Please find below a summary of House budget hearing with the Department of Public Welfare as provided by PLS. House Appropriations House Appropriations Committee Budget Hearing with DPW (BH) 03/06/13, 9:30 a.m., Room 140, Main Capitol By Jason Gottesman Reference Links: http://www.legis.state.pa.us/CFDOCS/Legis/PN/Public/btCheck.cfm?txtType=HTM&sessYr=2011&sessInd=0&billBody=H&billTyp=B&billNbr=253 2&pn=3873 http://wallaby.telicon.com/pa/library/2013/20130306tz.pdf At a Glance Committee(s): House Appropriations Meeting type: Budget hearing Subject: Department of Public Welfare Bills discussed: House Bill 2532 from 2012 Keyword(s): Medicaid, home care, disabilities Testimony: Bev Mackereth, Acting Secretary, Department of Public Welfare Dave Spishock, Budget Director, Department of Public Welfare Members Present: Chairman Bill Adolph (R-Delaware), Minority Chairman Joe Markosek (D-Allegheny) and Representatives Mauree Gingrich (R-Lebanon), Nick Kotik (D-Allegheny), Mike O'Brien (D-Philadelphia), Jake Wheatley (D-Allegheny), Matt Baker (R-Tioga), Cherelle Parker (D-Philadelphia), Matt Bradford (D-Montgomery), Deberah Kula (D-Fayette), Scott Conklin (D-Centre), John Sabatina (D-Philadelphia), Steve Santarsiero (D-Bucks), Mike Carroll (D-Luzerne), Steve Mentzer (R-Lancaster), Michele Brownlee (D-Philadelphia), Pam DeLissio (D-Philadelphia), Rick Saccone (R- Allegheny), Curt Sonney (R-Erie), Karen Boback (R-Luzerne), Mark Mustio (R-Allegheny), Jim Christiana (R-Beaver), Donna Oberlander (R-Clarion), Seth Grove (R-York), Mike Peifer (R-Pike), Tom Killion (R-Delaware), Glen Grell (R- Cumberland), Jeff Pyle (R-Armstrong), Madeleine Dean (D-Montgomery), Dave Millard (R-Columbia), Garth Everett (R-Lycoming), Scott Petri (R-Bucks), Dave Maloney (R-Berks), Phyllis Mundy (D-Luzerne), Kathy Watson (R-Bucks), Joe Hackett (R-Delaware), Brian Ellis (R-Butler), Duane Milne (R-Chester), Bryan Barbin (D-Cambria) The committee held a budget hearing with the Department of Public Welfare (DPW). Bev Mackereth, Acting Secretary, Department of Public Welfare and Dave Spishock, Budget Director, Department of Public Welfare represented the department. Chairman Adolph detailed the background of Sec. Mackereth, including work in health and human services at the state and local level as well as a stint in the Pennsylvania General Assembly. He said Sec. Mackereth is a "hands on" individual and indicated her appointment came as no surprise to him to replace previous department secretary Gary Alexander. Sec. Mackereth made an opening statement and discussed the department's budget. She said the department's budget is $28.4 billion including state and federal funds, with the state share making up $11 billion of that amount, including a $315 million, or three percent, increase over the prior fiscal year. She noted the job of the department is to help those that have the least, and stated while tough reforms and efficiencies have had to be found to deal with tough economic times, the current budget moves the department down the path of helping those most in need by getting people off waiting lists and giving the department the ability to provide services to the disabled, those with autism, and seniors. She indicated the department is trying to move people to home-based care and provide additional child care services so people can get to work. She noted continued investment in intervention, in early education, and ChildLine. Moving outside of the budget, Sec. Mackereth thanked the General Assembly for the Task Force on Child Protection, which she said did a great job in issuing a report that all will be looking at in order to help make Pennsylvania's children as safe as possible. Finally, discussing the Affordable Care Act, she said the department is working tirelessly to get information to the governor and stated while the governor wants all to have health coverage, there must be an understanding of what Pennsylvania uniquely needs and opined a mistake in this area cannot be made due to the large amount of dollars at stake. She also cautioned about comparing the state's Medical Assistance (MA) to other states since Pennsylvania spends more per capita than any other state except Missouri. She said if Medicaid expansion was chosen, there would be one in four people in Pennsylvania on MA with those on waiting lists still not covered. She also expressed concern about the future availability of federal funds to fund the expansion and pointed to other failed federal programs in this regard. Chairman Adolph discussed the increase for the waiting list for intellectual disabilities particularly as it relates to children and the elderly. He asked how the formula works, especially since an additional $20 million will be appropriated. Sec. Mackereth said it is broken up to 1,080 persons who cannot be taken care of anymore and those leaving