Saturday, January 30, 2010

Hawaii's health and education stimulus funds: more questions than answers

Recent reports from the Governor's Office, University of Hawaii, and Departments of Human Services, Education and Health paint an interesting picture of state spending of federal stimulus funds, while leaving many questions unanswered.

Questions include:

  • whose salaries at DOE were paid with $24 million in stimulus funds in the past two months, since it obviously wasn't the furloughed teachers?
  • speaking of the Friday furloughs, why aren't federal stimulus education funds being used to get us back to a normal five day school week?
  • how does UH justify $42 million in grants to study things like rocks in Iceland and how bees learn, creating a total of just over ten jobs?
  • how many of the state's 20,000 special ed kids were benefited by the $19.9 million paid out this summer to companies like Hawaii Behavioral Health, Nursefinders and the Behavioral Counseling & Research Center?
  • with Medicaid stimulus funds almost equaling the state's expenditure in 2008 for home Medicaid services, why are these services being cut so drastically?
  • how much of that Medicaid money is being paid out to for-profit companies UnitedHealth and Wellcare as part of their eight percent profit margin?
  • and can somebody please teach the DOE the difference between "passed" and "past"?

State Fiscal Stabilization Funds (SFSF)

These funds come from the federal Department of Education and are divided into two parts:  Part A, which must be used to "restore support for education"; and Part B, to be used for "education, public safety, and other government services".

As of December 29, Hawaii had received $105.3 million of its allocation of $192.7 million for Part A; and all of its $34.9 million allocation for Part B.

According to DOE's report to the state legislature, "the SFSF funds were used to offset budget reductions past [sic] in Act 162 of the 2009 Hawaii Legislative session.  Funds are being drawn down to meet payroll expenses."

On December 16 and January 12, the DOE withdrew $24 million from the Part A funds to pay for salaries. An additional $44 million in Part A funds are promised to the University of Hawaii (UH), and $4 million to the Charter Schools Administration Office.

In a report to the state legislature, UH estimated its $44 million in Part A funds will save 206 jobs (measured as Full Time Equivilent positions, so that the figure includes adding together part time with full time jobs).  The Charter School office estimated it will retain 286.5 FTE jobs.  These numbers are slightly different in the Governor's office report to the state legislature, with UH estimating 208.74 FTE, the Charter School office reporting 343.51 retained positions, and DOE reporting retention of 1561.98 positions.

Of the Part B funds, $10 million is promised to UH, $6 million to the Charter School office.  The remaining $18 milion has not been allocated publicly yet.

The question is why this money isn't being used to reduce Hawaii's "furlough Fridays" that have garnered the state negative national publicity and even a reprimand from Secretary of Education Arne Duncan.   $120 million of the state's SFSF funds have not been allocated (at least publicly), which is more than enough to bring teachers and students back to a five day school week.

Stimulus Funds for Special Education

DOE is due to receive a total of $39.9 million for special education.  The state reports receiving $19.9 million of that amount, all of which it claims was "used to pay for autism spectrum disorder and school based behavioral health services."

Going through the list of vendors receiving that $19.9 million, it is questionable to what extent the autism student population was benefited.  All of the vendors provide behavioral and psychological services, "including [for] autism spectrum disorder".  Hawaii Behavioral Health, which alone received almost $6.1 million, states on its website it provides ten different types of services, with those for children on the autism spectrum listed ninth of the ten.  Nursefinders, receiving $2.98 million, provides paraprofessionals, personal assistants and nurses to the schools; again, services to kids on the autism spectrum are hard to separate from services to other special ed kids like my own daughter.

Hawaii's February 2009 report to the federal DOE classified only six percent of special ed children aged 6-21 as being on the autism spectrum.  Forty-eight percent were categorized as having "specific learning disabilities," fifteen percent as having "other health impairment", and thirteen percent as either developmentally delayed or mentally retarded.  While I'm well aware the parent community feels that autism spectrum disorders are greatly under-diagnosed by DOE here in Hawaii, the question still remains to what extent children who definitely fall outside ASD are being benefited.

Funds received by Hawaii's Department of Human Services

DHS reported receiving $183.7 million as of September 30, of which $171.3 can be spent only on Medicaid.  An additional $22.5 million has been received by individual health centers and community groups across the state, and UH has received grants totaling $10.9 million from (federal) DHHS.

According to the December 15 report to the state legislature, the Hawaii Med-Quest division was working with "affected state departments (mainly the Departments of Health and Education) related to the increased ARRA FMAP to coordinate expenditures, claims and other requirements."  This statement leaves open the possibility that Medicaid stimulus funds could have been shared with the Department of Health, which administrates the Developmental Disability Medicaid waiver program, and the Department of Education, which spends Medicaid funds under EPSDT.  Since stimulus Medicaid funds do not require detailed reporting, however, I have been unable to identify how much money was spent on which Medicaid program.  The report goes on to mention that "Increased ARRA FMAP funds are used for the Medicaid Program as well as other state programs."

As of September 30, all but about $350,000 of the received amount had been spent.

According to the January 15 report from DHHS, Hawaii has now received $184 million in Medicaid stimulus funds.  Any funds spent on Hawaii's QExA program for the aged, blind and disabled population will be subject to the standard 8% off the top profit margin for UnitedHealth and WellCare.

The University of Hawaii

UH is receiving a total of $95,958,600, with more grant applications outstanding.  Of that amount, $54 million is coming from the "educational state stabilization funds" (SFSF) received by the governor's office (over a two year period), and the remaining $41.9 million is coming from sixty-two separate grants received from the Department of Human Services, National Science Foundaiton, Department of Energy and Department of Justice.

UH estimates that the $42 million in federal grant funds is saving and/or creating 10.6 FTEs.

The Honolulu Advertiser has already reported on the questionable nature of some of these grants: $6.2 million to take monthly cruises to the North Pacific; $210,000 to study bee learning; $421,886 to build an evolutionary model for a single species of Hawaii moth; and $295,743 to collect rocks in Iceland.

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I'm the mom of a child with disabilities. Hannah's first neurologist said she might never develop beyond the level of a 2 month old infant, and there wasn't anything I could do about it. The brain damage was just too severe. Nine years later, she walks, uses a touchscreen computer and I've just been shown she can learn to construct sentences and do simple math with the right piece of technology. Along the way, I discovered I needed to teach myself what Hannah's rights to services really were. Learning about early intervention services led to reading about IDEA and then to EPSDT. I've been waiting for the Obama administration to realize the power and potential of EPSDT for the medical rights - including the right to stay at home with their families - of children with disabilities. The health reform people talk about long term care, and the disability people talk about education and employment, but nobody is talking about EPSDT. So I am.