Do you visit a state park? Do you travel on Metro Mobility? Do you have a child in the Medical Assistance Tax Equity and Fiscal Responsibility Act program, known as MA – TEFRA?
Do you or a family member use incontinence product? If you answered yes to any of these questions, you were likely following the work of state lawmakers this session.
For Minnesotans with disabilities, the end of the Minnesota Legislature’s 2019 session brought decidedly mixed results. While there is happiness over many gains this year, including additional wages for support staff and preservation of the health care provider tax, there’s also the disappointment over measures that didn’t pass. The shelved priorities range from improved local government website access to legalizing marijuana plants for medicinal use.
The 2019 Minnesota Legislature met for five months and then held a special session, completing its work the morning of May 25 after a 21-hour marathon. The main event for 2019 was the $48.3 billion two-year budget, which is encompassed by several bills. Health and human services (HHS) spending is the largest share, at about 40 percent.
Here’s an overview of disability-related legislation wins and losses. It was very different from 2018, when a contentious fight between state lawmakers and Gov. Mark Dayton resulted in almost everything falling to the veto pen.
Medical supplies and equipment providers were hard-hit in recent years by restrictions from the federal Centers for Medicare and Medicaid Services, as well as state laws. The restrictions have made it difficult for people with disabilities to get the products they need, and has forced longtime supply companies out of business.
Lawmakers repealed the unpopular Preferred Incontinence Purchasing Program (PIPP). The program, adopted in 2017, was widely criticized for not providing choice and flexibility for consumers. Some feared negative health impacts from inferior personal care products. Legislation has also restricted the Department of Human Services from using its competitive bidding authority on this category of products in the future. Those are big wins for providers involved in the Midwest Association for Medical Equipment Services and Supplies (MAMES).
Also, the legislature chose to comply with the federal 21st Century Cures Act by reducing payments to certain durable medical equipment subject to Medicare’s competitive bidding program. The payments will be reduced as of July 1 to the Medicare rate. This is a 25-50 percent reduction for most if not all of these codes. The change affects dozens of items. More on this change will be in the July issue of Access Press.
One of the session’s biggest disappointments is the failure to pass an emergency insulin program. Although the effort had bipartisanship support in the House and Senate, it wasn’t enough. Supporters vowed that they’ll be back in 2020.
High costs of insulin, and deaths of Minnesotans who had to ration or skip medication, drove the measure forward. It would have required insulin manufacturers to pay for a program that offers emergency access to uninsured diabetics or those who can’t afford their medication.
Although there was agreement that such an emergency measure is needed, it wasn’t in the final HHS bill. Nor could agreement be reached early in the morning of May 25 to include it. The measure failed 33-34 in the Senate, and then failed in the House. Having a second special session to address the need has been raised.
Mental health advocates can celebrate many gains. One big win was a major increase in funding for suicide prevention, with $5.6 million in the first biennium and $7.46 million in the second biennium.
Another key win is a funding increase for school-linked mental health services. There will be $1.21 million in the next two years and $9.6 million in the following biennium along with expansion of who can apply for grants, what grant funding can be used for and an analysis of the program going forward. Also, there is $250,000 for youth shelter-linked mental health treatment.
Sustaining the Certified Community Behavioral Health Clinics (CCBHCs), and gaining funding for intensive children’s mental health treatment and 150 new psychiatric residential treatment facility beds are other accomplishments. See the entire list here.
Familiar issues, big wins
The HHS omnibus bill addresses measures that disability advocate groups have worked on for years, to keep Minnesotans with disabilities and their families from living in poverty. One victory is funding to increase the Medical Assistance spend-down to 100 percent of federal poverty guidelines by July 1, 2022.
That has been a goal of the Minnesota Consortium for Citizens with Disabilities and other groups for years.
Funding was provided to reduce parental fees for MA-TEFRA and HCBS waivers by 15 percent. Money is also earmarked to streamline MA-TEFRA enrollment and renewal. MA-TEFRA has long been criticized for forcing families into poverty, so that they can obtain services for their children. The Minnesota Family Investment Program (MFIP) cash assistance program will also see increases.
Elders will see more protections, thanks in large part to a series of articles by the Star Tribune that exposed problems. Assisted living facilities will now be licensed. Minnesota is the last state to put such licensing in place.
Elders also now have the right to have cameras in their living spaces. That is part of a larger consumer protection measure in a bill of rights for elders.
Rare diseases council
A rare disease advisory council was created during the regular session, to advocate for the research and treatment of rare diseases. The Chloe Barnes Advisory Council’s establishment was led by Hopkins mother Erica Barnes, whose young daughter Chloe died of metachromatic leukodystrophy, a rare degenerative neural disorder similar to ALS. The little girl died within six weeks of her diagnosis, right after she had her second birthday.
Erica Barnes’ advocacy first began by Chloe’s Fight Rare Disease Foundation to fund University of Minnesota research on rare genetic childhood diseases. “Knowing that 1 in 10 Minnesotans are affected by a rare disease and knowing there 7,000 rare diseases and 500 treatments, that is just a really bad ratio,” she told KARE-11 News earlier this year.
The state’s medical marijuana program will be allowed to expand, with the ability for the state’s two medical cannabis manufacturers to open twice as many dispensaries, buy hemp locally and write off some expenses.
State lawmakers on the last day of the regular session agreed to create a fund for opioid addiction treatment and prevention. About $20 million is to be raised annually through fees assessed to the drug companies. Prevention strategies to reduce opioid addiction and deaths are a focus, along with helping children and family affected by the opioid crisis.
A quest to gain $19.5 million in access improvements for Minnesota state parks was set aside, along with the rest of a roughly $500 million bonding bill. Even-numbered years are typically bonding years in Minnesota, but a wide range of statewide infrastructure needs prompted House members to bring a bill forward.
Minnesota Council on Disability has made state parks access one of its priorities, and had hoped to build on success from 2018. The proposal will be brought back in 2020.
The lack of a bonding bill also means that accessibility improvements needed for the state capitol complex tunnel system will also have to wait for at least another year. Parts of the tunnel are hard to navigate for people who use wheelchairs and walkers.
Despite a high-profile launch, efforts to raise the gas tax by 20 cents per gallon were curbed by the Senate. Walz and House leadership said the tax, which they touted as the way to get state roads and bridges fixed, will be back in 2020.
A push for a Twin Cities area tax increase to support mass transit also stalled. So did efforts to promote autonomous or driverless motor vehicles, which are seen as boon for people who cannot drive themselves to destinations.
One bright spot is that the state budget will now provide a separate appropriation for Metro Mobility. That will alleviate pressure on the budget for the regular bus and rail system. Metro Mobility also received a one-time funding increase for the next two-year budget cycle to meet increased demand.
Another change is that Metro Mobility will expand its service into Lakeville. Another change allows Metropolitan Council and Minnesota DHS to share data to access federal funds for eligible Metro Mobility rides.
“I’m pleased we were able to prioritize people with disabilities, by fully funding Metro Mobility and separating it from the regional transit budget,” said Metropolitan Council Nora Slawik. “Demand for Metro Mobility service continues to grow, and this separate line item will assure Metro Mobility doesn’t compete with funding for regular route transit. Community prosperity relies on fully funding Metro Mobility and our bus system.”
Increased funding for special education, resulting in $91 million over base in the first biennium (2020-2021), and over $142 million over base in second biennium (2022-2023) is a victory for advocates. There is $90 million to address the cross-subsidy, which is how much school districts have to pay to cover unfunded state and federal mandates. The gap has grown to more than $800 million statewide.
Look for more legislative roundup coverage in the July issue, as new laws start to take effect.