Cuts to health and human services programs

Disabled Minnesotans and advocacy groups may remember the 2009 session of the Minnesota Legislature as one of the most difficult they have seen. Despite the final outcome, brutal cuts to a wide range of health and human services are likely.

Conference committees were working on House, Senate and gubernatorial proposals as Access Press went to press. The House and Senate passed their health and human services bills late April, with House debate stretching far into the night. State lawmakers are to adjourn May 18 but many veteran capitol observers believe that will not be possible. That would bring the possibility of another year of a costly special session or at worst a state government shutdown.

The House bill passed 85-49; the Senate passed its health and human services bill on a 40-23 vote margin. Cuts to health care in both bills are in the hundreds of millions of dollars, with the Senate making deeper cuts than the House. But Gov. Tim Pawlenty is proposed even greater cuts of $1.7 billion, which has set up a showdown between him and state lawmakers.

Minnesota Consortium for Citizens With Disabilities, (MN-CCD) and the Arc of Minnesota and a host of groups have been rallying to oppose the cuts. But despite hours of testimony, rallies and organized call-in days, the picture doesn’t look good.

In one letter to members, MN-CCD Coordinator Anni Simons wrote, “We are at one of the most critical times in the evolution of our community-based services system – maybe the biggest challenge to the system we have ever faced. Individuals and programs are all at great risk. “

“In our previous alerts and updates, we’ve highlighted provisions in health and human services spending proposals by both the Governor and the House that are unfair. We want fairness restored. But as bad as those proposals are, things are getting worse – and could get much worse. “

The Senate’s health and human services bill has greater cuts to some disability supports than the House bill, Simons noted. Nor has Pawlenty wavered on his cuts. She noted that the House bill may be “as good as it’s going to get” for people with disabilities.

Another fear for MN-CCD is that the situation could deteriorate further as there are rumblings that some legislators who may have supported tax increases necessary to preserve the service system are getting skittish. If there is no tax increase, the House could make cuts twice as large as they’ve done already-or even larger, according to House Health and Human Services Finance Chair Rep. Tom Huntley, DFL-Duluth.

A bleak economy, combined with rising costs and the uncertainties attached to federal economic stimulus funding, complicate debate over health care spending. Another wrinkle is that demand for services is rising while the state has less money coming in. Health care is the fastest-rising part of Minnesota’s budget. One looming factor in the debate between the governor and DFlers is the prospect of tax increases to help cover the rising costs. Pawlenty has vowed to veto tax increases this session.

The state is looking at about $2 billion in health care-related help from the federal government, as a result of the economic stimulus package. The state has to accept the funding while meeting a number of federal requirements. But that money is likely to be one-time funding, which has in turned sparked another round of debate over whether using the money builds in longer-term structural imbalances with the state budget. Once the federal money is gone, the governor’s budget has even steeper cuts.

Yet another complication this session has been the delay in getting fiscal notes to legislators. DFLers have complained that delays in getting the notes, which provide information on how much various proposals would cost, have caused problems throughout the session. Delays in getting fiscal notes returned on health and human services bills have sparked numerous complaints and in some cases resulted in hearings being postponed and very irritated legislators. Legislators request the fiscal notes from the state’s Office of Management and Budget. The requests go to various state agencies for information. That information is then sent back to the budget office and finally attached to specific pieces of legislation.

During floor debate Sen. Linda Berglin, DFL-Minneapolis, said that while it is time to stand with people and help them through difficult times, the cuts will have a severe impact. Huntley, author of the House bill, also warned that despite efforts to mitigate cuts they will be felt.

At one point during the House debate Huntley forced a vote to eliminate the state’s health care access fund. He opposes that type of drastic action but said he wanted to show how much support there is for fund. The funding pays for MinnesotaCare, the state program for low-income Minnesotans. Huntley’s motion failed 131-1. “This bill does contain $400 million in cuts,” said Huntley. “That means there are 400 million reasons to vote against this bill.” Still, there are deep divisions between the House, Senate and Pawlenty over how much the Minnesota Care fund should be given over the next two years.

Health care is cut by $625 million in the Senate budget. The House cuts spending in that area by $400 million. Hospitals and health care providers would see their funding cut by both bills. The governor wants to eliminate or drastically reduce dental, speech therapy, and several other rehabilitation therapies as well as eligible for health care for 113,000 Minnesotans. People would be dropped from the rolls starting in January 2011.

Other cuts would be made as hospitals cut services, ranging from dialysis to mental health treatments.

Another change being watched warily by many in the disability advocacy community is cuts to the personal care attendant or PCA programs. The House proposal would mean the loss PCAs for about 800 Minnesotans; the gov-ernor’s proposal would cut PCA service for about 2,200 Minnesotans. The Senate would cap the number of hours PCAs can bill the state. (See related story.) Advocates have been trying to defend the program in the wake of a recent state audit which found problems in the program. Advocates have strenuously disagreed with some of the audit findings and argued that while reforms are needed, the program shouldn’t be cut.

Yet another concern is the impact the various bills would have on nursing homes and what they are paid by the state in reimbursements. That, too, will have to sorted out in budget negotiations.

Officials from the state’s counties, which also provide an array of services to persons with disabilities, are also warily watching the fate of the bills and the governor’s proposal. Counties use various program aids to pay for health and human services costs. The following numbers are for all county program aids; a breakdown of health and human services aids wasn’t available. Statewide, the governor would cut $42 million from counties ion 2009 and $110 million in 2010. The House would cut $15 million in 2009 and $99 million in 2010, with a greater cut in 2010 if counties adopt a half-cent sales tax. House members are pushing for counties to adopt a half-cent sales tax as a way to help cover their costs, a move many county commissioners statewide have questioned.

The Senate wouldn’t cut program aids in 2009 but would make a cut of $9.4 million.

Jane McClure is assistant editor of Access Press