GAMC ends, other cuts pose many challenges

A projected state budget deficit of $994 million has brought a proposal for deep cuts in Gov. Tim Pawlenty’s budget. The cuts, announced in mid-February, include $347 million in various health and human services programs. This devastating budget news comes on top of the current efforts at the capitol to save General Assistance Medical Care (GAMC).

The crush of issues has added a sense of urgency to upcoming disability community events at the capitol, and adds to the complexity of the debate over saving programs and services. Advocates have been going to the capitol, helping at phone banks, and calling and writing to make their concerns known.

GAMC was eliminated by Pawlenty in 2009. The program, which provides health care for some of the state’s sickest and poorest residents, ends April 1. Department of Human Services officials have proposed moving GAMC participants to MinnesotaCare. But critics contend that would wipe out MinnesotaCare and

create a system that many very poor GAMC recipients cannot afford. A temporary restraining order was filed March 4 to block Pawlenty from ending GAMC.

The budget proposal anticipated $387 million from the federal government. If that doesn’t come through, additional cuts would be necessary. The proposed budget cuts for 2010 aren’t final. House and Senate leaders are expected to roll out their budget proposals soon to counter what the governor brought forward. But throughout the disability community and the state, advocacy groups and self-advocates are bracing for the worst.

Several groups have issued action alerts and distribution information on what the cuts would mean for their constituents. Minnesota Consortium for Citizens with Disabilities (MnCCD) has been reviewing the cuts and their impacts at the group’s weekly meetings.

“Legislators need to hear from community members and hear their stories,” said MnCCD Co-Chairman Jeff Nachbar. While cuts may be inevitable given the state’s economic situation, members of MnCCD are emphasizing that many of the programs and services slated for cuts now will have much higher, longer-term costs later.

Having the controversial GAMC debate and the overall state budget cut proposals going on at once is daunting. Funding for GAMC was wiped out last year as one of many measures to balance the state budget. The governor used unallotment and a line-item veto to eliminate the program. It runs out of money this month. Since then a coalition of state lawmakers, health care providers, social services agencies and advocacy groups have worked to bring forward proposals that would help at least some of the current program participants.

Last month the House and Senate passed proposals to partially restore GAMC. Pawlenty immediately vetoed the proposal from Washington where was attending a fundraiser. The Senate was able to override the veto; the Minnesota House failed to do so despite an initial 125-9 vote of approval. The override fell short by five votes.

Many House Republicans said they had voted earlier for the GAMC package with the understanding it would be sent back to legislators for further negotiations, not simply sent to the governor for his signature.

As the March issue of Access Press went to press, Pawlenty and legislative leaders were still discussing ways to save some semblance of GAMC. One idea the Republicans have put on the table is that of creating accountable care organizations (ACO). These groups would direct patients into state or federallyrun programs for their medical care.

These organizations, known as ACOs, are used in other states and have been a focus during the national health care debate. An ACO could include doctors and one or more hospitals. ACOs have been eyed as a way to help provide Medicare coverage for patients.

Most legislators involved in the talks with the governor are saying very little. Rep. Erin Murphy, DFL-St. Paul, has been very involved in the GAMC legislation discussions. In a statement to the news media, she said, “Our efforts remain centered on covering the most people at the best price, and building on the strong reform measures included in our plan. These elements must be included in reaching a successful solution. This is not about which party has the best ideas, but is about what ideas work best.”

About 30,000 people are in GAMC. In early March DHS began enrolling some GAMC recipients into MinnesotaCare, a program aimed at low-income working Minnesotans.

But there are worries that many GAMC recipients will not be able to afford the even modest co-pays and premiums MinnesotaCare requires. There are also concerns that MinnesotaCare, which faces cuts this session, will be overburdened by the many GAMC recipients moving into the program.

Not only are many people working to save GAMC, the disability community is also mobilizing against a slew of health and human services cuts, as well as $250 million statewide in cuts to counties. Nineteen Minnesota counties will lose all of their County Program Aid or CPA dollars, which in turn affects human services and health programs at the county level.

The $347 million in health and human services cuts is daunting. Persons with disabilities stand to lose programs ranging from dental care and special diets to physical, speech and occupational therapies. Rates for long-term services and supports funded by Medical Assistance, including waivered services, are cut 2.5%, effective July 1st 2010.

Anyone who relies on a personal care attendant (PCA) could lose service hours and as the 275 hours per month limit on PCA hours would be made permanent. This was set into motion by unallotment by the governor last year. It could possible force some people out of their homes and into nursing homes.

Capping of the disability waivers is also a concern. Effective July 1st, 2010, the Community Alternatives for Disabled Individuals (CADI) Waiver will change. This waiver is for people who are disabled and require the level of care provided in a nursing home. The CADI waiver will only be allowed to serve 60 new people per month (down from 95 per month). And effective January 1st, 2011 the developmental disabilities waiver is limited to six new people per month (down from 15 per month).

Then there are the impacts on families. SSI income for families on Minnesota Family Investment Program (MFIP) will be counted toward families’ MFIP cash grants and child care assistance grants, reducing their benefits. This will be phased in starting in November, 2010. Anne Henry, attorney with the Minnesota Disability Law Center, described this as “one of the cruelest cuts.”

“People don’t realize how harsh this is,” she said. “It’s a massive cut for people who are just barely scraping by.” Another cut that will hit families is a $22.5 million cut for the 2012-13 biennium in Children and Community Services Act funding. This funds child welfare, adult protection and services for vulnerable adults. Its impacts are very wide-ranging.

For more information on the cuts and for more information on upcoming Tuesday events at the state capitol, visit www.mnccd.org