As the state’s biennial budget takes shape, Minnesotans with disabilities and dozens of advocacy groups are working to make sure their needs aren’t left out. But much was uncertain as the 2015 Minnesota Legislature returned April 7 from spring break. In the six weeks before the end of the session, difficult decisions must be made on state spending.
For the disability community there are three major spending issues: Medical Assistance (MA) reform in the way of income, asset or spend-down changes; repeal of an MA for Employed Persons with Disabilities (MA-EPD) premium increase and a five percent raise in compensation for Home and Community-Based Services (HCBS). Money for these priorities wasn’t included in Gov. Mark Dayton’s March 17 supplemental budget. Dayton adjusted his budget after an additional $1.87 billion state surplus was announced.
While Dayton has indicated that he supports repealing the high MA-EPD premium increases that took effect in October 2014, how that repeal would be covered has budget implications. The costs aren’t covered in his proposed budget and will have to be hammered out in negotiations with the House and Senate.
What ramped up the activity level at the capitol are House and Senate budget targets announced in March. House Republicans announced a goal of $2 billion in cuts. The budget puts the squeeze on spending, mainly in health and human services, where $1.2 billion would be slashed. Another goal is to slow state government growth. Proposed is an overall state budget just below $40 billion, or $3 billion less than what Dayton proposed.
Democrats in the Senate released a budget that would spend nearly $43 billion over the next two years and provide more than $200 million in cuts. The Senate’s numbers more closely follow what Dayton proposed, and would put $250 million into the state’s rainy day account. The Senate and Dayton would increase the health and human services budget by $430 million.
Many self-advocates have been presenting testimony before House and Senate committes. Some of the most compelling testimony on the need for the MA-EPD premium rollback was West St. Paul resident Jim Carlisle, a 78-year-old tax accountant.
Carlisle told the House Health and Human Services Reform Committee, March 24 that he wants to retire without being forced into poverty.
He works under MA-EPD and has managed to set aside a small retirement fund, own an accessible home and an accessible vehicle. “Last year my MAEPD premiums jumped from $43 to $118 a month. That was a 277% cost jump while my income stayed steady,” he said. “If these types of increases would be imposed on the general public, most people would be searching for lower insurance rates. People with disabilities usually do not have that option.”
The hefty increase means Carlisle must continue working or be driven into poverty by having to meet the strict income and asset limits of the MA program. He would be forced to live at 75% of poverty level, or $730 per month and lose most of his assets. “If I retire, I would soon be living in public housing, riding on state subsidized Metro Mobility, and shopping with government food stamps,” he said. “It is perplexing to comprehend why state policymakers support education, rehabilitation and employment for people with disabilities but then deny them the fruits of their labor when they retire.”
Members of the Minnesota Consortium for Citizens with Disabilities (MNCCD) and other groups said it will be an uphill battle to get needed dollars for the changes, but that the changes will save money for the state in the long run.
“Members of The 5% Campaign are stunned that Gov. Dayton’s supplemental budget includes funding for nursing homes, but no rate increase for Home and Community-Based Services,” said Bruce Nelson, ARRM CEO. “It’s really a matter of fairness. It’s important that caregivers in Home and Community-Based Services are treated the same as their peers in nursing homes. They do essentially the same work.”
Even with the 5 percent rate increase Home and Community-Based Services (HCBS) received last session, funding lags behind inflation. Between 2006 and 2015 provider rates that pay for caregiver wages increased 10.4 percent while inflation rose by 23.3 percent. HCBS funding is determined by state reimbursements rates, so providers cannot increase their employees’ pay as caregivers pay unless the reimbursements are increased by the state.
If caregiver wages and benefits are not addressed, advocates said it will mean a lower quality of care for older adults and people with disabilities who depend on services. “I work 50-plus hours a week and it’s still hard to support myself. The work we do is tough, it’s physically and emotionally demanding. I hope that I won’t have to start thinking about leaving the work I truly love behind,” said caregiver Tina Cielinksi of Mary T. Inc.
Rallies draw crowds
Capitol renovations this session forced many of the annual rallies to be canceled or to move elsewhere. A March 10 rally organized by ARRM and MOHR drew more than 1,000 people to the State Armory. Busload after busload of self-advocates from around Minnesota showed up. Several legislators promised the group that they won’t give up on the fight for the five percent rate increase. Many self-advocates then went to the capitol and state office building to meet with their legislators.
Another large group, this one of mental health advocates in the Mental Health Legislative Network, rallied March 12. This followed a March 10 press conference to express support for building on the foundation of Minnesota’s mental health system and ensure access to effective mental health care across the state.
Minnesota, key legislators from both sides of the aisle, health care and other mental health advocacy organizations came together at a press conference on March 10 to express support for building on the foundation of Minnesota’s mental health system to ensure access to effective mental health care across the state. More than 30 bills on mental health issues have been in play this session.
In a statement, NAMI Minnesota executive director Sue Abderholden said, “Many say that we have a broken system of mental health care. Frankly, our mental health system was never built. We have spent the past ten years building the foundation for home and community-based services and supports, crisis services, and intensive services. We now know what works. We need to complete what we started and finish building our mental health system.”
Phantom fiscal notes a worry
One issue that raised red flags for the disability community was seeing two unknown author fiscal notes pop up. Disability advocates are tracking the notes closely, as both have potentially huge implications for people with disabilities. Neither of the “phantom notes” has an author or a bill attached, the concern is that such a tactic doesn’t give disability community members and advocacy groups an easy way to respond. While fiscal notes can be used by policy makers to explore ideas, the lack of transparency for those affected is worrisome.
Dayton’s staff, House and Senate leadership were informed of the fiscal notes and what they could mean for people with disabilities. One note calls for a personal care attendant (PCA) eligibility cut which save $6.2 million for 2016-2017 and $8 million for 2018-2019. It would require dependencies in at least three activities of daily living instead of just one.
Such a change would force many people to lose PCA services that keep them living and working in their communities. The other note would make cuts to Developmental Disabilities (DD) and Community Alternatives for Disabled Individuals (CADI) waivers, which would also affect daily life for many Minnesotans with disabilities. Without CADI waivers, many people would have to leave their home communities and live in nursing facilities. The fiscal note suggests forecasted caseload cuts which would save $40 million for next biennium and $109 million for the subsequent biennium. It would also reduce DD from $300 to $180 per year and CADI from no caseload limits as of July 1, 2015 to $1,020 per year.
The notion of cuts to waiver programs is troubling to advocates because there are already about 3,500 people on the wait list for the DD waiver and another 1,450 waiting for the CADI waiver.