Following the money at the state and federal levels has a renewed urgency for Minnesotans with disabilities and their allies. The February 28 announcement of a $1.65 billion state surplus for fiscal year 2018-2019 and a $743 million ending balance for the current biennium, has generated calls for more spending on caregiver programs and an array of other services and supports.

While additional state funding is a potential bright spot, many advocates are wary of what is on the horizon at the federal level. Drastic cuts are proposed by Congress to Medicaid, as part of the effort to repeal and replace the Affordable Care Act. Medicaid, which is known in Minnesota as Medical Assistance or MA, ensures health care cover for Minnesotans with disabilities, the elderly, children and low-income adults.

Currently the amount of MA funding Minnesota gets is based on what it actually costs the state to provide coverage. One change being considered would move MA to a block grant system. Each state would get a lump sum of funding for MA. In the event of an economic downtown, an epidemic, rise in aging population or a disaster states would either have to pick up more costs or leave people without care.

Another change eyed would to be use per capita caps, with a set amount of money for each MA enrollee. Caps could be index to rise with inflation but if the Consumer Price Index is used, a concern is that it usually grows much more slowly than health care costs. Funding would likely shrink over time, and not keep up with new technology, medications or treatments.

It’s not certain what Minnesota could lose under a change to the system, but estimate are at $5 billion.

The changes are promoted by their advocates as providing flexibility. Disability advocates disagree and contend that changes would only shift more costs to states, and result in cuts to service. Since long-term care services make up the bulk of Medicaid expenses, changes would mean cuts to services to people with disabilities and the elderly.

Groups including the Minnesota State Council on Disability and Minnesota Consortium for Citizens with Disabilities (MNCCD) are among the groups tracking the federal funding issue. MNCCD Board Chairman Randall Bachman said that the changes proposed for Medicaid need to be watched closely.

“While we’re cautiously optimistic about how the legislative session has gone, and the news of a state surplus, what is happening in Congress could undo everything we’ve done here,” Bachman said. “Every state’s health and human services structure is built on Medicaid. Changes to that could unravel the whole system.”

The online website Disability Scoop, which covers a wide range of developmental disabilities, has extensively followedthe Medicaid issue. One recent article focused on concerns school officials are raising, about the impacts to special education. Read Disability Scoop’s coverage here.

In contrast to the federal worries, Minnesota disability community members are cautiously optimistic about what is happening at the state level. Many bills have been heard and aimed toward the first committee deadline of March 10. Bachman and others note that bills on a wide ranging set of disability issues have gotten a favorable reception so far. But how funding shakes out is worrisome.

Gov. Mark Dayton earlier this year unveiled an almost $46 billion budget, with $300 million in tax relief and funding for a number of programs. He is expected to announce further changes. Some Republicans have called for more tax relief, and have major tax cuts in the works.

How legislative goals will shake out should be known soon. Spending targets were to start coming out in early March.

Best Life Alliance, a statewide coalition advocating for community-based services that support Minnesotans with disabilities, responded to the budget surplus announcement by calling for funding to address the serious staff shortages and low wages affecting home and community-based services for people with disabilities. Best Life Alliance Chair and parent Pam Gonnella said it is critical that lawmakers invest in home and community-based services that affect thousands of people with disabilities across the state, including her own daughter. “If we don’t address the workforce shortage, the entire system will fall apart,” Gonnella said.