Changes to the personal care assistant (PCA) program will top the disability community’s priorities when the 2010 Minnesota Legislature is gaveled into session Feb. 4. PCA issues lead an ambitious legislative agenda adopted by the Minnesota Consortium for Citizens with Disabilities (Mn-CCD). Work is currently underway to prepare specific bills, offer support to proposed legislation and organize for events that start in January.
It’s important for the disability community to go to the capitol with a proactive agenda, said Mn-CCD Co-Chair Steve Larson, public policy director of the Arc of Minnesota. The legislative agenda adopted Nov. 19 provides that framework, with information on topics including housing, transportation, employment, health care, quality assurance, education and other issues.
The 2010 session is a shorter session, said Larson. It is a non-budget year, although legislators will be focused on the state’s projected budget deficit.
Hearings on some issues will start in January. Since July policy committees have met to discuss specific issues and ways the issues could be addressed by state lawmakers.
Some of the issues will become legislation. Others may have to be handled administratively, said Mn-CCD Co-Chair Jeff Nachbar, who is public policy director for the Brain Injury Association of Minnesota. “We can’t address every single issue on this list,” Nachbar said.
PCA services are shaping up to be one of the 2010 session’s flash points. Much of the Nov. 19 Mn-CCD discussion focused on cuts to the PCA program, and how the cuts made this year will have far-reaching consequences. The cuts affect Minnesotans of all ranges, with a wide range of disabilities.
Cuts to the program that were made by the 2009 Legislature will affect more than 8,000 Minnesotans. Although cuts are not supposed to start until January, discussion at the Mn-CCD meeting indicates there is already confusion. Some said they are aware of services that have already been cut. Others said that scheduling appeals with the Minnesota Department of Human Services (DHS) is a problem.
“By February, peoples’ PCA hours will have been cut and services terminated,” said attorney Anne Henry. One message Mn-CCD must deliver this legislative session is that the cuts will have the consequence of forcing people into more costly nursing home care and out of their own homes.
PCA services have been part of Minnesota’s Medical Assistance program since 1977, and have expanded since that time. Mn-CCD estimates that about 14,500 Minnesotans living at home with the help of PCA services obtained through the fee-for-service Medical Assistance program. An additional 4,000 people, mainly senior citizens, get PCA services through managed health care plans under contract with the state to provide Medical Assistance benefits.
But the PCA programs have been cut in recent years, most significantly during the 2009 session when hours of service were cut, eligibility for service was tightened and PCA work hours were limited. While the changes were promoted as a way to increase oversight and prevent fraud, the fear is that the cuts will make it impossible for many people to continue to maintain their services. There are concerns that it will be harder for people to obtain services of PCAs and home health aides. Without these services many people couldn’t live in the community.
Mn-CCD is stating its strong support for PCA programs and opposes cuts in funding and eligibility. The group is asking that PCA Choice must be maintained as a service option. The group is also supporting annual cost-of-living increases for PCA staff to assure that staff does not lose ground financially and reduce staff turnover, which hurts the quality of services for persons with disabilities. Support is also being voiced for health care reforms which will improve health coverage for PCA staff. The group also supports improvements in the assessment process to increase the quality of the review of the person’s need for assistance.
Another key change sought is a change to allow for 24-hour coverage for those who need intermittent care to live at home. Thus would allow a consumer to choose one person to live with them and provide care. Tied to this is a request to lift the 275 hour per month cap the state has placed on PCAs.
The disability community needs to be closely involved in any state proposals to monitor and evaluate the PCA program, said Henry.
Health care is another topic that will be watched closely at the capitol. One looming issue is the General Assistance Medical Care (GAMC) crisis, which will be felt when many Minnesotans are dropped from that program due to unallotment of state funding. Many enrolled in GAMC have multiple chronic conditions and/or mental health conditions that will worsen if they are not cared for.
Changes to the Minnesota Disability Health Options (MnDHO) program will also have to be monitored closely, to track impacts on persons with disabilities. MnDHO is an integrated managed care plan for people with physical disabilities. Changes at the state and federal level mean Medicare is no longer a part of this care plan.
Another topic of concern is housing for people with disabilities. Margot Imdieke Cross co-chaired a group that studied housing issues and held focus groups throughout Minnesota. DHS is developing a report for state lawmakers on housing for people with disabilities. That report is due in December 2010. Community monitoring and involvement in that report is essential.
One huge concern is that of tenants feeling too intimidated to make complaints about poor housing conditions or bad management practices. That promoted considerable discussion among Mn-CCD members, who want to see those issues addressed.
Another issue that will be tracked closely is transportation. One issue many consortium members would like to see resolved is that of specific responsibility for ADA complaint. “There are many players in those organizations, which must ensure that facilities are accessible,” said Chris Bell. He co-chaired a group that looked at potential transportation legislation. Dealing with transportation and transit issues means working with a myriad of agencies and staff. Bell said it’s important for the community to know who the players are.
The transportation advocates will be monitoring the transportation omnibus bill that was vetoed by Gov. Tim Pawlenty during the 2009 session. This bill had several provisions of interest to the disability community, including a requirement that bridge crossings be accessible to bikes, pedestrians and people with disabilities. Bell noted that many bridges in the state can only be accessed via stairs.
Transit service changes will also be tracked. The state has benchmarks to meet in making such transit service is provided statewide, and the disability community needs to make sure those goals are met.