certain special education programs. Chairman Adolph asked what types of services will be available for the children. Spishock said the children will be moved into a program providing for family direct services and noted a significant difference in costs between the children and the adults. Chairman Adolph asked how the decision regarding the numbers breakdown was made. Spishock said the department took those who were leaving special education programs this year and chose to provide them services rather than have them on the waiting list. Chairman Adolph asked how many people are on this waiting list. Spishock said there are about 14,000 on the waiting list with 4,000 on the emergency list. He added those on the waiting list are getting some level of services. Chairman Adolph noted his experience meeting with some of the people on the waiting list in Philadelphia with the governor and said attacking the waiting list is one of the governor's priorities. He said the effort to get them off the waiting list needs to be continued and said the provision of services is something that is owed to the people that need assistance. Chairman Adolph said he rarely receives calls from constituents about not being able to get through to local welfare offices, but indicated this number has increased over the last two or three months. He said people that cannot get through to a person are struggling filling out their forms for benefits and stated it is wise to enlist in the labor forces at the local level. Sec. Mackereth noted the department is aware of the problem and asked Chairman Adolph and all members to let the department know about problems with constituents. She said the department is looking at streamlining its processes to better provide access to services. She further indicated a lot of turnover at the county assistance offices and stated it takes a lot of training to get someone ready for the position. She said the department needs good people to work at these offices that are committed to stay, and encouraged people that are eligible for the job to try for it. Chairman Markosek commented on the Affordable Care Act and said all know this is a big issue in Pennsylvania and said if Medicaid expansion is not included in this budget, the state will miss out on a huge opportunity to provide health insurance to 500,000 Pennsylvanians with the federal government paying the cost for the first three years. He said a relatively small state investment means tens of billions of dollars coming into the state's economy. He said this will spur job creation in the health care sector and pointed to a report saying the expansion will support over 41,000 jobs across Pennsylvania's economy, which he opined will result in more revenues. He argued the governor's cost estimates are over-inflated and include costs the state will have to incur anyway, including already required administrative costs, and stated the governor's office is forgetting about a number of savings that the Affordable Care Act has and will continue to provide. "The more Pennsylvania drags its feet, the more Pennsylvania stands to lose," he said, and argued politics should not get in the way of doing what is right for Pennsylvania and makes financial sense. He indicated what should be looked at is the cost of doing nothing, particularly in terms of the human cost, the economic cost, and the budget costs for the Commonwealth and local governments. Finally, he said if Pennsylvania does not opt in, Pennsylvania tax dollars will go to improve health care in other states, but not Pennsylvania. Sec. Mackereth responded saying the governor did not say "no" to expansion, but rather said the state needs to talk to the federal government about flexibility and reform. She noted the state will be meeting with the federal government and said seeing what other states have been doing and getting will be helpful to Pennsylvania. Chairman Markosek asked Sec. Mackereth to urge the governor to adopt the expansion. Chairman Adolph asked when the money from the federal government would start coming to the states. Sec. Mackereth said January 2014. Rep. Baker, chairman of the House Health Committee, said it is a numbers game, with one-third of the state's budget tied up in welfare programs. He said he has serious concerns about the costs and proliferation of growing the welfare budget. He noted he testified in front of Congress regarding whether or not the federal government will pay for the expansion. He explained the first year costs for Medicaid expansion will be in the hundreds of millions of dollars and will continue to increase in the out years, particularly as the federal government reduces the amount it pays for. He also said if Medicaid expansion is chosen, one in four Pennsylvanians will be on welfare and indicated the woodwork effect of Medicaid will be 178,000 people.