The deaths of 26 children and adults at a Newtown elementary school Dec. 14 had the unintended consequence of highlighting the importance of child services to legislators facing decisions this week about where to make cuts in state funding.
"I think it was a very immediate reaction, and it was shared by everybody around the table," said state Rep. Betsy Ritter, D-Waterford. "That was just not the place that we needed to be going now, and I don't think anybody disagrees with that."
Once the decision was made to cut fewer services for children, the General Assembly still had a job to do, and it looked to hospitals, she said.
"None of the cuts we made were easy. They are all in programs that affect constituents because they help people," said Gian-Carl Casa, undersecretary for legislative affairs for the state Office of Policy and Management. "Hospitals have gotten large increases over the last couple of years, so it seems like a fair place to make changes."
In a special one-day session Wednesday, the legislature voted to reduce Medicaid funding by $109 million, which meant reducing state spending for Medicaid by $54.5 million and federal Medicaid contributions by $54.5 million. For every dollar spent by the state on Medicaid, Connecticut receives one dollar from the federal government.
Cuts to Medicaid and to Disproportionate Share Hospital adjustment payments - for uninsured low-income patients - contributed to hospitals losing $103 million in funding.
"I don't think any organization could absorb these kinds of cuts and not have an impact," said Shawn Mawhiney, spokesman for The William W. Backus Hospital in Norwich.
Clinics that serve the uninsured, low-income, homeless and frail elderly may need to be eliminated, said the Connecticut Hospital Association in a press release. Programs for prenatal care, special needs for children and adults and behavioral health programs could also be terminated, and hundreds of jobs could be impacted.
Backus lost nearly $3.8 million in funding, while Lawrence & Memorial Hospital in New London lost close to $2.8 million.
L&M recently laid off 22 employees and eliminated seven positions because of a shortfall in its budget. Now, everything is on the table, said hospital spokesman Michael O'Farrell.
OPM staff said hospitals have provided services for the uninsured and insured before, with less financial support, and can do it again.
"They are providing services to fewer people that aren't paying," Casa said. "A couple of years ago they were providing those services without any reimbursement, and we assume they will make similar kinds of decisions now."
In fiscal year 2009, before Connecticut adopted Medicaid expansion under the Affordable Care Act, hospitals in Connecticut had about 37,000 low-income adult patients and received roughly $70 million from the state, said Stephen Frayne, senior vice president of health policy for the Connecticut Hospital Association.
In fiscal year 2013, hospitals will receive more than five times as much funding - $372 million - for about twice as many patients, 86,000 low-income adult patients, Casa said.
Spending had to increase once Connecticut adopted Medicaid under the Affordable Care Act because the state had to pay a higher rate for low-income adults, and more people qualified for coverage, Frayne said.
He said in 2009, only 35 percent of hospitals' costs were met. Although hospitals were happy to have more funding through Medicaid, only 70 percent of hospitals' costs were being met for these patients, he said. The costs for low-income adults are $548 million, Frayne said, so the $372 million in funding will not cover it.
"Now the hole has been made another $103 million bigger," he said.
Some programs for children did lose funding in Gov. Dannel P. Malloy's Nov. 28 rescissions, but the additional tidal wave of cuts was stopped Wednesday.
The legislature did not hit education, mental health and social programs for children as hard as originally proposed in Malloy's Dec. 7 road map, said nonprofit representatives and state legislators.
"The Newtown tragedy saved the safety net for individuals in this state if you take a look at what the legislature ended up doing," said Thomas Gullotta, chief executive officer of Child & Family Agency of Southeastern Connecticut.
Being able to provide social services and identify children having difficulties at ages 4 through 10 gives professionals the "greatest chance of success to change behavior," he said. It's harder to do, and more expensive, later in life, he said.
In the wake of the Columbine High School massacre, the Child & Family Agency of Southeastern Connecticut designed a training program for preschools in hopes of preventing another school shooting.
As far as observing children goes, "The basic rule of thumb is: Can you play well with others?" Gullotta said.
The program often calls for classroom intervention in which the entire class learns how to demonstrate empathy, friendliness, sharing and compassion, he said. If a child doesn't respond to the intervention, the child's environment, including family life, is further examined. Ultimately, medication might be prescribed.
The agency has been asked to ramp up its trainings after the Sandy Hook Elementary School shootings. Special education directors and operators of large child care centers will be attending trainings on Jan. 24 and 25 in Glastonbury.
Bob Davidson, executive director for the Eastern Regional Mental Health Board, said he recognizes that the government is doing the best it can in a tight financial situation, but that in general, there are not enough mental health services for children.
One of Malloy's rescissions was to the school-based health clinics under the Department of Health, which provide physical, mental and oral health services to children. There are 75 clinics in schools around the state, but the plan was to build more.
Malloy's $577,171 budget cut means the new clinics will be postponed and underfunded.
Davidson and Gullotta each said that although the mental health of the Newtown shooter, Adam Lanza, is unknown, it is clear that he was having a hard time.
"Kids in school get bullied or treated badly by both their peers and by teachers and the school itself for lots of different reasons," Davidson said.
"Maybe it's Asperger's, or maybe it's just poor social skills or being fat or being a nerd, and the schools don't do very much to counter that, to promote acceptance of kids who are different," he said. "That is the kind of thing that can lead to a lifetime of anger that every once in a while boils over to a tragedy like the one in Newtown."
The shootings have awakened the public and policymakers to the idea that there needs to be more, or at least more accessible, mental health services. But with a $1.1 billion state budget deficit for the fiscal year beginning July 1, it will be no easy feat to reach this goal.
The legislature spared what it could Wednesday, but, Ritter said, "Now we will move to the bigger problem. It will not be easier."