By Shira Schoenberg
The Concord Monitor
CONCORD, N.H. — There are more prisoners in New Hampshire today than several years ago, and more people in need of social services. At the same time, there are fewer state employees to deal with the growing needs. That leaves departments turning to technology to make government more efficient, and, when all else fails, to cuts in service.
That was the message from directors of two of the state’s largest departments at yesterday’s budget hearings. “We will not be able to provide certain services to certain segments of the population,” said Health and Human Services Commissioner Nick Toumpas. “In many cases, that will amount to a cost shift to local counties as well as cities and towns.”
Health and Human Services and Corrections were among the state agencies that made presentations during the second of two days of budget hearings. The hearings were run by Department of Administrative Services Commissioner Linda Hodgdon, with Gov. John Lynch’s budget director, John Beardmore. Lynch will work with department heads on their budgets through February, when he will release his proposed budget for the House and Senate to consider. Lynch asked department heads to submit a maintenance budget — the amount needed to maintain current service levels - and a budget that proposed a 5 percent drop in spending.
Health and Human Services is the state’s largest department, with a budget of $2.15 billion this year, including money spent on veterans’ services. The department has asked for $2.43 billion in fiscal year 2012 and $2.54 billion in 2013. This year, just under $700 million of the department’s money comes from tax dollars. The department is asking for $952 million tax dollars in 2012 and $996 million the following year.
Toumpas said 80 percent of the department’s tax dollars go toward five areas: mental health, developmental disabilities, children’s services (such as juvenile justice), children and family (such as housing and transportation services), and public health. With the recession, more people need state services. Since July 2008, the department’s caseload has gone from 125,000 people to 151,000 people. The Medicaid caseload has grown from 103,000 to 118,000. The department predicts that caseloads will increase by 3.9 percent a year in fiscal years 2012 and 2013.
Meanwhile, the staff has a 17 percent vacancy rate, clients tend to be sicker and have more complex needs than in the past, and the department’s technology is old and insufficient, Toumpas said.
“We just cannot sustain the current business model . . . without fundamental change to a number of different areas,” Toumpas said.
The state must also adapt to new federal regulations. For example, the state cannot change eligibility requirements for benefits programs it funded with federal stimulus money. The state must build up infrastructure because of federal health care reform - for example, creating health benefit exchanges where individuals can shop for health insurance. Toumpas said once federal health care reform is fully implemented in January 2014, it will add at least 30,000 Medicaid patients to state rolls.
Toumpas said he is proceeding as if health care reform will not be repealed. “I don’t have the ability to be selective about which laws are on my plate and which I choose to enforce,” Toumpas said.
In addition, the state is reworking the model it uses to reimburse hospitals that care for uninsured and Medicaid patients. The federal government audited the state over its reimbursement policy in 2004 and demanded repayment of $35 million, which is under appeal. If the government audits the state for 2005 to 2009, that could cost $65 million more, Toumpas said.
Toumpas avoided specifics on where he might cut services, other than saying he would ask the state to reconsider the amount it pays for long-term care, possibly shifting costs to the counties.
Toumpas said the department will make several technological changes. For example, it is instituting an electronic records system, which would include more online services for clients and more document imaging. Staff would not need as many paper records, and jobs could be transferred to the North Country once documents are online. Statewide advances in technology could also benefit the department - for example, using voice capabilities over the internet. Toumpas said he would look at video conferencing to prevent staff from having to travel.
Toumpas said the state would look at a managed care model for Medicaid patients. And it would begin investing in projects based on projected cost savings over a four- or five-year period, rather than a one- to two-year period.
Corrections
Corrections Commissioner William Wrenn cited a similarly stressed budget. After Health and Human Services, the Corrections Department is the department that relies most heavily on taxpayer funding. Its current general fund budget is $102 million, which the department hopes to increase to $119 million in 2012 and $120 million in 2013.
Already, Wrenn said, the department is strapped for personnel. Since June 2007, the corrections workforce has dropped from 1,090 employees to 874, through layoffs and budget cuts. Next year, 19 employees will be deployed for active military duty, requiring other employees to work overtime to cover their shifts. Overtime is expected to cost about $3 million a year from 2011 through 2013.
At the Concord state prison, Wrenn said he starts each day with 20 staff vacancies, which he must fill using overtime to meet minimum staffing requirements. Wrenn said the prisons get by with the minimum staffing to keep a prison safe, leaving little time to be proactive with activities such as random searches.
“We’re primarily in the reactive mode, because we don’t have the numbers we used to have working in uniform behind the walls,” Wrenn said.
Since personnel accounts for 71 percent of agency expenses, Wrenn said it would be difficult to make cuts without further hurting personnel.
At the same time, the state’s prison population has grown by 31 percent over the past decade. Wrenn said the state is “constantly juggling bed space.” The prison in Berlin was built to house 500 inmates and now has about 730. A gymnasium was turned into a dormitory. In 2010, the average number of offenders in state prison or transitional housing was 2,755.
Like Health and Human Services, Wrenn said the Corrections Department has old technology, in addition to an old vehicle fleet.
The department hopes to move forward with plans to build a new women’s prison over the next two years, since the Goffstown prison is widely considered to be inadequate. Priorities in future years include building two new halfway houses. Today, Wrenn said, there is not enough space in halfway houses for prisoners looking for a transitional space. The halfway houses instead are reserved for those who would otherwise be homeless or cannot find jobs.
Wrenn said the largest factor driving the prison population is the rate of recidivism, which has risen to nearly 50 percent in recent years.
Last legislative session, lawmakers passed a bill aimed at curbing recidivism and lowering costs. The bill is expected to save $10 million between 2011 and 2015, with the money going toward improving community-based services for offenders, Wrenn said. By letting offenders out of prison earlier, it will give them more time under community supervision. Wrenn said provisions of the bill will allow parole and probation officers to focus on high-risk and high- need offenders. Asked whether the department has the resources to adequately monitor offenders who are released early, he said the state infrastructure can handle it, but “we’re continuing to evaluate every day.”
And Wrenn said his department is also looking to technology. It has instituted a computer-generated monthly mailing of restitution letters and installed energy-efficient equipment in prison laundries.
Copyright 2010 Concord Monitor/Sunday Monitor