We have all seen it–some have even tried to stop it–but the reality is some people with disabilities in Minnesota have faced significant budget cuts and resulting changes in MinnesotaCare, Medical Assistance, Metro Mobility and Greater Minnesota transit services, just to name a few. After three years of budget deficits, the state is facing another $700 million deficit this session. But now a comprehensive plan is being developed to improve services to people with disabilities and not continue to make cuts to key programs.
When you look at how the legislature is structured, you have health issues in one committee, transportation issues in another committee and employment issues in yet another committee and then housing in another committee. For many people with disabilities, access to health care, transportation, employment and housing are issues of equal importance. Maintaining these issues is a constant balancing act, and for many, the budget cuts of the past three years have decreased access in these critical areas. Many legislators never see the whole picture because they only see a narrow slice of the issues, such as transportation or health care.
The Minnesota Consortium for Citizens with Disabilities (MN-CCD) is developing a comprehensive plan to help legislators see the whole picture of both the negative impacts of budget cuts and the positive solutions we are proposing for 2005. The MN-CCD is a coalition of nearly 40 disability organizations and providers that work at the capitol on a variety of disability issues. The coalition has been working since April to identify key issues for people with disabilities and how changes in public policy could improve their lives. In September, the MN-CCD approved almost 65 pages of position papers with solutions to some very complex problems.
For some individuals, there is a role for government to help support them in their home and community. It is the strong belief of the MN-CCD that public policies should support the cost-effective delivery of these services with results that produce positive health and independence outcomes for the individual with disabilities. The 1999 U.S. Supreme Court Olmstead decision mandated that states deliver services to individuals with disabilities in the ‘least restrictive setting.’ The State of Minnesota has made great strides toward this goal of delivering community-based care, but needs to do more. While 48 states have adopted comprehensive plans to address the Olmstead decision, Minnesota has not. The following outlines a multi-pronged approach that is based on a few fundamental principles:
Access to Needed Services:
Individuals with disabilities have the same hopes and desires as their non-disabled peers. They want to be healthy, safe, and participate actively in their communities. Doing so often means reliance on multiple public programs and services, such as Medical Assistance, Metro Mobility, or Vocational Rehabilitation Services. In many cases, a person may need all three of these programs to be functioning properly in order to keep a job and earn a paycheck. Access to essential programs and services is critical for individuals to be successful in the community and to remain independent. The recommendations here reflect a holistic approach and acknowledgment that coordinating these systems and understanding how they interact is crucial to supporting Minnesotans with disabilities.
Empowerment and Choice:
Minnesotans with disabilities and those who support them ought to be held accountable for their decisions, but need and deserve to have enough financial control over the support services they require to maximize their ability to function as productive and contributing members of society. Certain options exist within the Medical Assistance program, such as PCA Choice and Consumer Directed Community Support options that are consistent with this philosophy. They must also include enough policy oversight to ensure the safety of program participants.
Quality of Care:
Access to services and choice of providers will only be meaningful if there are services in the marketplace competing not just on the basis of price or risk but on quality, particularly in the area of health care. Quality must be demonstrated (and measurable) on the part of health care and disability service providers, but for those who rely heavily on state public program reimbursement, there is a limited ability to affect quality of care. True market forces don’t apply to providers who cannot raise prices to compensate for the ever escalating fixed costs associated with running their businesses. In many cases these reimbursement rates are directly linked with the wages paid to employees providing care to individuals with disabilities. Quality of care is not just a function of regulatory reform, but also of targeted state investments in critical direct care services.
With these ideas as a framework, the MN-CCD has adopted several recommendations that will advance the needs of Minnesotans with disabilities, including:
* A state-level commission to formulate a plan in response to the Olmstead decision. This body, similar in composition to the Long-Term Care Task force of 2001, would formulate a comprehensive plan to meet the program and policy needs of the non-elderly disabled;
* De-institutionalizing the non-elderly population of individuals with disabilities in nursing homes. Currently, there are 2,600 Minnesotans under the age of 65 who call a nursing home their home;
* A dedicated funding source for Metro Mobility, the door-to-door para-transit service for 18,000 individuals with disabilities. Currently, it is fully funded through the state’s general fund, unlike the regular route bus system which is a mix of state and county dollars;
* Greater access to transit in Greater Minnesota. Currently, several counties have no form of accessible transportation for people with disabilities. Transit funding remains static or declining. People with disabilities in rural Minnesota deserve transit options;
* Increase the assets an individual with a disability can keep to qualify for Medical Assistance. Today an individual can only retain $3,000. A couple can keep $6,000. These amounts haven’t increased since 1983;
* Better coordinate the state’s employment efforts for people with disabilities. Currently, both the Department of Human Services and Department of Employment and Economic Development share some programs and responsibilities, but have little interaction and no comprehensive vision;
* Choice of case management provider. Currently, Minnesota counties authorize services and provide case management services for individuals with disabilities. Qualified community service providers should be able to compete for this service coordination responsibility;
* Expansion of Minnesota Disability Health Options, the state’s voluntary managed care program for people with physical disabilities. Currently, it’s only available to individuals in the Metro Area. This program saves money and produces better health outcomes. More people deserve access to it;
* Lower parental fees for families with children with disabilities enrolled in the TEFRA program. Premium increases in 2003 were too steep and too punitive;
*Provide additional protections for special education students, including additional certification of qualified teachers and standards on the use of locked time out rooms.
Passage of this legislative package will depend upon legislators hearing from their constituents about the need for changes outlined in this article. Make sure that you contact your legislator and focus in on one or two of these topics and why they are important to you.
Joel Ulland is the Public Policy Director for the National Multiple Sclerosis Society, Minnesota Chapter, and serves as co-chair for the Minnesota Consortium for Citizens with Disabilities.