Legislative Session in Review: Budget Means Big Changes for Disability Community

Avoiding a government shutdown by the narrowest of margins, state lawmakers adopted a new health and human services budget June […]

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Avoiding a government shutdown by the narrowest of margins, state lawmakers adopted a new health and human services budget June 29. The proposal includes many changes that will affect the disability community. What follows is a cursory description of the bill’s major components.
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Direct care staff crisis: Cost of living increases of 3 percent were earmarked in each of the next two fiscal years for nursing homes and home and community based providers. Workers at Intermediate Care Facilities for Persons with Mental Retardation (ICF-MRs) and day training and
habilitation providers will see 3.5 percent gains during the same period. The funds are designed to stem the flow of workers leaving these critical jobs for more lucrative paychecks elsewhere. Two-thirds of these dollars must be spent on salary or compensation, which includes wages and health premium costs incurred by employers.

An additional Medical Assistance rate increase was approved for skilled nursing facilities that will pay an increased per diem rate for the first 90 days of an individual’s stay. The hike, 20 percent for the first 30 days and 10 percent for days 60-90, will especially aid facilities such as
Courage Center and Trevilla of Robbinsdale with a high percentage of residents with disabilities covered by Medical Assistance.

Medical Assistance for Employed Persons with Disabilities (MA-EPD): A new premium structure will take effect November 1, 2001, for those enrolled in this state program which allows people with disabilities to work, yet still retain Medical Assistance coverage. While less draconian than the governor’s original proposal, the change will increase monthly premiums foran estimated 4,000 individuals with disabilities. Those with incomes at 100 percent of Federal Poverty Guideline (FPG) will pay a premium equal to 1 percent of total income. Graduated increases will cap at 7.5 percent of total income for those earning 300 percent of FPG and above. Previously, only individuals earning 200 percent of FPG faced a premium charge, at a flat rate of 10 percent of income earned above this level.

Individuals enrolled in the MA-EPD program who must discontinue work due to a medical condition will remain eligible for the program for four months. Previously, individuals were disenrolled after two months. The change will prevent a spend-down from occurring until the fifth month after a work cessation.

Additionally, those who leave the program will have any accumulated assets frozen for one year. This will allow for any savings to stay intact avoiding the need to liquidate savings to meet the MA $3,000 asset limit in the event of a work separation.

Income standard increase: Individuals earning up to 100 percent of FPG will be able to retain their monthly earnings (up to about $716) without spending down their income in order to qualify for Medical Assistance. Those earning above this level can retain 70 percent of their
income this year and 75 percent next year.

Prescription drug program: Attempts to accelerate the inclusion of people with disabilities under age 65 who are enrolled in Medicare were unsuccessful. However, more Minnesotans will qualify for the discount prescription program, since the income limit was raised from 100 to 120 percent of FPG. The start date of July 1, 2002 remains unchanged.

Nursing Home discharge: Two new targeted case management benefits are designed to aid in getting more non-elderly people with disabilities out of nursing homes and into the community. Approximately 2,600 disabled Minnesotans under age 65 reside in skilled nursing facilities
(SNFs) today. The benefits, for those currently in SNFs and those eligible for home care, were initiated by the Department of Human Services and contained in the governor’s proposed budget.

Mental health: Significant changes to the state’s mental health statutes, including civil commitment procedures, the establishment of mental health crisis services, and much needed rate increases for community and other providers also were enacted. A new benefit under the state’s
Medical Assistance program, adult rehabilitative mental health services, was also established.

TBI waiver expansion: The Traumatic Brain Injury (TBI) waiver will be expanded to include services for persons with cognitive dysfunction such as Multiple Sclerosis or Alzheimer’s Disease. The change will ensure that individuals will receive therapies and services for cognitive
impairments that were not previously available to them.

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