Tough decisions lie ahead as the Minnesota Legislature heads into its final weeks. While a compromise has been reached to preserve at least part of General Assistance Medical Care (GAMC), action is expected soon on the potentially most difficult and contentious cuts, those to health and human services and K-12 education.
By state law the session must end by May 18. Numerous bills affecting the disability community are still in play, including proposals that will affect areas ranging from personal care attendant (PCA) programs to transportation.
Disability community members and advocacy groups will be watching closely and are planning a stepped-up presence at the capitol. Minnesota Consortium for Citizens with Disabilities continues its regular Tuesdays at the capitol, encouraging self-advocates to tell their stories and make their issues known.
One of the biggest issues of the session was resolved in early March when Gov. Tim Pawlenty and state lawmakers reached agreement on General Assistance Medical Care (GAMC). The compromise GAMC program will provide stripped-down services to fewer clients. The program budget was slashed from $400 million to $132 million. While most advocates say it’s not the solution they wanted, it is what they will have to live with.
The new GAMC program not only means fewer people will be served, it also meant reductions in payments to hospitals and other health care providers, cutbacks to county mental health funding, and other service changes. GAMC serves Minnesota’s poorest and most chronically ill residents, many with disabilities. Ending the programs entirely, as Pawlenty had proposed, brought protests from advocates and the health care community. Some current GAMC recipients will be moved to MinnesotaCare, but some may not even be able to afford that program.
What could affect GAMC is if state lawmakers decide to opt in to federal Medicaid funds, which would require additional state funds to match the federal dollars. That is something Minnesota’s counties are watching closely.
More budget battles are ahead. One proposal calls for eliminating General Assistance (GA) and cutting state assistance for low-income families with disabled children, substituting one-time emergency assistance. GA gives $203 per month to about 19,000 adults with disabilities or serious illness. This would only allow these individuals to receive emergency funds once a year.
About 4,500 families with children would lose their income through Minnesota Family Investment Program or MFIP. This cut would force families to live on the small amount their children receive from Social Security.
What is driving all of these cuts is the state’s budget deficit. Pawlenty and legislators continue to struggle with a budget deficit that is at about $994 million for the biennium. About one-third of that amount was addressed in late March as the governor signed budget bills that will reduce the state’s nearly $1 billion budget deficit by $312 million in fiscal year 2010-11 and $419 million in fiscal year 2012-13. Those bills covered issues including courts, local government aid, and aid to counties, higher education, housing, corrections and natural resources. The cuts to these programs totaled about $312 million, leaving $682 million yet to cut.
As of early April it wasn’t clear how the agreed-upon cuts would affect the disability community. One of the areas that has to be weighed is that of funding for Minnesota’s counties, which deliver many health and human services programs. Counties use county program aid dollars to deliver these services. How services would be affected won’t be know for some time and will vary by county.
The cuts ahead
Lawmakers returned to the capitol April 6 with the intent on focusing on the rest of the deficit, namely spending on health and human services and K-12 education. These two areas make up about 70 percent of the state budget, so cuts will have a major impact on how the deficit is addressed.
As of early April the House had proposed a target of $155 million in cuts for health and human services and $1 million for K-12 education, with the Senate expected to bring forward cuts of about $200 million for health and human services. As Access Press went to press the amount of Senate cuts, if any, for K-12 education wasn’t known. Special education advocates are keeping a close eye on any cuts to those programs.
One wild card in the ongoing House and Senate health and human and K-12 education budgets is that Congress has not yet finished work on important Medical Assistance funds. Federal decisions would likely reduce cuts in health and human services necessary to help address Minnesota’s budget deficit.
Pawlenty had proposed cutting $330 million from health and human services, including sweeping changes to the PCA program, elimination of physical, occupational and speech therapies for Medicaid clients, a 2.5 percent provider rate cuts and many other cuts.
One huge challenge for lawmakers is the need to make cuts with a long-term impact. All of the cuts being made are against a background of potentially deeper cuts in the future, of about $5-6 billion for the following biennium.
