Prudent budget-cutting measures or irresponsible attack on the lives of people with disabilities? A report on proposed health care spending cuts is sparking intense debate throughout Minnesota, as sweeping changes are proposed to state programs.
The report, “Minnesota’s Healthcare Imperative,” contains specific proposals for potential cost savings from within Minnesota’s current public health care system in the face of the state’s $6.2 billion deficit. HealthPartners, Allina, Blue Cross and Blue Shield of Minnesota, Fairview, Medica, Park Nicollet and UCare, outlined $1.8 billion savings in service cuts and tax increases in the report. Representatives of those organizations contend that a change is needed to hold down the costs of health care, starting with changes to state programs.
Some report recommendations are seen by disability advocates as threatening the ability for many Minnesotans with disabilities to live independently. The report was criticized at a January 31 press conference hosted by a number of disability community groups. Representatives also met with Lt. Governor Yvonne Prettner Solon and Minnesota Department of Health leaders in early February to discuss the report.
Representatives of the report’s authors haven’t contacted the Minnesota Consortium for Citizens with Disabilities (MN-CCD) or other groups to discuss the report, said Steve Larson, public policy director for The Arc of Minnesota and co-chair of MN-CCD. That is prompting much frustration.
The report sponsors contend their recommendations would hold down health care costs. But the lack of public participation, and that fact that the organizations would likely profit from the changes, upsets many.
“It is infuriating when decisions about our state health care system are being made about us, without us,” said Corbett Laubignat from the Minnesota Center for Independent Living (MCIL).
“This report is extremely troubling,” said Larson. “It proposes cuts that currently help Minnesotans with disabilities live independently. It fails to provide factual data to back up the proposed savings it claims. It was developed under a closed process that didn’t involve the disability community and other affected stakeholders. And it seems to allow the HMOs to profit from its recommended budget cuts.”
Anne Henry, attorney with the Minnesota Disability Law Center, calls the report’s recommendations for disability services “nothing short of an irresponsible attack on persons with disabilities in our state.” She said those recommendations in the report are full of mistakes and shoddily researched, with misinformation about services used in the Medical Assistance program.
“The fact that this report reflects such a poor understanding of the MA program for person with disabilities makes it all the more disturbing,” she said. “The arrogance of these misinformed recommendations is stunning and very troubling.” Henry also criticized a suggestion that the state should require authorization of PCA services and limit hours people can obtain. “Anyone with a passing knowledge of Minnesota’s PCA services knows that all services must be prior authorized by a county nurse and the hours are strictly limited by a rigid assessment.”
In a written statement, a spokesperson for the seven report authors said, “We continue to support the public process that addresses the issue of health care and the budget shortfall. If better data can be found, it by all means should be considered.”
Others say the report lacks understanding of the issues people with disabilities face. “It must be recognized that many persons with disabilities not only have complex medical conditions, but also need services and supports to live in the community and be contributing members of society,” said Randy Bachmann, Executive Director of AXIS Health Care. “If we’re only looking at the cost of care we are missing the bigger picture of the value these citizens bring to all of us—some through employment, some through other types of engagement. If we think it is too expensive to provide people with disabilities with the supports they need to live at their homes, then are we willing to go back to institutionalization?”
Self-advocates, Nichole Villavicencio called the proposed cuts “frightening,” adding, “I’m tired of the legislature telling me to compromise my quality of life.”
Jenna Johnson and her mother, Cindy Johnson are already impacted by cuts to funding for Jenna’s care. Jenna Johnson holds a job and has her own apartment but that could change. Cindy Johnson said their experience with managed care has been that it amounts to “rationing of care.”
One significant recommendation would move individuals with disabilities who currently access services through a fee-for-service model into a managed care model. There are also fears that could move people out of their home communities and back into institutions.
“The disability community is eager to engage in discussions with HMO leaders about ideas for saving money on our health care and long-term support programs – ideas on which the disability community is working diligently,” said Larson. “We have no illusions about the size of the deficit that Minnesota currently faces. But our ideas for changing disability services could achieve cost savings without undermining the services that help make [community] life possible for people with disabilities and their families, and which Minnesota has worked so hard to establish.”
Changing to more managed care would save the state about $300 million, according to the report. CCD’s argument is that that Minnesota hasn’t yet perfected the technique of matching provider payments with needs of complex individuals. One example is that of the financial collapse of Minnesota Disability Healthcare Option or MnDHO, a managed care program for Minnesotans with disabilities.
Bachman cites the end of MnDHO as a lesson. “Persons with disabilities currently have a choice to enrolled in managed care or be on fee for service Medicaid,” he said. “Many choose to enroll in managed care to have the care coordination that AXIS Healthcare provides. However with the closure of the MnDHO program, people have experienced a disintegration of the integrated experience they had under MnDHO. If health plans propose to expand their services to all persons with disabilities through mandatory enrollment, they and DHS must ask themselves why MnDHO went away and what were the lessons learned? Otherwise, history will repeat itself.”
“The key is consumer choice and self direction,” Bachmann added. “Consumer-directed services can be efficient and effective if properly managed, regardless of the payment mechanism. To force everyone into a one size fits all program is counter to the principles of self-determination.”
Another proposal in the report would reduce spending on a specific disability program called “waivered services” by five percent—despite the fact that there is no evidence to support the report’s claim that reducing up-front costs in these programs will save costs in the long-term. An additional proposal to cut dental and rehabilitation therapy benefits for Minnesotans with disabilities left disability advocates baffled, saying it won’t create long-term savings.