens to reduce incidences of low birth weight, premature delivery, maternal and infant mortality, preventable childhood diseases and disabling conditions. Yet another state will see cuts to a county immunization program and may have to limit vaccinations to high-risk populations. In addition, a community nutrition program in the same county that taught elementary school children about nutrition and healthy living has been eliminated. With a substantial cut to the tobacco use prevention program the county health department will no longer offer local smoking cessation classes. With less focus on tobacco prevention, states may see an increase in poor outcomes among women who might have been reached by these programs.
In addition to cutting programs and services and reducing their workforce, states are exploring ways to raise revenue. To help balance the severe budget cuts, over half of all states are raising taxes or considering doing so. Increases in personal income, business, sales, and excise taxes have been enacted or are under consideration.[iv] Unfortunately, future projections of the state fiscal crisis reveal a continued crunch looking forward to 2011, when total gaps are expected to exceed $350 billion.[v]
As health reform continues to be debated in Washington D.C., state fiscal restraints will certainly have an impact on what health reform proposals states will be able to support. A bipartisan group of governors met recently with the President to voice their concern over increasing the burden on states to deliver health services. The President shared his urgent desire to restructure the nation's health-care system but warned that any changes should not place more burdens on strained state budgets or eliminate innovative programs they already have in place.[vi]
AMCHP continues to closely monitor the fiscal crisis faced by states and MCH departments in particular. We will continue to advocate for an increased investment in public health both through the appropriations process and in health reform. Most importantly, we consistently urge Congress to increase funding for the Title V MCH Block Grant so that states can continue to provide essential preventive services that reduce health care costs and promote wellness.
[vi] States Assert Place in Health-Care Debate Governors Fear Shifting of Costs By Michael A. Fletcher Washington Post Staff Writer Thursday, June 25, 2009