On February 1 I testified on behalf of Minnesota Consortium for Citizens with Disabilities (MNCCD) before the Senate Committee on Human Services Reform and Policy. We support the governor’s budget increase for Minnesota Supplemental Aid—Housing Assistance (MSA-HA), but we also request consideration for MNCCD’s other top priorities: Enhancements and upgrades to Consumer Directed Community Supports which would allow more choice particularly for adolescents transitioning into adult services; and increases in the income and asset limits for Medical Assistance (MA) spenddowns so that people with disabilities can keep more of their own income and savings to live in the community. These programs are not new mandates or initiatives, but enhancements to already existing programs.

Here are my thoughts as an individual. I appreciate the challenges legislators face. In my 40-year career in health and human services, as well as service on the Rochester School Board, I am keenly aware of the in balancing constant requests for increases in funding with resources at hand.

There is a constant dilemma in deciding what needs to be funded by taxpayers, and what should be individual and family responsibilities. What is the proper balance? It goes to the heart of who we are. I ask that you ponder this question: Should persons with disabilities have to live in poverty to get the services and supports they need?

I understand if people dohave the means to pay for at least a portion of their support they should do so. But I also contend that the balance is way out of whack and puts an undue burden on persons with disabilities, as well as seniors who need MA services. About 12,200 people including 7,100 people with disabilities and 4,700 seniors are impacted by the MA spend-down. The spend down limit for persons with disabilities is $792 and month (80 percent of the federal poverty guideline), with a limit of $3,000 in savings. HF 225 and SF 250 would change MA so people can keep $990 a month of social security income and $10,000 of savings. This is a step in the right direction, but will hardly allow for persons with disabilities to pay for anything more than the basics.

The recent ABLE act allowing people to build up savings over time without loss of benefits is welcomed. However, in order to build up savings you must have something left over to save. At $792 a month after paying for rent, utilities, food, clothing and other expenses, where is the “left over” to save?

We’ve built much of our health and human services infrastructure on Medicaid funding, and Medicaid is means-tested. When I was state director of mental health in Utah, a veteran colleagues said the mantra was: If it moves, Medicaid it. The “free” federal match seduced everyone. But now the chickens have come home to roost with the looming possibility of block granting Medicaid to the states. If that happens, Minnesota stands to lose $5 billion a year, nearly half the current health and human services budget. What then?

Medicaid may currently be an entitlement, but it is also means-tested. You have to be poor, or spend down enough income and assets to be poor, in order to qualify. And if you are a middle-class family with a child with disabilities who qualifies for TEFRA you must pay a large parental fee while still paying health insurance premiums, in effect paying double for the services your child needs. If you are an adult with disabilities, services supported by Medicaid are vital to your ability to work and live in the community, or even just live. Many have no other options. And the government, through the Olmstead decree, says you have a right to live in the community if you so choose. You may have that right, but what good is it if you can’t exercise it because you can’t get services?

Some may say that the taxpayers should not be funding entitlements, that everything should be means-tested. However there are other entitlements that are not means-tested: VA benefits and Medicare are examples.

Here are a few suggestions to guide legislative decisions:
• Is the program or service cost-effective?
• Does it duplicate other services that are easily accessed?
• Is it an investment in long-term cost savings?
• Do we have a moral obligation to this population?
• Do we have a legal obligation to this population?
• Is the mechanism we’ve established to determine eligibility efficient and without undue red tape?
• Is there a mechanism to assure accountability, and protect against waste, fraud and abuse?
• Are there sufficient funds to assure that the infrastructure that has been built up to sustain the service?
• Is there a public/private partnership that shares responsibility for providing the services and supports?
• Will providing this service help integrate people into the community and preserve and protect families?

When you apply the above principles to the priorities we’ve outlined for helping people with disabilities live in the community, and to help children with disabilities get the services they need, the answer is all the boxes are checked.


Randall W. Bachman, Afton (This letter was excerpted from a longer letter to Sen. Jim Abeler.)