Editor’s note: These letters were written after $347 million in health and human services cuts were proposed as a means of balancing the state budget. Those numbers are subject to change, in light of the $994 million state budget shortfall announced March 1. Stay in touch with disability advocacy groups for the latest updates on the state budget shortfall and how it could impact programs and services.
Cuts disappointing from two perspectives
The $347 million total cut to Health and Human Services included in the Governor’s Budget is disappointing- from both a social justice and economic perspective. Many of these individual cuts target programs that enable Minnesotans with disabilities to remain living in our communities rather than in institutional settings – which is what any of us would want for ourselves or loved ones, and which saves the state money in the aggregate.
The proposal to eliminate coverage of rehabilitative therapies for some adults on Medical Assistance (MA) means that a young adult with disabilities will no longer have access to the occupational therapy necessary to help him return to work. The 2.5% rate cut to disability service providers means that the small group home in rural Minnesota which has struggled to absorb past cuts will now likely have to close, leaving many area residents jobless.
The proposed limits on disability waiver slots means that the family down the block who has waited for a waiver for their adult son for years to help him live independently in the community will now have to consider moving their son to a more expensive institutional setting. These proposed cuts as well as others lead Minnesota to an outdated and expensive model of providing care for Minnesotans with disabilities.
The disability community understands the reality of our state budget troubles. We have ideas to achieve true cost savings through system reforms such as self direction – rather than simply denying an increasing number of Minnesotans with disabilities access to the supports they need.
Steve Larson, Jeff Nachbar- Co-chairs, the MN Consortium for Citizens with Disabilities (www.mnccd.org)
MCIL cites return on investment
(This is a letter Metropolitan Center for Independent Living, Executive Director David Hancox sent to Gov. Tim Pawlenty after state budget cuts were announced in February.)
No doubt with the release of the supplemental budget proposal, you will be receiving a volume of letters, emails and phone calls. I am writing on behalf of the Metropolitan Center for Independent Living (MCIL). MCIL provides a wide range of services to individuals with various types of disabilities across the seven county metro areas of Minneapolis and St. Paul. We provide these services without regard to income, age, disability, gender, race, or ethnicity. In reporting year 2009, we provided services to nearly 17,600 individuals. All of the services MCIL provides are designed to enable individuals to live as independently as possible in community settings, and with the intent to prevent more costly out-ofhome placements.
While we maintain that all of our services are critical, two services in particular provide a significant “return on investment” or ROI. Our Personal Care Attendant (PCA) program and our Nursing Home Relocation Coordination services (NHR) served 233 individuals in 2009. This may seem like a small number between these two particular services, but combined they provided significant ROI. Individuals served by each program meet the Minnesota Department of Human Services (DHS)definition of “at risk” populations. Using a DHS formula for average daily nursing home costs, these two programs alone in 2009 provided an estimated long term or projected savings of more than $11,500,000.
During this same reporting period, MCIL received approximately $370,000.00 in direct allocation from the state’s general fund. For this modest investment, the state of Minnesota realized an impressive ROI of more than 300%. In the 2009 legislative session MCIL received a reduction of 2.5%. In the 2010 supplemental budget we are slated for an additional 6.68%, and an additional cut of 6.76% in FY 2011. Combined this is a 16 % reduction for this biennium.
MCIL employs nearly 600 individuals, and we have operated with an administrative rate of less than 7% for the past consecutive eight years. The wages paid to these full and part time employees translate to a substantial purchasing power on Main Street.
Clearly we offer a positive example of stewardship of Minnesota’s taxpayer dollars. Reducing our allocation by another 6% will severely impact our ability to continue to provide quality cost effective services, and a continued significant ROI.
There are seven other Centers for Independent Living located across the state of Minnesota providing similar services,and doing so in the same cost effective manner. I urge you to consider these facts, and the impacts of the proposed cuts on Minnesota’s citizens with disabilities, as you work with the Legislature to resolve Minnesota’s budget challenges.
David Hancox- Executive Director, MCIL
Courage Center: Protect rehabilitation services
(This was sent out by Courage Center to its constituents.)
