DHHS head Toumpas discusses impact of state budget cuts



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NHDHHS COMMISSIONER Nick Toumpas (left) discusses the difficulty of assessing how cuts to his department will impact counties and towns with Carroll County Commissioners Dorothy Solomon and David Sorensen. (Image from GovernmentOversite.com tape of the meeting.) (click for larger version)
July 14, 2011
OSSIPEE— County commissioners welcomed NH Department of Health and Human Services (NHDHHS) Commissioner Nick Toumpas to their meeting last Wednesday, June 6.

Toumpas is making his rounds throughout the state to field questions and address concerns about the cuts to his department's budget and the impact those will have on counties, towns, and contracted agencies.

When asked what segment of the population would feel the most impact from the cuts, Toumpas said, "How can I say that the reduction in children's services is more injurious than cuts to the elderly services that is more challenging than cuts to the mentally ill that is more challenging than huge reductions in hospital funding…I could go on and on. There is not one segment that is not going to be impacted."

The big numbers are easy to understand. Toumpas said his department initially presented with a budget of $768 million for 2012. The governor cut that by five percent. The NH House of Representatives whittled it down to $638.6 million and the NH Senate passed a budget of $665 million, which is what the department is left to work with. Toumpas said these budget cuts as well as an additional $35 million the department will not be receiving in federal funds are cause for extreme and swift changes to be made in the department. First, about 500 employees will be affected, with 370 jobs being abolished and the rest of that total will be laid off. Toumpas said it is expected that the number of NHDHHS offices in the state will be reduced from 12 to seven. "This is a challenging, challenging time for us…we are living in a new reality where clearly we have to do more with less," he said. At a time when "there is a rising tide of need for services," resources are going in the other direction, said Toumpas.

It is too early to tell what the smaller numbers will look like. Toumpas said though it is not clear yet exactly how the department's reduced budget will affect those served in the state, he added, "We can cut the budget but the spending is still going to manifest itself someplace. The cost will shift to families, communities, cities and towns, and the county. The issue is how quickly and how much." When services that were once offered on the state level are no longer available, those in need will likely reach out to their town halls, churches, and local leaders, and what that will mean in dollars is unknown.

NHDHHS administers many welfare and service programs in the state, including child support services, disease prevention, community health, elderly services, disability services, alcohol and drug services, homeless services, food protection, juvenile justice and many more. A complete list and more information about the department can be found online at www.dhhs.nh.gov/index.htm.

Toumpas said the reduced budget requires many changes that while not easy to implement are also opportunities to create more efficient ways to run the human services delivery system.

Toumpas said the mission of the department is to make people healthier and more independent. The long-range effects of the budget cuts are unknown, but Toumpas is confident they will have an impact on the people served now or who might seek services in the future.

"We are dealing with people's lives. It's not like I am in the private sector and make a mistake making widgets. I can go back and make a new widget," he said.

Aging New Hampshire

While implementing budget cuts there are some statistics that cannot be ignored ,he said. According to the 2010 census, the median age of New Hampshire residents grew to four years older. In fact, he added, the state now has the fourth oldest population in the country. With that, he said there are increasing pressures in a number of programs that serve the elderly population to do more with less. Ideas for regionalization of services, such as Meals on Wheels, which the department oversees, are welcome by Toumpas.

Though it affects hospitals outside of this county, Toumpas explained the big cut in the budget that will leave non-critical care hospitals scrambling to recoup lost revenue. The state taxes hospitals on net revenue from patient services delivered at 5.5 percent. This taxation brings in a pool of money that is matched with federal funds and then disbursed back to hospitals to help offset their loss of revenue for care delivered that has not been paid for (uncompensated care). The new budget eliminates all funding for this program for "non-critical" hospitals such as Dartmouth-Hitchcock Medical Center. Fortunately for Carroll County hospitals, Memorial Hospital in North Conway and Huggins Hospital in Wolfeboro, both are listed in the 13 critical care hospitals in the state.

Toumpas first served as acting commissioner in 2007 and then was appointed as commissioner in 2008. He said he has made it a point to travel in the North Country. "Above the Lakes Region is a very different environment. The goal is to try to have policymakers understand what we deal with in Manchester, Nashua, Concord, Portsmouth, and Keene is so fundamentally different – it's like two different states at times in terms of infrastructure," said Toumpas. He cited transportation as a main issue in the northern part of the state, noting that when trying to consolidate services in the southern half of the state it is much easier to do so while getting someone to an appointment in the North Country is much more difficult.

NH Rep. David Babson asked Toumpas questions about what is being done to prevent and prosecute cases of fraud or abuse of the benefit services administered by his department. Toumpas said his department aggressively pursues cases of provider fraud and has recouped large sums of money with help of the NH Attorney General's office. Going after individuals who fail to report a change in income may not be as cost-effective to pursue, he said, but his department does and welcomes any and all tips about suspected abuse of the system.

Babson also questioned Toumpas about his feelings regarding random drug testing for welfare recipients. Toumpas said that practice is illegal under federal law.

Toumpas said he wants to remain in close contact with town and county leaders as well as service delivery agencies regarding any concerns that show as a result of the budget cuts and how those costs have trickled down to communities.

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