Decisions at the federal level could help Minnesota’s budget situation and could dictate when health and human services decisions are made. State officials expect Minnesota to receive about $400 Million in increased Federal Medical Assistance Payments (FMAP) for the Medical Assistance program. Current federal stimulus increase in FMAP expires at the end of 2010. The increase FMAP provides Minnesota with a federal Medicaid match of 60 cents for every 40 cents Minnesota spends for Medical Assistance services. This is an increase, due to federal stimulus funding, over the usual 50 cent federal to 50 cent state match.
It appears that an extension of the increased FMAP will be adopted by Congress in a second Jobs Bill, by the end of April. State officials expect FMAP to be extended for at least an additional six months of 2011. Because the increase in FMAP would bring the state nearly $400 million, it is unlikely state lawmakers will finalize their budget reductions for health and human services until the amount of increased FMAP has passed Congress. Once Minnesota’s House and Senate complete action on their budget bills, the differences will be resolved in a conference committee and negotiations with the governor will likely occur to resolve the state budget deficit.
Minnesota’s many disability service organizations are zeroing in on the cuts that would most affect them and their clients. The Arc of Minnesota is raising a number of concerns, with several family members testifying at a March State Office Building press conference.
Courage Center is informing its constituents of the need to preserve the various rehabilitation therapies slated for cuts by the governor. In a recent update, Courage Center officials stated, “Much of our work as an organization is focused on maximizing independence and returning individuals to the community. Rehabilitation therapies play a key role in accomplishing these goals. More than 35% of our clients rely solely on MA as their source of insurance. Taking such services away would result in increased severity of disabilities, development of preventable secondary conditions, and increased costs over time.”
Other key bills await action. A bill containing PCA changes developed by a work group through MN CCD is making it way through both the House and Senate. The PCA changes had to be cost neutral because of the state’s budget shortfall. Proposed changes to fill gaps in the PCA program for those who lose eligibility or too many hours of care, due to the substantial cuts enacted during the 2009 Session were removed from both bills.
The remaining no-cost provisions include clarifying definitions of:
• extended PCA services for those using home and community waiver programs; and
• wages and benefits to allow PCA providers to comply with a 2009 provision requiring that 72.5 percent of all Medical Assistance revenue be provided in PCA wages and benefits to PCA staff.
Language clarifying that recipients’ need for services is on an “ongoing” basis rather than a “daily basis” has been included in both bills, as well as minor changes in the supervision requirements for PCA’s by qualified professionals. The bills make modifications to various training requirement for qualified professionals, PCA agency owners and managers and enrollment requirements related to recipient rights. In addition, the PCA Choice Option section of the law has clarifying language regarding the recipient’s responsibilities and the written agreement for hiring and firing of staff and removes the qualified professional position from PCA Choice recipient hiring and firing authority. Finally, the bill requires that the Department of Human Services (DHS) provide a service agreement authorizing PCA hours of service pending appeal when requested by a recipient. While none of these changes will alleviate the serious problems for some PCA users due to the cuts enacted in 2009, they will improve the operation of PCA services.
It is important to remember that the Legislature required the development of alternative services for those with mental illness or behavioral issues who have been or will be terminated from PCA services. The report is due on January 15, 2011, with alternative services required by July 2011. About $8 million was set aside for the biennium, beginning in July 2011 to use as state Medical Assistance match for these alternative services. DHS is required to consult with interested stakeholders in the development of PCA alternatives.
A modest change in the Medical Assistance for Employed Persons with Disabilities (MA-EPD) bill, would allow MA-EPD enrollees who turn 65 to retain the assets they were able to accumulate while on MA-EPD for at least 24 months prior to their 65th birthday. The asset retention provision has been removed due to cost. This provision would have cost over $100,000 for this biennium and about $140,000 in the next biennium. All that remains of the MA-EPD bill now is a clarification in eligibility for MA-EPD to assure that a working person whose disability qualifies under Social Security standards is not excluded from the state disability determination process due to earnings or assets and a requirement that beginning two years before turning age 65, enrollees receive a notice annually of the income and asset changes when MA-EPD ends at age 65.
Many other bills affecting persons with disabilities in areas such as transportation, service animals, special education, residential services, are moving through legislative committees, but the all important budget decisions are still ahead. Because the budget deficit is deep, it is clear that many important services and programs for persons with disabilities will be cut.
For more information on legislation affecting the disability community, visit www.mn-ccd.org for Action Alerts. [Information from MN CCD was used in this article.]