By law, Minnesota is required to have a balanced budget in each biennium. State revenue is lagging behind state spending at a rate of about $4.3 million, per day. Lawmakers are tasked with having to plug that gap before the 2010 session ends on May 17. If unchecked, the deficit would grow to $1.2 billion by the end of the fiscal year. Gov. Tim Pawlenty recently released his plan for balancing the state budget, largely focused on cuts in spending. Of great concern is $347 million in proposed cuts to health and human services programs.
How do the proposed state budget cuts affect Courage Center’s work? As he did last year, the governor has proposed the elimination of physical, occupational, and speech therapy services if enacted into law, this would take effect Jan. 1, 2011, for adults enrolled in the Medical Assistance or MinnesotaCare program. Additionally, Medical Assistance payments to Courage Center would be cut by 2.5 percent, effective Oct. 1, 2010, for participants in the Transitional Rehabilitation Program, and for all waivered services (such as Independent Living Skills and Behavior Services). What does that mean for Courage Center and the people it serves?
Our 12,000 clients represent some of the state’s most vulnerable citizens. More than 35 percent of them rely on Medical Assistance (MA) as their only form of health insurance. Important reforms are now underway in the health system overall and in MA specifically that over time will greatly improve the system: payment reforms, Health Care Homes, tightening the PCA program, standardizing payment for services and state (rather than county) regulation of providers, and more consistency in assessing long-term care needs. These and other changes will save money and create greater program accountability.
Unfortunately, the savings won’t be booked this biennium. We urge the Legislature to stay the course and even accelerate progress toward fundamental reform. The governor’s proposals to drastically limit access to needed health services—like rehabilitation therapies—for those with complex needs will not save moneyin the long run. Nor will further reducing the already unsustainably low payment rates to providers of basic services.
Further cuts will cause high-quality organizations like Courage Center to cut services and reduce access, and the clients we now serve will see declines in health and independence. The building blocks of reform would be seriously compromised.
Is this a done deal?
No. Courage Center’s Public Affairs team will be working to preserve access to rehabilitation therapies and current payment rates for services. Working with many organizations last year, we preserved rehabilitation therapies. We’re hopeful we will again succeed this year.
What can I do?
Call your legislator and respectfully say: Hello, I am calling to ask you to please consider preserving Minnesota’s rehabilitation therapies, and I’ve seen the difference they can make in the lives of individuals who have had an accident, injury, or live with a disability.
I hope my taxpayer dollars will continue to fund these cost-effective services. Thank you for your time. This outreach really does make a difference, and is critical for us to be successful in preserving such vital services for individuals with disabilities.
Here are the key points in opposition to the proposed elimination of rehab services under Medical Assistance, GAMC, and MNCare that MTA has put together so far:
Overview: The governor proposes to eliminate rehabilitation services, including occupational therapy, for all non-pregnant adults enrolled in any of the Minnesota Health Care Programs (MHCPs—MA, GMAC, and MNCare). This proposed elimination would save the MHCPs $2.105 million in FY2011, $6.173 million in FY 2012, and $6.726 million in FY 2013. This would severely impact many people with acute and chronic mental or physical disabilities, who without occupational therapy services would be institutionalized in a long term care setting or require repeated episodes of crisis intervention, at a much higher cost to the state. Eliminating these services may appear to save money in the short term, but would cost more money in acute and continuing care in the long term. This proposal sets the state up for a future crisis in healthcare expenditures.
Rehabilitative care saves for the future
Quality rehabilitation services offer a great return on investment. Money spent helping people recover from disabling injuries and illnesses, or preventing further disabilities, saves future dollars in both acute and long-term care.
Occupational therapists work with people who have had strokes, spinal cord injuries, head injuries, arthritis, multiple sclerosis, Parkinson’s, developmental delays, mental illness and many other disabling conditions. The expected outcome of occupational therapy intervention is that the client’s skills in living are enhanced and that they will need less help than before occupational therapy services started, saving money in the long run.
Occupational therapy offers a great return on investment. For example, the average cost for a psychiatric hospitalization in MN is $19,774 (MHA, 2007). The average cost for an entire year of weekly occupational therapy intervention to prevent hospitalization costs $3240 (DHS, 2009).
Occupational therapists often provide access to and training in the use of assistive technologies for persons with disabilities, including wheelchairs, computer adaptations, dressing and feeding aids, and environmental modifications and controls that increase the independence of users. Eliminating occupational therapy services for persons with disabilities would limit access to these devices, further increasing dependence on human supports at a time when those supports are also being cut.
