After enduring the first partial government shutdown in state history, the 2005 special session ended July 13, 2005, with major policy advances for people with disabilities.
Several core components of the Minnesotans with Disabilities Act of 2005, the comprehensive proposal championed by the Minnesota Consortium for Citizens with Disabilities, were enacted into law, including lower parental fees for parents of kids with disabilities, choice of community provider for those leaving nursing homes, lower prescription drug co-payments and an increase in the personal needs allowance.
The legislative stalemate that extended the business of state budgeting from May into mid-July was largely caused by major differences in health care priorities. Governor Pawlenty’s desire to rein in spending would have significantly cut MinnesotaCare enrollment. House Republicans initially aligned with Pawlenty while Senate DFLers not only refused to trim public programs but demanded additional revenue. In the end, state health programs were protected and additional investments were made that rolled back some of the cuts made in 2003, largely funded by an additional 75 cents per pack charge on cigarettes. The ‘health impact fee’ will raise an estimated $401 million each year.
Of concern to Capitol advocates are limits that will be placed on the state Medical Assistance waiver programs. Access to these services, which provide access to a case manager and additional community based services, will be ‘capped’ at certain levels each month and may delay or prevent individuals from getting the health services they need. The state will save $52.7 million over the next two years by limiting enrollment for those eligible for the TBI, MR/RC and CADI waivers.
Additional funds were also directed toward transit programs, which will preserve the current Metro Mobility service area. While modest fare increases (50 cents for peak hours and 25 cents for off-peak) took effect July 1, the draconian cuts proposed earlier this year by the Metropolitan Council will not take effect.
While details on all the legislative action can be found online at www.leg.state.mn.us, the following summary highlights several key changes that will affect Minnesotans with disabilities:
Eliminates the annual $500 cap on dental services for Medical Assistance, GAMC, and MinnesotaCare enrollees. This cap has significantly limited access to dental services and resulted in increased hospital emergency room utilization.
Lower Drug Co-pays
People enrolled in Medical Assistance will pay a maximum of $12 per month regardless of their prescription needs. Currently, the cap is at $20.
More Pocket Money
Individuals receiving subsidized housing in licensed group residential setting can keep more of their money before turning it over to the state to pay for room and board. The proposal lets them keep an extra $12 per month. (Current law allows them to keep $79 each month.)
The proposal moderates monthly premium costs that parents of children with severe disabilities must pay to access needed medical services. Some increases implemented in 2003 have created tremendous hardships for middle-income families.
Increased Choice for People with Disabilities Leaving Nursing Homes
Allows for individuals to choose the targeted case management provider to help in moving out of a nursing home. Currently, counties choose to provide this service or contract with a qualified organization. Counties would retain administrative duties and approve service plans. Private agencies would coordinate the services to make sure the transition goes smoothly. More than 3,000 non-elderly individuals with disabilities languish in nursing homes today.
Transitional Support Grant
To assist individuals with disabilities in relocating from a nursing home to a more independent, community-based setting, a one-time payment up to $3,000 would be available to pay for lease or rent deposits, essential furnishings, or other transition expenses. (No net cost. Funds come from existing waiver allocations.)
Community-based Provider Rate Increases
Boosts by 2.26 percent in each of the next two fiscal years the MA rates paid to agencies delivery community-based services to people with disabilities. Most of the increase must be used to increase the compensation of direct care workers providing assistance and support to Minnesotans with disabilities. Home and community-based service providers and ICFs/MR would receive a rate increase.
Home Care Provider Rate Increases
Boosts by 5 percent the MA rates paid for in-home delivery of skilled nursing, home health aide, or physical, occupational or speech therapy. Minnesota lags behind most Upper Midwest states in payment rates for these services. Effective October 1, 2005.
Disability Services Interagency Work Group
Requires the Department of Human Services, the Minnesota Housing Finance Agency, and the Minnesota State Council on Disability to convene an inter-agency work group to make planning and policy recommendations relating to persons with disabilities who are attempting to relocate from or avoid placement in institutional settings. Requires the group to report to each participating state agency and the chairs of legislative health and human services policy and finance committees by December 15, 2006.
Case Management Re-Design
Requires the Department of Human Services to examine case management services to improve access, quality, and cost-effectiveness of delivering these services to Minnesotans with disabilities. A similar 2003 legislative mandate did not result in the policy and draft legislation recommendations called for in the report. This ensures that the 2006 legislature will revisit this issue after careful study by the department and all stakeholders.
The state is instructed to seek federal approval to expand the current voluntary managed care program for individuals with disabilities enrolled in Medical Assistance—called the Minnesota Disability Health Options (MnDHO) program—beginning with regional population centers throughout Minnesota. Currently, almost 500 high-cost, medically complex individuals are enrolled in this innovative care coordination program.