Health and Human Services make up a little more than 40 percent of Governor Gina Raimondo’s proposed 2018 budget. There are no huge surprises in this year’s recommendations, but much uncertainty over the fate of federal health care funding.

The sprawling $3.8 billion Health and Human Services agencies provide medical and social services for nearly one in three Rhode Islanders. Funding is relatively level compared to the previous year, but would have been higher had it not been for some savings.

Accounting for a big chunk of that budget is Medicaid, the state’s health insurance program for the poor and disabled. That piece of the pie will cost about $100 million dollars more in the new budget thanks to higher enrollment and a decrease in federal matching funds under the Affordable Care Act (in the first year of the ACA, the Medicaid expansion was covered 100% by the federal government; now that support goes down to 90%).

And that’s where the uncertainty comes in, as Congress moves to repeal the Affordable Care Act with no clear replacement. Health and human services head Elizabeth Roberts says Rhode Island is watching lawmakers closely.

“Right now we have the federal government supporting Medicaid, Medicaid expansion, our SNAP program, our child care supports. We are going to maintain those for Rhode Island families and then keep a close eye and advocate for Rhode Islanders who are trying to move forward.”

It’s not clear whether Rhode Island would be able to maintain health insurance for people who obtained it under Obamacare’s expansion of Medicaid. 

The health and human services budget includes higher costs due to the state’s new IT system for human service benefits, UHIP. There’s also some shuffling of staff around the new system. Raimondo has said she won’t “pay another dime” until the system is fixed, but it has still cost about $50 million dollars in general revenue funds. The savings anticipated from the system’s implementation have not yet been realized, according to the budget.

Hospitals will face a payment cut of one percent in the next fiscal year. Both hospitals and nursing homes will face a rate freeze for fiscal year 2017. (The Hospital Association of Rhode Island responded to these proposed cuts with this statement:

“The Hospital Association of Rhode Island and its members are disappointed the proposed budget includes hospital payment cuts. We will continue to work with the General Assembly and Administration to find lasting solutions that address state fiscal problems while ensuring a financially stable healthcare system.”)

But there’s funding for higher wages for home health care workers. 

Health and Human Services Secretary Elizabeth Roberts says her agencies will save about $40 million dollars compared to last year thanks to shaving some administrative costs.

“We have an innovative program for managed long term care, and we have discovered that some of our administrative costs are higher than they should be for some of that population. So we are taking a cut there for example and reinvesting half of those resources into community-based services for elders.”

Some additional highlights from Raimondo’s funding plan for health and human services in fiscal year 2018:

– a small line item for a trial run of some addiction recovery housing ($200,000).

– the Department of Children, Youth, and Families will receive a few million dollars less than the previous year. But officials say that’s because they’ve reduced their reliance on costly group home services.

– the Department of Health could see a bump in funds for the medical examiner’s office, which has been overwhelmed by cases related to the heroin overdose deaths.

The governor’s budget requires approval from state lawmakers.