Editor's Column - December 2015

Tim BenjaminWe finally got some snow on the ground with just a few days left in 2015—and then it melted in our 40-degree week. We can only hope that the rest of the winter is as mild as it’s been.

Good news from Commissioner Myron Frans of the Minnesota Management and Budget Department on the state’s financial forecast. The available balance is $1.206 billion, which is a two percent or $90 million increase over what the state forecast at the end of the 2015 legislative session. And much of the savings is, in their words, “…primarily driven by lower health care rates and payments in the medical assistance programs.” The legislature should be encouraged to spend a considerable part of that surplus to create more equity in the medical assistance program.

The 5% Campaign, now Best Life Alliance, was successful in promoting legislation that resulted in a five percent reimbursement increase to home and community-based services in 2014. But the campaign was not successful in achieving any compensation growth in 2015. The rumor was that there was a general sense in the 2015 legislature that “direct support providers got a five percent financial expansion last year and there are other worthy programs this year.” Considering the overhead cost savings they yield for the state’s Medical Assistance budget, homecare workers should get an increase to match the nursing home workers’ incomes. The home care workers should get the same pay rate as their counterparts, in nursing homes. The pay rate should be even handed working in either location.

For 2016, the Best Life Alliance is requesting a five percent increase in home and community-based services to be divided up into three components; Workforce compensation (wages), enhanced quality of life and person-centered services (advancing services that address individual needs and choices). Both of the latter components could be huge advances in the quality of life of people with disabilities, so I wonder if the funding strategies should be separated.

Most legislators are in agreement that community and home-based services are the direction Minnesota needs to go. If the legislators are serious about that commitment they should put more capital into these “quality and person-centered components.” Besides, I keep thinking, doesn’t the Olmstead Plan require these projects? Shouldn’t separate funds be dedicated to compliance for the federally required plan?

A federal rule that seems to be threatening to tangle up other waiver services in Minnesota is the Affordable Care Act’s (ACA) new broader spousal impoverishment rule. Medicaid has had rules in place to protect, or disregard, a percentage of a non-institutionalized or able-bodied spouse’s income and assets, not considering them in the approval of community-based services. In Minnesota, we’ve called that a “spousal disregard rule.”

Without the Minnesota state disregard rule in place, a spouse may not retain his or her full salary, 401(k)s, college funds for children, pensions and retirement funds and several other assets. While Medicaid had only applied a certain level of impoverishment to spouses of institutionalized Medicaid recipients, the ACA has now applied such rules to recipients of community-based services. The federal rule would require the non-institutionalized spouse to spend down assets to a level of poverty qualifying for aid, thus impoverishing both the able-bodied and the spouse with disabilities. To avoid this outcome, married couples would be incentivized to divorce in order for the non-institutionalized spouse to maintain his or her assets.

This doesn’t seem at all as though it was the intent of the law, but the Centers for Medicaid and Medicare indicated that they interpret the ACA to require spousal impoverishment to all recipients of institutional and home-based long-term services and supports. The ACA authors likely had no intentions of impoverishing or forcing families to divorce in order to allow both spouses a secure quality of life. In a state like Minnesota which is more progressive and family-friendly, it would be forcing many into poverty and losing lifetime savings and accumulated retirement
funds. There are a lot of healthcare, senior care, and disability advocates working on this issue right now, and it can’t be fast enough. The primary response from Minnesota’s Department of Human Services is not to make any quick decisions until more facts have become clear.

The Access Press Charlie Smith Award event was, once again, a fabulous success—and it was obvious in the sight of 200-plus people waving their hands in the air in applause for the deaf community leader, advocate Jessalyn Akerman-Frank. Our centerfold pictures and the smiles on the faces of so many participants tell the story: everyone had a fun time, talking with old friends and learning more about our community and the wonderful people in it.

Hope you have a great holiday season and will talk again next month.