Significant progress was made on two key Medical Assistance (MA) Reform issues this past legislative session that will benefit about 20,000 adults and seniors with disabilities in Minnesota. Despite a difference of more than $1 billion between the House and Senate Health and Human Services budget proposals, the final budget that was sent to Gov. Mark Dayton includes $8.2 million in new MA funding. Of that amount $4.8 million funded a full repeal of the Medical Assistance for Employed Persons with Disabilities (MA-EPD) premium increase through legislation authored by Rep. Tony Albright (R – Prior Lake) and Sen. Chris Eaton (DFL – Brooklyn Center).
Additional funding, championed by Rep. Nick Zerwas (R – Elk River) and Sen. John Hoffman (DFL – Champlain), will raise the MA excess income standard (spend-down) from 75 percent of the Federal Poverty Guideline (FPG) to 80 percent on July 1, 2016.
MA-EPD – full repeal of the premium increase
MA-EPD is a work incentive program designed to allow persons with disabilities who are able to work to benefit from their earned income by paying a monthly premium for MA rather than having to spend-down their income far below the poverty level. The premium increase was part of budget deficit resolution in 2011 but did not go into effect until October 1, 2014 due to Affordable Care Act requirements. This increase immediately placed thousands of adults with disabilities in precarious financial situations where they were unable to pay their bills. Persons with disabilities who wanted to work had to give up their jobs, could not make payments on their accessible vehicle or even lost their apartments. DHS data showed that about 650 more people have been dis-enrolled than is typical for that three-month period before the premium increases were imposed, indicating that people were losing not only their jobs but essential health care coverage.
Both the House and Senate included full repeal of the MA-EPD premium in their HHS budgets and while it was not included in his budget, the governor came out in support of the repeal of the premium after hearing personal stories of those impacted by the premium increase.
The Health and Human Services budget returns the MA-EPD premiums to what people were paying before the 2014 increase. Specifically, the monthly minimum fee on earned income decreased from $65 to $35/month and the unearned income charge (usually from social security) was decreased from 5 percent to .5 percent. Beginning September 1, 2015, 8,700 Minnesotans with disabilities will once again be able to benefit from earnings and additional savings while still maintaining eligibility for MA, a big win for working people with disabilities.
Raising the MA spend-down – moving the spend-down from 75 to 80 percent of Federal Poverty Guideline
Progress was also made on the centerpiece of MA Reform, raising the MA excess income standard (spenddown) from 75 percent of the Federal Poverty Guideline (FPG) to 80 percent. MA is so important to people with disabilities because it allows them access to waiver services that help them remain independent. The problem is the standards to qualify for MA are too low, forcing adults and seniors with disabilities deep into poverty to get the services they need to remain independent in their community. Additionally, when people can’t afford to pay for services they either go without care or providers of MA services are expected
to absorb these costs without repayment.
This change will impact 12,000 adults and seniors with disabilities who will be able to keep $50 more each month to help pay living expenses while still qualifying for MA health care services which are essential to living independently. Advocates recognize that this is only one small step toward what really needs to happen with the MA income, asset and spend-down standards but it is the first time the spend-down standard has been raised since 2001.
Plans are already underway to build on this small success next session to further raise the spend-down standard and increase the $3,000 MA asset limit for the first time in 32 years. Every 5 percent increase in the spend-down standard means an additional $50 more for adults and seniors with disabilities to pay their living expenses. Both House and Senate authors have committed to work next session to continue making progress by raising the spend-down.
The MA Reform Campaign’s most important advocacy strategy this session was sharing the personal stories of people subject to the spend-down and impacted by the income and asset standards. These stories were shared in person with legislators during Tuesdays at the Capitol, in testimony during committee hearings and as part of the MN-CCD’s Faces of Disability exhibit in March. The Minnesota Brain Injury Alliance delivered an MA impact story every week during session to legislative leadership and members of the Health and Human Services policy and finance committees.
Go to here to see excerpts from these powerful stories. The MA Reform Campaign plans to build on this strategy for 2016 and is looking for people willing to share their stories of the impact of the spend-down or the low income and asset limits contact MN-CCD at [email protected].