For Minnesota’s disability community, the 2010 legislative session may be remembered, like so many others, as one which there could have been much worse consequences.  As it turned out, most existing services were spared but few gains were made as the Minnesota Legislature adjourned May 17. Leaders of statewide disability organizations and self-advocates are already planning for 2011 and what promises to be an extremely difficult and challenging budget session.    

The 2010 session adjourned following a brief special session that extended into the day May 17. Gov. Tim Pawlenty and House and Senate leaders worked to plug a $3 billion budget hole. The hole grew wider this spring after the Minnesota Supreme Court found that unallotments Pawlenty made to balance the state budget last year were unconstitutional. The budget actions taken by state lawmakers and signed into law by the governor ratified the unallotments.

But solutions chosen to fill the gap will come back to haunt the next governor and future House and Senate members. About $2 billion of the $3 billion deficit was eliminated by delaying state payments to school districts. No source was identified to repay that in the future although the state is required to pay that money back in the budget cycle that begins in July 2011.

Also, no final resolution is in place on a proposal that would allow early Medical Assistance/Medicaid enrollment. That will have to be decided by the next governor, as Pawlenty isn’t seeking re-election. A decision needs to be made by mid-January for the state to qualify for matching federal funding.

Disability advocates and members of the Minnesota Consortium for Citizens with Disabilities (MnCCD) were pleased that there were no rate cuts for providers of some disability services, including waivered services, day programs, and personal care attendants (PCAs). The 2009 rate cuts for physical, occupational, and speech therapies were partially restored. Pawlenty had proposed eliminating rehabilitation therapies for those on Medical Assistance (MA) but that didn’t happen.

 

General Assistance Medical Care (GAMC)

The session began with a high-profile clash to save General Assistance Medical Care, a program which provides health care for many of the state’s poorest and sickest residents. More than 30,000 single adults and childless couples were covered. It was proposed that GAMC recipients move to MinnesotaCare, but the move would most likely have depleted MinnesotaCare’s resources. GAMC was to end March 1, then April 1, as lawmakers scrambled to find a compromise program to cover at least some clients.

Pawlenty vetoed the first GAMC compromise bill in February, criticizing its potential costs to the state. After long hours of discussion, another “bare bones” version of GAMC bill was brought forward and approved before the session ended.

The program is taking a 75 percent funding cut, which means many who were covered may not receive help any more. At the eleventh hour, an additional $10 million went into the program. Larger hospitals have been asked to join a coordinated care delivery system—meaning the hospitals would get a lump sum of money to care for a certain number of GAMC patients.

That still may not be enough incentives for hospitals to opt in. Only four Twin Cities area hospitals have signed up, with no outstate hospitals opting in.

The Minnesota Hospital Association has expressed disappointment with the legislation passed; saying it only passes on more patient care costs to hospitals and creates risks for hospitals.

In an interview with Minnesota Public Radio, Sue Abder-holden, executive director the Minnesota chapter of the National Alliance on Mental Illness, said her organization works with mental health crisis homes that no longer will get funds from GAMC, unless hospitals send patients to them. She has been in talks with metropolitan-area hospitals that will be coordinating GAMC.

“What we don’t know is what kind of relationships and contracts will they enter into with the community?” she told MPR. Abderholden is worried that the hospitals won’t give out their GAMC funds to the providers that will offer the most appropriate care to patients.

 

Medicaid/Medical Assistance expansion

One potential solution to the GAMC dilemma is to expand Medicaid under new federal health care laws. But expansion of the federal Medicaid program, known as Medical Assistance in Minnesota, sparked controversy in the closing days of the session. How this is resolved depends upon who the next governor is. The issue already has emerged in the 2010 gover-nor’s race.

DFLers wanted to expand Medicaid coverage to include childless adults whose income is less than 75 percent of the federal poverty level. They argued that by spending $188 million in state money, Minnesota could bring in $1.4 billion in federal funds over the next three years. Some GOP preferred a state-run plan that utilized federal dollars. A change could affect about 100,000 Minnesotans.

DFL-endorsed candidate and House Speaker Margaret Anderson Kelliher supports Medicaid expansion. Independence Party-endorsed candidate Tom Horner also supports expansion. Rep. Tom Emmer, the GOP endorsee, has described such a move as moving into “Obamacare.” He opposes the expansion and said it would give up the standards set for other state programs, including GAMC and Minne-sotaCare.

In Minnesota MA currently covers more than 500,000 people. About half are seniors and people with disabilities; the rest are families.

Various health care groups and hospitals supported the expansion, despite hospitals having to pay additional surcharges. The tradeoff is that hospitals would get more coverage for uncompensated emergency room visits.

The legislative session ended with Minnesota having the option to opt into the program by Jan 15, 2011.

 

Personal care attendants (PCAs)

A number of changes were made to regulations covering PCA services, for PCA and their clients and for PCA agencies. Many changes were meant to clarify existing state law, including definitions of extended PCA services, which expenses should be considered wages and benefits and that the number of hours worked by a PCA per day not be disallowed by the department unless in violation of the law. One clarification is that an activity of daily living (ADL) and an ADL does not need to take place everyday to be considered for reimbursement. (The recipients must be assessed as dependent based on a daily need or need on the days during the week the activity is completed)

One change will make it easier for a PCA to follow a client to a new agency, before the PCA’s new background check is completed. Another change confirms the limit of 275 working hours per month for each PCA. This will affect many people who have live-in PCAs.

Another change is that a PCA agency cannot require a PCA to sign an agreement not to work with any particular PCA recipient or for another agency after leaving the agency.  n