Mitchell targets budget 'bleeders' to be staunched Plan would alter state's approach to Medicaid, welfare

February 07, 1992|By John W. Frece | John W. Frece,Annapolis Bureau

ANNAPOLIS -- House Speaker R. Clayton Mitchell Jr., certain that the public is sick of big government and costly social programs, has developed a budget-cutting plan that would put welfare recipients to work, shrink the state work force and shift Medicaid costs to the federal government, nursing homes and patients themselves.

The conservative Kent County delegate said that as the House leader, he felt obliged to come up with a plan to slow state spending before giving in to growing pressure to raise taxes from other legislative leaders, Gov. William Donald Schaefer and a variety of advocacy groups.

The speaker's plan, unveiled privately to other House leaders yesterday, would:

* Trim $67.6 million from the state's exploding Medicaid budget, in part by instituting a new $1,000 per bed tax on every nursing home in the state in an attempt to capture matching federal Medicaid funds.

* Shave $20 million off the higher education budget TC recommended by Gov. William Donald Schaefer, largely by continuing a 15 percent surcharge on college and university tuitions for another year.

* Institute a new "workfare" program that would require able-bodied welfare recipients who have job skills but are not in school and don't have preschool children at home to take minimum wage jobs or face a reduction in their benefits.

But their new employers would only have to pay the difference between the amount the recipients receive in benefits and the minimum wage of $4.25 an hour.

Similar recipients who lack job skills would be required to perform some sort of community service, such as helping to pick up trash, he said.

* Force state agencies to fill only half their job vacancies. Mr. Mitchell said that that could reduce the state's 85,000-member work force by 3,000 employees a year and save up to $90 million by the second year.

Although he's the most powerful delegate in the House, he has been working virtually alone on the plan, dealing directly with Cabinet secre- taries and bypassing the legislature's budget staff. He has intentionally stayed away from other House and Senate leaders who have been developing a budget plan that will include up to $450 million in higher taxes.

"One of the things I'm trying to do is challenge the people to come up with new ideas and new thoughts," Mr. Mitchell explained. But he said he also has borrowed ideas from the governor's Commission on Efficiency and Economy in Government.

Although his total plan is unlikely to become law, now that he has a proposal, Mr. Mitchell's power over the House is likely shift the debate away from higher taxes and more toward cutting the cost of government.

"I think what he is suggesting is something that probably will be welcomed by the rest of the . . . leadership," said Del. Timothy F. Maloney, D-Prince George's, chairman of an Appropriations subcommittee.

The heart of Mr. Mitchell's approach is a detailed, 25-part program to trim back the state share of the runaway Medicaid health program for the poor, which has expanded by 130,000 cases since last year and now covers one out of every 10 Marylanders.

In Fiscal Year 1993 alone, Medicaid will cost the state nearly $1.2 billion, about 10 percent of the overall budget.

Mr. Mitchell, a former Appropriations Committee chairman, said his colleagues had not cut deeply enough into Medicaid. Among his recommendations:

* Establish a $1,000 per bed "provider tax" on nursing homes to raise $9 million that would then be matched by $9 million in federal Medicaid contributions. Half of the combined federal and state money would be used to offset a $9 million reduction for nursing homes in Governor Schaefer's proposed budget, with the balance being returned to the nursing homes through Medicaid reimbursements.

Nursing homes that do not participate in the Medicaid program would be hit with a double whammy: they would be taxed but would not receive any of the redistribution.

* Levy a fee on families of retarded people who now receive community-based services from the state for free.

Fees would be set on a sliding scale, based on taxable income and family size. The maximum would be $94 a month.

The plan would raise an estimated $9.7 million.

The state already levies an identical fee for persons with such disabilities who are in state institutions, and raised $2.5 million from it last year.

* Prohibit hospital emergency rooms from treating Medicaid patients for "non-urgent care," a projected savings of $4.5 million.

* Increase the prescription drug copayment for Medicaid recipients.

"If we're going to have responsible Medicaid cost containment, this is how it is going to happen," Mr. Maloney said.

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