Mental health services, education and families fared well in Gov. Mark Dayton’s two-year, $42 billion budget. But the budget proposal met dismay from the 5% Campaign and groups calling for Medical Assistance (MA) reforms, as those priorities were left out.
When Dayton’s budget was released Jan. 27, there was relief that many disability services programs were spared cuts. But there was disappointment that more needs weren’t met.
One point made during recent testimony on the state’s Olmstead Plan, which is meant to full integrate people with disabilities into the community, is that many programs need additional support and flexible funding if Olmstead is to succeed. Concerns raised at that hearing covered topics ranging from transportation to job training and employment. A key point is that the Minnesota Department of Human Services (DHS) needs flexibility in funding as well as policies to be more inclusive and help meet the Olmstead goals.
How Dayton’s proposals and other requests will fare is still a question mark at this point. Since the budget’s release, disability community members have testified at various House and Senate Health and Human Services Committee hearings to make the case for programs and funding.
The governor’s budget also faces political battles. House Republicans criticized Dayton for spending the $1 billion state surplus and not providing more tax relief. Other interest groups will also be lobbying for additional dollars.
Disability community advocates are not only defending their gains or calling for their programs to be added, they are also watching for the February budget forecast to be released at the end of the month, After those numbers come out, Dayton will release a supplemental budget. That’s likely to change the amount of money state departments have to work with.
Mental health gets a boost
One highlight of Dayton’s proposed budget is how it would help various mental health programs. The Mental Health Legislative Network, a coalition of more than three dozen groups, was pleased with the budget. Mental health advocates have worked for many years to set up core services statewide. Dayton’s budget would fund statewide access and stabilize the provider network, and improve access to intensive services and earlier intervention.
Dayton proposed a $4.6 million increase for the biennium for mental health crisis services. This includes creating a single phone line, increasing rates for crisis services, and expanding 24/7 availability across the state. If passed, this would result in people in crisis receiving the treatment they need and diverting people from emergency rooms, hospitals and jails.
Stable housing and employment for people with mental illness are part of Dayton’s budget. Dayton proposed an increase of $1.25 million in funding into the Minnesota Housing Finance Agency for the Bridges housing program for people with mental illnesses. He also included increased funding of $1 million per year into the Department of Employment and Economic Development budget for evidence-based employment programs for people with mental illnesses.
The governor’s budget also puts an additional $2.3 million per year to expand Positive Behavior Intervention and Supports, which improves educational and behavior outcomes in schools. The governor also wants more funding for community treatment teams, respite care for families, new residential programs for children with very serious mental illnesses, adult supportive housing and behavioral health homes. About $35 million would go into various efforts for mental health.
“We thank Governor Dayton and fully support adding Psychiatric Residential Treatment Facilities to the continuum of care for children with mental illnesses. This more intensive level of care will fill a gap in services that has been recommended by multiple task forces and provide children and adolescents who have required extended hospital stays or placement out of state with effective treatment in Minnesota,” said Mary Regan, LICSW, executive director, Minnesota Council of Child Caring Agencies.
“These are important investments in our mental health system,” said Sue Abderholden, executive director of NAMI Minnesota. “This funding will greatly improve access across the state. Most importantly it funds services that have proven to be effective and addresses several of the key problems facing our system.”
Dayton’s focus on mental health comes at a time when a state panel is calling for changes that would make it easier for people to pursue psychiatry careers. Legislators recently received a 226-page report describing how the state has an acute shortage of mental health practitioners, especially in rural Minnesota.
In parts of Minnesota, clinics and hospitals have had to curtail services or even close. Catholic Charities had to close a 16-bed intensive treatment center in Fergus Falls for children with severe mental illnesses last fall. The nonprofit couldn’t recruit a program director and experienced counselors.
The March 2014 closing of Riverwood Centers, one of the state’s largest community mental health providers, left about 3,000 people in north central Minnesota without care.
All but 13 of Minnesota’s 87 counties are officially designated by the federal government as “mental health professional shortage areas,” based on the number of psychiatrists per 30,000 residents.
The report calls for increasing the number of psychiatric residency fellowships, expanding college mental health degree programs in rural areas, and more targeted efforts to expose students to mental health professions. One bill has already been introduced to respond to the report. Sen. Greg Clausen,
DFL-Apple Valley, wants to extend the state’s loan forgiveness program to mental health professionals and public health nurses. Clausen also want to introduce legislation to increase the number of psychiatric residency and fellowship slots in Minnesota over the next two years.
