Major erosion of disability services feared at capitol

Minnesota’s personal care assistant (PCA) program has provided functional supports to persons with disabilities to maintain themselves in their homes since 1977. Originally PCA services were provided to adults with physical disabilities who could direct their own care. Over the years, as the civil rights struggles for persons of all types of disabilities and ages took form, Minnesota’s PCA program evolved to provide functional support for persons with cognitive limitations, mental illnesses, children, and those who could not direct their own care, hence the need for a responsible party but not necessarily a parent invading and adult child’s independence. Minnesota’s use of PCA services which have allowed many to enjoy their civil rights to live in the most integrated environment possible will end for many and be restructured in significant ways which will erode the effectiveness of this service for more than half of the Minnesotans who now use it.

The PCA program is being dismantled in numerous significant ways due to cuts proposed by Gov. Tim Pawlenty to deal with the state’s huge budget deficit and concerns about fraudulent practices by a small percentage of PCA staff, agencies and recipients. Overall, the House adopted fewer of the governor’s PCA cuts than the Senate. The House position is less onerous because the cuts to PCA eligibility are less and a responsible party doesn’t have to live with the person who gets PCA services.

The governor has proposed massive and fundamental changes to the way personal care assistant services are provided in Minnesota. The Senate adopted nearly 78% of the governor’s cuts for PCA services while the House adopted about 66% of those cuts. Although both the House and Senate did not adopt the governor’s proposal to drop 2,100 people from PCA services by requiring dependencies in two activities of daily living, both adopted new eligibility restrictions for the coming biennium. These will eliminate more than 500 persons from the PCA program by setting more stringent eligibility criteria by requiring at least one dependency (constant supervision or hands-on assistance) in one activity of daily living (ADL) or displaying Level I behaviors.

Other significant changes include the complete abandonment of a key, longstanding component of effective disability support services: individual consideration of needs. Under the guise of “simplification,” DHS has proposed in the governor’s budget, the elimination of individual consideration of a person’s functional need for assistance in their home environment as a basis for authorizing the amount of PCA services. Instead, DHS proposes to divide the 14,000 PCA recipients into 10 new home care rating categories (reduced from the current 21 categories) and give each category one standard amount of PCA time based on the median use of hours by people with similar characteristics during 2007. While currently individuals with disabilities are now assigned a home care category and within that category are authorized for and use a range of hours of PCA services to meet their needs, under the governor’s proposed changes everyone in a category will get the same base amount of PCA hours. DHS estimates that more than 6,500 persons will have their PCA hours reduced by an average of two hours per day. This rigid, cookie-cutter approach to providing supports to persons with disabilities is harsh indeed, and will have significant and unfortunate consequences for many across our state.

A new proposal from the governor which was adopted by the Senate will require that anyone who needs a responsible party to direct their PCA care will have to live with a responsible party in order to qualify for PCA services. Individuals had to live with their responsible party until 2002. The change was made primarily for those who are elderly and living in their own apartment or home and for some adults who became disabled and wanted as much independence as possible. These individuals have persons acting as their responsible party, but do not wish to live with them. Also affected by the “live with” responsible party provision are those parents of adults with disabilities and adult children of elderly parents who are living with their family member and providing some PCA services for which they are paid as well as many hours of unpaid care and services. Since a person cannot be both the responsible party and the PCA for the same recipient, families who are being paid as a PCA and must rely on that income to pay for housing and food, face a horrible choice; either give up needed basic income from PCA wages or find a house or apartment large enough and a responsible party willing to move in together. Many caring families with modest incomes will be significantly destabilized if the “live with” responsible party provision is enacted. The House is to be commended for refusing to adopt this ill-conceived attack on low and moderate income family caregivers which will certainly not save the $5 million in state funds described in the fiscal note. DHS estimates that this provision will eliminate 350 to 400 persons younger than65 years of age from PCA services because they do not live with the responsible party. An unknown number of seniors in managed care plans will be similarly affected. Unfortunately, there is no data from managed care plans which have been strong proponents of the governor’s PCA cuts, arguing that PCA services should be changed to a more medical model service and become more standardized and more regulated to prevent fraud.

Providers of housing with services will no longer be allowed to provide Medical Assistance-covered home care to their residents. In addition, there will be a thorough review of the services provided and paid for as housing with services to assure there is no duplication when Medical Assistance Home Care services are provided to residents of housing with services facilities. Step-parents will no longer be allowed to provide PCA services to their minor stepchildren. Only family foster providers (not staffed foster group homes) will be able to provide PCA services and then only if the services can be shown not to duplicate the foster care provided under contract. Under somewhat different provisions in both the House and Senate bills, PCA agencies will be required to pay PCAs from 65 to 75 percent of the PCA rate in wages and benefits.

It is crystal clear that the lives of 19,000 Minnesotans with disabilities and seniors in Medical Assistance managed care plans will be significantly different, and in most cases, more difficult if the sweeping PCA cuts are enacted. As the legislative session concludes, there are some significant decisions about personal care assistant services still to be made. Clearly the House cuts less from PCA services than the Senate because of not adopting the “live–with” responsible party provision or the two ADL eligibility criteria. In addition to all of the cuts described here, PCA provider agencies will be cut at least three percent in their provider rate payment.

Further, it is crucial to note that all of these cuts in the House and Senate are lower than they could be because they are part of overall state budget plans which raise taxes as part of the solution to balance the budget. The governor has stated on many occasions that he will veto any tax increase. If there is no tax increase enacted during this session, the Health and Human Services cuts will get worse. The conference committees are meeting to make final decisions. For information on how to contact your legislators or you can contact disability advocacy groups such as the Brain Injury Association of Minnesota, Arc Minnesota, National Alliance for Persons with Mental Illness Minnesota or the Consortium for Citizens with Disabilities, visit www.mnccd.org