Efforts to address direct support provider wages continue as the Minnesota Legislature nears the end of the 2019 session. As May began, both the House and Senate had passed health and human services omnibus bills. Each bill passed with a “competitive workforce factor” to address staff wages.
The 2019 session is slated to end MayBy the time Access Press went to press, legislative leaders and Gov. Tim Walz were to have reached agreement on their fiscal targets. Those targets then went back to conference committee chairs. The targets guide what is and isn’t poised for adoption this session.
A second deadline is May 13, when conference committees are supposed to have completed their work and submitted reports to their house of origin.
With the conference committee process underway, no one is taking anything for granted. What ends up in the final omnibus bill will have a great impact on thousands of Minnesotans who rely on support staff. The House and Senate bills went into conference committee with major differences, and how those will be worked out is an open question.
Several advocacy groups have launched email and phone campaigns to keep the competitive workforce factor in the final bill. They are urging Minnesotans with disabilities, their family members and allies to make the case for the measure.
Current data shows wages for disability services DSPs fall 17 percent behind wages of jobs with similar training and education requirements. One sample email calls the state’s healthcare workforce situation “bleak,” due to very high rates of vacancies, turnover and overtime. The competitive workforce factor is an important step in bridging that wage gap and the workforce crisis.
The House includes $34 million to increase pay for workers who care for people living with disabilities, along with $37 million for the union contract to support personal care attendants or PCAs. The Senate includes $4 million for workers and nothing for the union. Some analyses of the bills indicate that the Senate bill would actually reduce spending on PCAs by limiting the number of people and conditions that would qualify for PCA help.
It increases the PCA eligibility threshold to one critical activity of daily living or a behavior that “increases vulnerability” and requires intervention at least four times per week. That is seen as making it more difficult to quality for services.
Disability advocates have spent hours poring over the bills, and many groups have published summaries. What also is noted is the difference in health and human services spending proposal, with House members lining up behind Walz’ budget proposal and the Senate looking to limit costs. Senate leadership has questions about the long-term sustainability of some of Walz’s centerpiece OneCare Minnesota proposals, including those centered on a prescription drug benefit and a 20 percent premium discount for Minnesotans who buy health insurance via private plans on the individual market. One big difference cited in the bills is how the House and Senate address the looming sunset of the 2 percent provider tax that supports the state’s Health Care Access Fund. (See related story.)
There are some bright spots. Improvements are proposed for the Tax Equity And Fiscal Responsibility Act (TEFRA), which allows parents to receive in-home supports and medical supplies for their children through the Medical Assistance program. This is a supplement to private insurance.
A longstanding concern with TEFRA is that the sliding fees families pay have increased dramatically over time. Reducing parental fees and streamlining enrollment are longtime goals for many disability groups.
Another bit of good news is a proposal to move the Medical Assistance disability excess income standard (the “spenddown”) from 81 percent of the federal poverty guideline to 82 percent. On July 1, 2021, the spend-down would be moved to match the income standard, currently 100 percent of the Federal Poverty Guideline.
Increased funding for a state-run suicide prevention hotline, and more money for the Office of the Ombudsman for Long-Term Care are among other positive proposals. Responses to the state’s opioid crisis have also won praise as have more efforts to support vulnerable adults and long-term care.
But the differences are troubling, and a potential cause of political gridlock. One huge red flag is that the Senate wishes to cut Department of Human Services funding to 2016 levels. The House wants to provide operational funding increases for the Human Services and Health departments.
One Senate proposal with major impacts is that of eliminating Medical Assistance and MinnesotaCare dental and vision coverage for adults. Increased out-of-pocket costs for Medical Assistance are also proposed.
Another worrisome idea is that of capping the developmental disability and Community Access for Disability Inclusion or CADI programs to the number receiving waiver services on June 30, 2019. The programs have been criticized in the past for having long waiting lists, and such a change could cause that problem again.
The House wants to expand community behavioral health clinics, mental health standards, children’s intensive services reform, school-linked mental health, improvements to substance abuse treatment, and puts reform of behavioral health financing on the table. In comparison, the Senate’s focus is largely on reform of behavioral health financing.
Looking for session updates and videos? Go to www.leg.state.mn.us