Gov. Baker Slashed Funding for Opioid, HIV, and Elder Care Programs

Now what?

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A series of budget cuts proposed by the Baker administration may put some Massachusetts health organizations—including some of the state’s hallmark programs—in peril.

In December, Gov. Charlie Baker’s office announced $98 million in wide-ranging mid-year budget cuts, citing lagging state revenues. The budget adjustments pull from nearly every corner of the state’s coffers, including opioid abuse relief, HIV treatment, and elder care. These areas stand to lose $1.9 million, $900,000, and $13.7 million, respectively—which may be enough to sideline some of the state’s most sorely needed public health efforts, as well as some of its most successful.

“A lot of people have been trying to make an impact, and this isn’t the sign we need to be seeing from our government in the face of the epidemic,” says David Hanley, executive director of opioid treatment organization Into Action Recovery, which will lose $200,000. The group was working toward opening a sober living house in Tewksbury, a goal that’s now been thrown off course.

Despite the cuts, an Executive Office of Health and Human Services (HHS) spokesperson maintains that “the Baker-Polito administration is fully committed to investing resources necessary to fight the opioid crisis and provide public health programs that support citizens throughout the state.”

The organizations fighting those battles aren’t so sure.

While the state budget includes more opioid funding than ever before, totaling $177 million for the fiscal year, Hanley says that’s not enough, especially in the midst of an epidemic that kills hundreds of Massachusetts residents each year. “The current projects aren’t keeping up with the epidemic, so we need to pull a lot of new money in, not just the status quo,” he says. “The status quo is kids are dying.”

Last month, Hanley lost his younger brother, Derek, to opioid addiction. Derek died while waiting for a bed in a sober living facility, and left behind an 11-day-old daughter. “Any time someone loses a life due to substance abuse or alcoholism, it’s sad,” Hanley says. “But when they die because they’re seeking help and they can’t get it, that, to me, is unconscionable.”

In elder care, budget cuts may actually force aging adults into getting more help than they want.

The reductions mainly target funding that pays for long-term at-home care, nurse visits, and other specialists. If those resources become more scarce, older adults may be increasingly pushed into nursing homes they don’t want, says Al Norman, executive director of elder advocacy group Mass Home Care.

“When you cut the programs that are allowing people to age in place, it does put them in jeopardy of needing a higher level of care,” he says. “Economically, it makes little sense to do this.”

Norman notes that taxpayers’ money would pay for this unnecessary—and costly—institutional care. “If we waste our money putting people at a level of care that they don’t need, it’s simply financially wasteful,” he says. “It’s not smart government.”

It’s especially frustrating, Norman says, because Massachusetts’ home care system is a national leader, serving 45,000 elders each month. “There is no logical answer about why successful programs that are cost-effective are getting cut,” he says.

John Gatto, senior vice president of community health at the Justice Resource Institute (JRI) knows that paradox well. JRI, along with many other organizations, has helped make Massachusetts a model of effective HIV management, reducing diagnoses by 41 percent between 2000 and 2014. So why does that field stand to lose almost $1 million?

“We are often a victim of our own success,” Gatto says. “It makes some sense to say, ‘Let’s put our federal resources where there’s the greatest number of new infections.’ In our state, the same thing can happen.”

The problem is that shrinking bank accounts threaten to reverse that success. Gatto estimates that up to 20 local organizations, including JRI, will have to curtail their service offerings—namely medical case management for individuals with HIV—as a result of the budget adjustments.

“It’s not just about the 20,000 or 25,000 people in Massachusetts living with HIV,” he says. “If those people are not still connected to medical care, their risk of spreading HIV also increases. These sorts of reductions really have a broad impact on public health in the community, and that’s what is particularly frightening.”

JRI alone has to shave roughly $100,000 from its budget within six months, Gatto says. While the organization is trying to save that money internally, it’s an uphill battle. “You can’t save $100,000 by not buying more paperclips,” Gatto quips.

JRI and its contemporaries will need to find creative ways to partner with clinical care centers to avoid a duplication of efforts and better optimize what resources remain, Gatto says. Similar strategies will need to carry over to substance abuse, a field that’s already trying to integrate addiction with primary and mental healthcare.

Inevitably, though, Gatto says services will suffer as a result of the cuts.

“Frankly, we can’t continue to deliver all the same services to the same number of people,” Gatto admits. “Eventually the infrastructure starts to crumble. And what’s equally scary is what this means for the future. It’s very hard to make up ground going forward.”