Karen M Sames, MBA, OTR/L, FAOTA
Dir. of Strategic Initiatives
Associate Professor
Depart. of Occupational Science and Occupational Therapy
St. Catherine University, St. Paul
What Advocates Can Do
People with disabilities will again bear a large burden of the cuts being proposed by the governor in his supplemental budget. The governor came out with his proposal on Feb 15th to balance the state budget, which is projected to have a $1.2 billion deficit for the remainder of this biennium. The proposed human services cuts total $347 million and touch many areas that affect persons with disabilities:
• Rates for long-term services and supports funded by Medical Assistance, including waivered services, are cut 2.5%, effective July 1st 2010.
• Disability Waivers are capped. Effective July 1st, 2010, the CADI waiver will only be allowed to serve 60 new people per month (down from 95 per month). Effective January 1st, 2011 the developmental disabilities waiver is limited to six new people per month (down from 15 per month).
• Physical, occupational, and speech therapy will be eliminated for non-pregnant adults on MinnesotaCare and Medical Assistance at the start of 2011.
• The 275 hours per month limit on the number of hours a PCA can work, created by the Governor’s unallotment last year, will be made permanent
• SSI income for families on Minnesota Family Investment Program (MFIP) will be counted toward these families’ MFIP cash grants and child care assistance grants, reducing their benefits as a result. This takes effect on November 1st, 2010 for the MFIP grants and March 1st 2011 for child care grants.
• An end to grants to counties that help low-income individuals and persons with disabilities with emergency aid for housing and utilities.
• A $22.5 million cut for the 2012-13 biennium in Children and Community Services Act funding. This funds child welfare, adult protection, and other services for vulnerable adults.
• A $250 million cut in local government aid. These funds help pay for a portion of disability services in counties.
• Less money to dentists to help them pay for the services they provide to vulnerable Minnesotans.
• Elimination of funds to help low-income persons pay for diets that are medically-prescribed and deal with serious medical conditions.
These proposals make no sense in human terms. The governor’s budget is yet another tax on our vulnerable citizens. People with disabilities last year shouldered cuts in provider rates, PCA services, personal needs allowances, dental services, and therapies. They have extended their wait for the community-based services that would help them live more independently and help keep their families together. In the past several years, they have borne the burden of more than $500 million in cuts, fee increases, and service reductions. They do not need further cuts to services that maintain their independence. These proposals also make no fiscal or economic sense.
Provider cuts will likely mean layoffs of direct care staff across Minnesota. Cuts to medically-prescribed diets, to physical and other therapies to dental care, and to emergency aid will just mean we will face often higher costs down the road through institutional placements, emergency care, and efforts to deal with deterioration in functioning.
Programs funded through Medical Assistance often receive a federal match, so cuts made in Minnesota mean a loss of federal funds, more job losses, and a greater budget gap to fill.
People with disabilities, their families, and disability advocacy groups have already been speaking up about the supports they need. This advocacy must and will continue.
You can be part of an ongoing presence at the state capitol this session by taking part in Tuesdays at the capitol. Different disability groups will be sponsor a Tuesday during the legislative session. Staff from the sponsoring groups will be available at the capitol to brief on the issues, offer tips on how share your story, and provide an opportunity to meet with your state legislators. Visit www.mnccd.org, or contact Anni Simons at 651-523-0823, ext. 112 or asimons@arcmn.org to get more information.
Whether or not you have shared your story with your legislator before, we are being told by some long-time lobbyists at the capitol that legislators need to hear stories now more than ever. It is crucial that you share with your state representative and senator if and how budget cuts have already hurt you, and how further cuts would cause further harm.
We need to have a balanced and humane approach to solving our budget woes and still provide quality services. In a deep recession, we cannot forget those whose needs have become more acute, and we call on our state officials for more revenues. Disability groups are also calling on legislators to focus on those programs that spend money more efficiently, especially by giving people with disabilities and their families greater control over their funding and staffing.
And, if the state budget forecast next month shows a slight reduction in the projected deficit, elected officials should translate this into smaller human service cuts. Join with others now, and speak loudly and often about the need to maintain your independence through the supports you receive.
Steve Larson – Public Policy Director, The Arc of Minnesota
