Hospice care on budgetary chopping block

Hospice care for non-nursing home patients was among the dollars Gov. Bobby Jindal placed on the chopping block Friday as part of midyear budget cuts.

Jindal had to erase a $166 million shortfall in the current $25 billion budget year. The reason for the shortfall is twofold. Sales and personal income tax collections are weaker than economists expected, forcing them to lower their projections. Adding to the problem is the need for more dollars for basic student aid and a college scholarship program.

“We are acting swiftly,” Commissioner of Administration Kristy Nichols told legislators Friday in announcing how the governor would balance this year’s budget.

The reductions mark the fifth year of budget cuts in the middle of the fiscal year. The trimming started at the end of the governor’s first year in office, coinciding with a rare snowfall in Baton Rouge.

For the latest round of cuts, the governor was able to fill the gap without needing legislators’ approval. Nichols outlined a combination of spending cuts, found money and streamlining savings to the Joint Legislative Committee on the Budget.

Among the deepest cuts were at the state Department of Health and Hospitals and the state Department of Children and Family Services.

Doctors, hospitals, mentally ill patients, pregnant women and dying patients will be affected by the state’s financial problems.

State Sen. Sharon Broome, D-Baton Rouge, complained that the reductions affect departments that deal with the state’s most fragile residents. “I hope we can see these reductions with faces on them,” she told Nichols.

Nichols said the administration avoided across-the-board reductions that would have dealt heavier cuts to health care and higher education. Instead, she said, the governor made cuts and drew in dollars from a legal settlement, a prison closure and a self insurance fund.

Higher education received $22 million in reductions. Nichols said that is softened by tuition increases producing more money than expected.

Other reductions include:

Contract reductions for health care providers who help the poor, the mentally ill and the drug-addicted.

A 1 percent cut in the rate that doctors and hospitals are paid by the state to care for the poor.

The elimination of dental benefits for pregnant women relying on the state for health care.

Possibly laying off 63 state government workers.

Additionally, the administration will use money in a maintenance fund to operate state parks. Domestic violence victims will move into hotels or seek shelter with their families, reducing the cost of residential care. Some children at risk for mental illness might not receive treatment.

Several legislators zeroed in on the hospice program cut.

State Sen. Dan Claitor, R-Baton Rouge, said the cut amounts to the state not assisting people on their death beds unless they are in a nursing home.

“That’s pretty rough,” Claitor said.

Nichols said tough decisions had to be made.

Later in the day, DHH Secretary Bruce Greenstein said the hospice funding reduction will become effective Feb. 1 and will not affect those currently receiving the services through Medicaid.

When the reduction does take effect, Greenstein said patients still will receive medication to keep them comfortable. He said numerous nonprofits and faith-based organizations also provide end-of-life services.

Lt. Gov. Jay Dardenne said the diversion of money from a maintenance fund to save park operation dollars will prevent him from making the necessary state match to receive federal funding for repairing Fontainebleau State Park near Mandeville. Hurricane Isaac battered the park.

Dardenne said the Jindal administration did not consult him before taking the money.

“They didn’t ask us about this cut nor did they tell us it was coming,” he said.

Midyear budget reductions have hit higher education especially hard in the past four years, including a $55.2 million mid-year cut in 2008; a $76.2 million mid-year cut in 2009; a $34.7 million cut in 2010; and a $50 million cut last year.

Jindal and the Legislature have cut total funding for higher education by $426.5 million since 2008, a 26.5 percent reduction, according to the Board of Regents. Jindal’s spokesman, Kyle Plotkin, said Friday that budget cuts to higher education have been offset by tuition increases, therefore total funding for higher education has been reduced by roughly $220 million, or 7 percent.

State Commissioner of Higher Education Jim Purcell said he appreciates the governor’s efforts to minimize the latest round of cuts to higher education.

“The Board of Regents will distribute these cuts on a pro rata basis,” he said.

Louisiana Hospital Association President John Matessino said the constant cuts may come to a breaking point in health care.

“At some point they are going to start breaking down. Hospital margins are getting smaller and smaller,” he said.

Matessino said hospitals are already getting $100 a day less in reimbursements than what they were in 1995. “We can’t keep on,” he said.

Koran Addo and Marsha Shuler of the Capitol news bureau contributed to this report.