'Savings' would reduce choice, access to needed medical items

'Savings' would reduce choice, access to needed medical items

In the midst of the COVID-19 pandemic, the Minnesota Department of Human Services (DHS) is championing a pair of proposals it made to a state panel charged with saving $100 million in DHS spending. These proposals, if implemented, would reduce access to needed medical equipment and supplies for Minnesotans who rely on Medical Assistance, especially disabled Minnesotans. 

A little background: A year ago, as part of the deal that resolved Minnesota’s budget impasse, legislative leaders and Gov. Tim Walz agreed to create a Blue Ribbon Commission on Health and Human Services. Among other things, the panel was directed to identify “significant cost drivers” of state health spending in order to save $100 million over the next two years. 

By last fall, the 17-member commission had been chosen and given the opportunity to pour over more than 250 strategies submitted by commission members and the public. Not surprisingly, none of these proposals targeted spending on medical equipment or supplies, because this spending constitutes no more than 3 percent of DHS health care spending. 

DHS, working with a consultant the agency hired, rejected most of the panel’s proposals out of hand. Among the 18 “strategies” identified in the commission’s draft final report were two that weren’t even in the original 250-plus strategies. Both of these proposals returned to a favorite target of DHS: the providers of home medical equipment and supplies and the disabled community they serve. 

The proposals: 

  • Implement volume purchasing of durable medical equipment, such as enteral nutrition, wound care supplies and standard wheelchairs and walkers. 
  • Lower Medicaid payment rates for certain categories of durable medical equipment to match Medicare rates. 

Setting aside the fact that neither of these proposals target “significant cost drivers” of state health spending, DHS is fuzzy on what it thinks it can save with these measures, suggesting a savings of between $1 million and $10 million for each. DHS has failed to provide any evidence to support these savings estimates or how it could reduce spending on these items without reducing access and choice for Minnesotans who rely on Medical Assistance for these items. 

This was the case in 2017 when they proposed the Preferred Provider Incontinence program, which resulted in a lawsuit and injunction against DHS and the retraction of this program. DHS could not substantiate what savings this program would effect, but it would have a major impact on access to products/services for 40,000 Medicaid beneficiaries. So given the history you can expect that if these BRC proposals were implemented they would 1) save little if any money; and 2) would reduce choice and thereby access to these needed medical items. 

While doing nothing to target real “cost drivers” of the health care budget, the consequences of these proposals would be devastating for Medical Assistance beneficiaries who need medical equipment and supplies as well as the Minnesota small businesses that provide these items to the beneficiaries. 

The alleged savings by applying Medicare rates for medical equipment and supplies would be minimal because most items paid for by Medicaid already are reimbursed at Medicare rates. The few items that do have different rates have different rates for good reason. The federal government originally assigned Medicare and Medicaid rates differently for certain supplies because the populations these programs serve are different, and the costs of providing care also are different. For instance, Medicare may have one reimbursement rate for basic feeding tubes, but those rates do not come close to covering the cost of specialized feeding tubes that many disabled Medicaid beneficiaries require. 

Any plan to reduce reimbursement to Medicare levels for these types of specialized items will reduce access and harm care for vulnerable Minnesotans. It also would harm the many small businesses around the state who provide these needed medical equipment and supplies. 

By the time you read this, the comment period on the commission’s draft report will have ended. But it’s not too late to contact commission members you know, and it’s not too early for you to contact your legislators — tell them about your reliance on home medical equipment and supplies. Explain how these dangerous and misguided proposals would threaten your ability to remain at home. 

DHS must not be allowed to undermine access to needed medical equipment and supplies based on dubious claims of savings 


Rose Schafhauser wrote this on behalf of the Midwest Association for Medical Equipment Services and Supplies (MAMES).