HE HUMAN SERVICES community will closely monitor Governor Paul Cellucci's promise that the voters' approval of Question 4 - the income tax rollback - will be affordable and can be implemented without material cuts (the words of the governor's secretary of administration and finance) to programs and services for vulnerable residents.
Since proponents claimed that Question 4 was all about making sure that politicians keep their promises, we want to make sure the governor keeps his.
There is cause for concern. Eve assuming a healthy 7 percent growth in revenues and spending over the next three years, the fully implemented cost of Question 4, a $1.2 billion reduction in revenues, will equal 4.6 percent of the state budget in 2004.
Roughly 36 percent of the state's budget ($7.7 billion in the current year) funds health, social, and human services provided through the Executive Office of Health and Human Services and the Executive Office of Elder Affairs. The largest single account in this year's budget, at $1.65 billion, is the Division of Medical Assistance line item, which funds long-term care for frail elders. People over 85 remain one of the fastest-growing segments of the Massachusetts population.
In response to a federal lawsuit, the Cellucci administration has just promised up to $114 million in targeted funds over the next five years to address the Department of Mental Retardation's chronic waiting list. Those waiting are hundreds of families in which aging parents have saved the state millions by caring at home for their adult mentally retarded children. Many have been waiting for residential and community services for a decade, and the parents simply wish to know that when they die, their children will be cared for.
While a reduction of just under 5 percent may not sound dramatic in a budget measured in billions, the differences between mandatory and discretionary spending need to be taken into account. The recent success of the Department of Mental Retardation lawsuit is based on the Medicaid program being mandatory: If a person meets income and eligibility guidelines, the state must provide the service.
However, much of our spending on human services is discretionary. The entire budget of the Department of Social Services, which is mandated to protect children from abuse or neglect, is discretionary. The budget of Elder Affairs is totally discretionary. If increases in mandatory spending equal or exceed the overall rate of growth in the budget, cuts to discretionary spending will need to be well beyond 5 percent. It is estimated that cuts of that magnitude to Elder Affairs will result in 2,500 frail elders losing home-care services. These cuts will come at a time when huge areas of need remain unmet. In addition to waiting list for help from the Department of Mental Retardation, there are more than 16,000 names on waiting lists at the Department of Mental Health for basic services such as case management, medication monitoring, and residential support. Soon advocates for persons with mental illness may also turn to the federal courts for relief.
Several recent Globe stories have highlighted the ''stuck kid'' phenomenon resulting from the lack of appropriate resources for child and adolescent mental health. Staff turnover rates throughout human services remain extremely high due to the ridiculously low salaries provided for direct-care workers. DSS social workers continue to battle high caseloads. Emergency shelters for homeless individuals and families funded through the Department of Transitional Assistance have been overflowing their capacities every night for years now. At least 350,000 Massachusetts residents face each day with no health insurance. Even if the state provides level funding in future budgets, that amounts to a cut, since it does not allow provider agencies to keep pace with increasing costs for health benefits, rent, fuel, and insurance.
A majority of voters supported Question 4, and their decision is to be respected. However, if the moral standard is that the current Legislature must be held accountable for a promise allegedly made a decade ago, then we will expect the governor to keep the promise that Question 4 is affordable for the state. We cannot accept or believe that the voters of Massachusetts want the price of Question 4 to be paid by vulnerable children, families, and elders who are afflicted with disability, poverty, abuse, neglect, or the frailties of advancing years. We must keep the basic promise that is made when we say we all live in a Commonwealth.
Stephen E. Collins is the executive director of the Massachusetts Human Services Coalition. Leo Sarkissian is the executive director of ARC/Massachusetts, an advocacy group for persons with mental retardation and other developmental disabilities.
