Dayton reveals programs; legislators review budget

It has been an eventful first month for the 2013 Minnesota Legislature and Gov. Mark Dayton. It has also been a very busy time for Minnesotans with disabilities and their many advocacy groups. Although much lies ahead there is optimism among community members on a number of fronts.

Dozens of pieces of legislation affecting people with disabilities have been introduced, ranging from improved mental health care to spinal cord research. Legislators and advocates are working toward their first key deadline, March 15, when bills need favorable action from the House or Senate.

Dayton has already announced two major initiatives that will affect people with disabilities. One is a package of reforms to provide better health care for 100,000 Minnesotans and lower costs for taxpayers. In an effort to further improve the state’s Medicaid program, the Minnesota Department of Human Services (DHS) is partnering with six health care providers to test a new payment model that prioritizes quality, preventive care and rewards providers for achieving mutually-agreed upon health goals.

Lauren Gilchrist (Special Advisor to the Governor's staff), Rep. Thomas Huntley (DFL-Duluth); Alex Bartolic (director of disability services for DHS) and Anne Henry (staff attorney for the Disability Law Center) were on a panel discussing disability issues.

“Minnesota is the first state in the nation to implement this results-based payment model,” said Dayton. “This new payment system will deliver better health care at a better price. By changing the way we pay health care providers we can incentivize reform, help Minnesotans live healthier lives, and slow the rising cost of health care in our state.” The reform measure makes needed changes to Minnesota’s payment system for publicly-funded health care programs, including Medicaid. The current system pays providers for the volume of care they deliver, rather than the quality of care they provide.

Under the new payment system, participating providers would instead receive financial incentives for reducing the total cost of care for Medicaid enrollees while maintaining or improving the quality of care they receive. A system of cost and quality targets will be used as incentives for innovative care. Each year, their total cost of care will be compared to a mutually-agreed upon targets for costs and care. Providers in the program are Children’s Hospitals and Clinics of Minnesota, Essentia Health, CentraCare Health System, North Memorial Health Care, Federally Qualified Health Center Urban Health Network and Northwest Metro Alliance, a partnership between Allina Health and HealthPartners. These providers will serve Minnesotans enrolled in publicly-funded programs.

Health care reform at the state level is a key focus this session, the governor’s budget and in DHS proposals. Many are building on the ongoing Reform 2020 effort by DHS and the Minnesota Health Care Reform Task Force which released itsRoad Map to a Healthier Minnesota in December. The full report is at http://mn.gov/healthreform/images/TaskForce-2012-12-14-Roadmap-Final.pdf

Also, last month, Dayton issued an executive order establishing a high-level group to improve opportunities for Minnesotans with disabilities to live and work in the community. The group will develop and implement a comprehensive plan to support freedom of choice and opportunity to live, work and participate in the most inclusive setting for individuals with disabilities.

Representatives of several  state departments will work on the task force. Lt. Gov. Yvonne Prettner Solon will chair the group.

The group’s charge is to come up with a plan that uses measurable goals to increase the number of people with disabilities receiving services that best meet their individual needs and in the most integrated setting. This is tied to the 1999 U.S. Supreme Court Olmstead decision, that the Americans with Disabilities Act (ADA) requires states to place people in community settings, rather than in institutions, whenever appropriate.

The group will seek input from people with disabilities, their families, advocacy organizations, service providers and others to develop and implement what Dayton calls a “comprehensive Minnesota Olmstead Plan.”

Review of Dayton’s health and human service bill began in late January. The bill calls for spending about $11.2 billion for the 2014-2015 biennium. A main focus of the bill is to bring Minnesota in compliance with the federal health care reform law or Affordable Care Act.

The budget also has a focus on mental health. For example, it includes a $7.4 million investment in school-based mental health grants, $2 million for expanded mental health crisis response services and $4 million for new mental health transition services.

Lauren Gilchrist of Dayton’s staff describes the budget as one of “no gains and no gimmicks.” She noted that not every program advocates want can be included, but that state officials have worked to prepare a budget that brings improvements to services while providing cost savings.“We know there’s a lot of change coming,” especially in terms of federal health care reform, Gilchrist said.

The HHS budget has met a generally favorable response, especially for its focuses on long-term care, children’s mental health and mental and behavioral health systems changes. The budget is framed against a March federal deadline to implement a state-based health insurance exchange.

At a Minnesota Consortium for Citizens with Disabilities (MN-CCD) forum January 19 in St. Paul, panelists and audience members said they generally like what they see happening this session, with the budget bills and other specialized pieces of legislation. But it will be a long and complex session, especially given the state’s $1.1 billion deficit.

“It sounds like there will be much focus this session on systems change,” said Rebecca Covington, director of MN-CCD. She and others disability community members said, everyone needs to be poised to address the many issues ahead.

Panelists emphasized that advocacy groups and self- advocates need to tell their stories and appeal to legislators representing their home districts. “People need to be very involved,” said Rep. Tom Huntley (DFL-Duluth).

Huntley is chairman of the House Health and Human Services Finance Committee.

Anne Henry, staff attorney for the Disability Law Center, said anyone working on an issue should plan to be at the capitol more than once this session, due to the Affordable Care Act issues and the potential for major changes in disability services.

“Community supports are also going to be changing and we need to be able to respond to that,” Henry said.

Huntley cautioned MN-CCD forum attendees that the state continues to recover from a very bad recession. He noted that because health and human services make up a large part of the budget, it can be a “very tempting target.”

Huntley also noted the “huge” time constraints faced in trying to meet Affordable Care Act deadlines. But there was applause when he noted that about 300,000 Minnesotans without insurance would have their choice of coverage.

Alex Bartolic, director of disability services for DHS, said the focus will be on how to get better outcomes, tied to the Reform 2020 effort. Reform 2020 is a compilation of about 20 different initiatives, including how to modify Medical Assistance, better deliver services and make programs more sustainable. There’s a need to help people earlier and to give people with disabilities more options. “It’s about having the life you want,” Bartolic said.

Bartolic also said that while talk of reform and change may make people anxious, “The point is to make things better.” She urged those at the forum to give state leaders very specific suggestions in response to proposals.

Disability community members are continuing to be involved in a number of issues. MN-CCD offers a number of reminders for those wanting to be involved at www.mnccd.org and visit the advocacy page.

One reminder is on parking. Due to construction delays, the new disability parking locations in Lot B will not be accessible by tunnel until mid-February. Until that time disability parking will continue to be provided in Lot N behind the capitol. Also, pedestrians can no longer access Lot N from University Avenue. To access Lot N, enter from Rev. Dr. Martin Luther King, Jr. Boulevard.

Another reminder is to watch for changes in Metro Transit bus service, as light rail construction has forced changes at capitol stops. Ask the bus driver for the closest stop.

Remember Tuesdays at the Capitol, which are regularly sponsored by MN-CCD groups. There is also a membership meeting most Fridays, noon-1 p.m. in State Office Building Room 500N. Please send proposed agenda items to rebecca@mnccd.org no later than 5 p.m. the Wednesday before.

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