The feeling of helplessness - in spite of our media efforts and our efforts to “enlighten” both the governor and his commissioners - remains even with this information. Regardless of political beliefs, it doesn’t seem “right” that there is no public forum available right now to explain the implications of the budget cuts; nor does it seem “right” that the budget hole can only be filled with spending cuts rather than with reductions and increased revenues. Within a matter of days, however, the announcement will be made (we expect to hear the list of unallotments around June 15th) and we will begin our analysis and responsorial.

We are currently in the throes of planning for all sorts of post-announcement scenarios and follow-up discussions depending on how the reductions are made:

• Will there be rate cuts or rateable reductions? (The former is permanent, the latter temporary.)

• Is application of the rate equalization law viewed differently under the latter?

• If there are nursing facility reductions included, how will the agency view the compensation plans that had been submitted?

We are starting the framework already for the 2010 legislative session and certainly need to build off of the implications from unallotment.

• Are there specific requirements under federal Medicaid regulations/laws and/or under the maintenance of effort requirements of the federal stimulus funds that can provide some measure of reduction protection?  

• If specific services are reduced (dental/therapy) how will the regulatory agency determine compliance/non-compliance?

After all of the issues are settled this summer, we need to take a deep breath, and step out from the trees to look at the longer range budget “forest”…The economy will be slow to recover, which means the structural budget gap between revenues and expenditures will remain, even after the unallotment - even more so when the federal stimulus funds go away in 2011.

We need to advance an agenda that includes a more balanced funding approach for our services, while at the same time we promote new state revenue options; otherwise, this will just be the first of many budget crises facing the state and our programs.