More oversight is needed for programs that provide care and services for people with disabilities and the elderly, according to a report from the state’s legislative auditor. The 84-page report, which focused on $2.4 billion in home and community-based services spending and providers, was hailed by disability coalitions ARRM and Best Life Alliance for shedding light on key issues.
The legislative auditor’s investigation found that the Minnesota Department of Human Services (DHS) doesn’t adequately regulate workers who go into clients’ homes. Nor does it provide adequate financial oversight of organizations that provide services.
A major finding of the report is that home and community-based service as they are now don’t always equate to more independence for persons with disabilities, and that Minnesota is behind in the areas of employment and integration of housing. Nationally, 67 percent of persons with intellectual or developmental disabilities live with their families or in their own homes. In Minnesota that number is 44 percent.
The red flags on employment center less on the number of people with disabilities who work, but instead on where they are employed. The report cities the state’s high number of sheltered workshops, many of which pay less than minimum wage. That means many workers with disabilities are segregated from the rest of the population.
Another red flag is lack of accountability. DHS doesn’t regularly investigate home and community-based service providers, or require that routine financial documentation be submitted. The legislative auditor found that DHS investigations only occur when it learns of a problem, through complaints or processing of payment claims. A concern raised in the report is the potential for fraud, as financial information on Medicaid-supported services isn’t always available.
Similar issues were raised in a 2009 legislative auditor’s report on the personal care attendant program, which revealed fraud. The findings led to more controls over that program.
The legislative auditor recommends extending similar checks and balances to other care staff who work in clients’ homes. Home and community-based workers would enroll with DHS, document their services and have limits on hours billable to the state.
Another recommendation is for development of a standardized menu of home and community-based services for people with disabilities and the elderly. Currently those services are obtained through separate waiver programs.
“The Best Life Alliance thanks the legislative auditor for its report and especially appreciates the attention paid to staff shortages, low wages and demanding work that complicates HCBS providers’ ability to hire enough staff,” said Best Life Alliance Chairperson Pam Gonnella. “This underscores even more the need for action now to stabilize these critical services that help people like my daughter and thousands of other individuals across the state.”
Best Life Alliance is working to increase caregiver wages, from an average of $12.32 per hour, and to improve insurance coverage for caregivers. The failure for wages to keep up with other job sectors has created a major workforce shortage and instability in these services. The situation is especially dire in rural Minnesota.
ARRM, an association representing more than 200 direct care providers and supporting service providers for people with disabilities in Minnesota, also expressed thanks for the report and reaffirmed a commitment to address the report’s findings.
“We are pleased the legislative auditor chose to address the workforce shortage, as this is the most pressing issue for home and community-based services,” said Cheryl Pray, ARRM CEO. “The recommendations for more regular study of workforce needs and direct care wages will serve us well down the road, although ARRM has the data now that shows we need to take action.”
ARRM has already introduced a set of policy reforms to help address some of the workforce shortage issues, such as excessive background check wait times and over regulation of how friends and family interact with people with disabilities (SF 359 / HF 696).
Minnesota spent $2.4 billion in fiscal year 2015, to help roughly 64,000 Minnesotans live in their home communities and not in institutions. That’s a higher share of Medicaid spending than most states allot for such services. The funds cover a wide variety of community- based services, which range from occupational therapies to transportation to jobs.
The report was presented February 21 to the House Health and Human Services Finance Committee. Representatives agreed with the report’s findings that people aren’t being served in the most integrated setting possible. Assistant DHS Commissioner Claire Wilson told the committee that DHS also supports the report’s finding and recommendations. She said the current system has taken years to get to this point, and that it is still evolving.
Disability coalitions said they look forward to working with DHS and state lawmakers to implement the report’s finding. “We look forward to partnering with DHS and the legislature to address the issues raised in the report,” said Pray. “ARRM prides itself in representing the best in the business when it comes to providing services to people with disabilities and putting their interests first. Our goal is to support the network of services that help people achieve their goals, and ensure regulations provide adequate safeguards and oversight.”
“Consistent, quality direct-care staff are the foundation of community-based services for people with disabilities,” Gonnella said. “If we don’t address the workforce shortage, the entire system will crumble. Just like maintenance of roads and bridges, we must invest today in order to have a sustainable system. People’s lives are really on the line.”
Read the report here: