How To Spend $5 Billion In COVID Relief: Mass. State Legislature Hears Public Health Proposals

From food insecurity and staffing shortages to an unequal and "broken" local public health system, advocates and lawmakers on Tuesday said the COVID-19 pandemic exposed gaps in the state's ability to meet the health needs of residents that should be filled with funding from the American Rescue Plan Act.

Gov. Charlie Baker has proposed to use $50 million to support financially stressed hospitals and $175 million for addiction treatment and other behavioral health services, while a coalition of lawmakers, public health leaders and municipal officials want to see the Legislature put $251 million toward a "dangerously inadequate" local public health system.

Other requests for funding came from organizations like the Greater Boston Food Bank, whose operations have been stretched thin by demand, and Berkshire District Attorney Andrea Harrington, who would like to see money put into victims' services.

"After this pandemic, I think it's clear that health care has to be a priority," said Rep. Ann-Margaret Ferrante, a Gloucester Democrat and vice chair of the House Ways and Means Committee.

The House and Senate Ways and Means Committees and the House Committee on Federal Stimulus and Census Oversight held another hearing Tuesday on how to spend billions of dollars in American Rescue Plan Act funds, this one focused on health care, public health and human services.

Over 100 people signed up to testify.

The committees plan at least two more hearings this fall, and House Speaker Ron Mariano said last week it would be reasonable for the Legislature to target Thanksgiving as date to reach agreement on how to spend at least some of the nearly $5 billion.

Sen. Cindy Friedman, who has been vocal in her criticisms of the Baker administration at times during the pandemic, welcomed Health and Human Services Secretary Marylou Sudders by telling her, "While we haven't always agreed, I've never doubted your commitment."

Friedman called the rates paid to direct care providers the "greatest barrier to moving to where we want to move."

"Do you have a plan or can you see a way that we can address this problem over the next five years with ARPA money, knowing that what we do has to be sustainable. I just can't see our way out of this if we don't increase our rates," Friedman asked Sudders.

Sudders agreed that rates are a problem, and pointed to the $55 million the governor put into a 10 percent rate increase for all health and human service providers, including those who work with the homeless and in private residential special education. That rate increase is good through December, and has been paid for with money from the $200 million in ARPA funding that the Legislature left to the discretion of the governor.

"We have to invest in our workforce," Sudders said.

While the rate increase was a short-term signal to providers, Sudders said there must also be a longer-term solution to the problem of low wages for care workers.

"The governor will file in January a bill that you've seen pieces of before to really invest in primary and behavioral health care because that is the way forward and it can't be once every 10 years," Sudders said.

In response to a question about adolescent behavioral health, Sudders told Rep. Marjorie Decker that on any given the day the state has roughly 400 inpatient psychiatric beds offline because of staffing shortages, with more beds at McLean Hospital's Middleborough facility due to come online imminently.

Sudders said the administration has put $31 million in APRA funds into staffing efforts at inpatient psychiatric facilities, but would like to use more to invest in the workforce and build a pipeline of caregivers to meet the existing need. The secretary said she also hopes to use the next 1115 Medicaid waiver to help build the workforce.

"We can't make people, but we can create professions," Sudders said.

Nursing facilities described their industry as facing the worst staffing crisis in its history with 6,000, or one in five, nursing and direct care positions currently unfilled. Eleven facilities have recently closed and more than 100 are at risk of closure over the next 12 months, according to industry leaders.

Massachusetts Senior Care Association President Tara Gregorio asked for a one-time investment of $98 million, more than half of which she said would be reimbursed by Medicaid, to fund wage increases, hiring of new staff, infection prevention measures and the purchase of PPE.

The organization also asked for an additional $461 million over the next three years for bonuses, training, scholarships and nursing home infrastructure upgrades.

"This historic workforce shortage has left Massachusetts nursing facilit[ies] with an urgent and immediate need to hire and retain direct care workers. The vast majority of our staff are working overtime to ensure adequate care coverage for residents and over half of nursing facilities are intermittently denying new resident admissions," Gregorio said.

Attorney General Maura Healey doubled down on the workforce needs, suggesting investments in entry-level job training and educational loan forgiveness for people who work in high-need communities.

"We just don't have enough providers to meet our behavioral health needs," Healey said.

The Democrat also supported using ARPA funds to modernize and bring equity to the local public health system, and called for investments in "digital equity" to ensure that everyone can access remote, telehealth services that have become a staple of the care delivery system.

For months now, public health advocates have been calling for a substantial investment in local public departments, many of which were strained during the pandemic or unable to meet the testing, contact tracing and other needs of their communities.

"There is no better use than to invest in public health. It impacts the lives of 7 million people in ways that are seen and unseen," said Rep. Denise Garlick, a nurse who noted how school nurses had to step up in many communities when schools closed to help administer COVID-19 tests.

Garlick said a commission created by the Legislature to investigate local and regional public health produced recommendations in 2019 that must now be funded.

"What we were trying to address were the fissures we saw. Those fissures have become fractures," she said.

Public health advocates want to see the $251 million, or about 5 percent of the state's ARPA money, put toward a statewide data collection system, workforce training and development and direct assistance to underfunded health departments to eliminate disparities from community to community.

"While these investments will rightly answer calls for equity they will also strengthen the health and well being of every single person living in the commonwealth. That's a pretty profound return on investment," said Sen. Jo Comerford.

Catherine D'Amato, president of the Greater Boston Food Bank, said that during the pandemic one in three residents of Massachusetts were food insecure, straining the bank's ability to meet demand as the volume of food being distributed increased 60 percent.

While the GBFB's warehouse was built to accommodate 50 million pounds of food a year, D'Amato said 115 million pounds will have moved through the facility by the end of September. She presented a $17 million plan to expand the food bank's refrigeration capacity at its Boston headquarters, establish two permanent food hubs on the North Shore and south of Boston, and to invest in the 600 agencies who distribute the food "the last mile" into the community.

"I urge you to invest in the health of our communities. Food is health," D'Amato said.