Other budget aspects
Dayton’s plan would provide free breakfasts for students up to third grade, increase per-pupil payments to school districts, boost reading programs, add money for autism programs and guarantee preschool access to every Minnesota four-year-old. Education would see a $373 million increase. The governor also wants to provide $32 million to hold down tuition at University of Minnesota campuses, as part of a $93 million ask. A $30 million chunk of that would pay for 50 research faculty members at the U of M Medical School.
Another proposal that met praise provides $100 million for child care and caregiver tax credits. Households earning up to $124,000 would be eligible for the credit, which would provide about $481 per family to about 130,000 families. The credits would also help families providing dependent care for families who care for members who have disabilities or are elderly.
Some advocacy groups are disappointed with what the governor is recommending. The 5% Campaign, a coalition of 131 disability, senior, and community organization, expressed unhappiness because Dayton’s budget didn’t include a rate increase for programs that support people with disabilities and older adults. The coalition will press on for the increase. Dayton has cited recent spending increases as sufficient but campaign leaders disagree.
Even with the five percent rate increase Home and Community-Based Services received last session, proponents said funding continues to lag far behind the pace of inflation. “Between 2006-2015 provider rates that pay for caregiver wages increased 10.4% while inflation rose by 23.3%. Including a rate increase in the state’s next budget is the right thing to do. It is a commitment to quality care that will help close the gap,” said Bruce Nelson, CEO of disability service association ARRM.
Home and Community-Based Services ensure quality of life and independence in the community for 93,000 older adults and people with disabilities in Minnesota. The estimated $170 million rate increase the coalition seeks would be implemented as five percent rate increases in 2015 and 2016, with the bulk of the money going to wage and benefit increases for 91,000 caregivers and staff. Chief authors of the coalition’s bills are Sen. Kent Eken (DFL-Twin Valley), and Rep. Rod Hamilton (R – Mountain Lake).
Due to past years of underfunding, caregiver wages and benefits remain low, causing high turnover and unfilled positions that continue pose a serious challenge, the campaign said in a news release. Consistent staff with low turnover is the foundation for quality care, according to campaign leaders. Because funding is determined by state reimbursement rates, service providers cannot increase caregiver pay unless it is funded by the state.
“With a projected surplus in Minnesota’s budget, now is the time to ensure that quality community services for people with disabilities and older adults continue to be available, stable, and sustainable,” said Steve Larson, senior policy director at The Arc of Minnesota. Campaign leaders hosted a session at the capitol February 10.
Bills on the move
During the first week of February, two key bills were introduced to seek changes to MA and MAEPD. MA Reform is the Minnesota Consortium for Citizens with Disabilities (MN-CCD) top priority this session. Changes are sought so that people with disabilities don’t have to spend down their assets to remain independent. Changes would affect more than 12,000 Minnesotans.
MN-CCD and its allies hope to increase the MA income standard, raise the asset limits and reduce spend-downs. The goal is to help people with disabilities and older adults to keep more of their income to live independently in the community.
2015 marks the second session in a row that MNCCD has made MA reform its top priority. MN-CCD Executive Director Rebecca Covington said that while not being in the governor’s budget means an uphill battle, campaign supporters aren’t giving up.
A state law change that took effect January 1, 2014 raised the amount that low-income Minnesotans age 18 and over without disabilities are allowed to make each month and remain eligible for Minnesota’s Medicaid Program, known as MA or Medicaid Expansion. But the law change didn’t include Minnesotans with disabilities or senior citizens. That is an equity issue as to why people with disabilities and seniors should be forced to live in deeper poverty than others who have access to the same health program.
With MA-EPD, a program meant to allow people with disabilities to work, there are worries about a premium increase that took effect last fall. Attorney Anne Henry of the Minnesota Disability Law Center said during an Olmstead hearing that when it comes to income and assets, “people with disabilities and seniors are left on the bottom of the pile.”
Henry is also part of an effort to counter a high MA-EPD premium increase, which needs to be corrected. She said the increase is hurting people who are trying to work and cover their basic costs of living. “We’ve heard from people who cannot manage their van payments,” she said.
MN-CCD is seeking stories about Minnesotans who are subject to the MA income standards and asset limits, or who have experienced increases in MAEPD premium. Those stories will be shared during the annual Faces of Disability week, March 9-13. Deadline is February 20.
More details can be found at www.mnccd.org MN-CCD is also using the hashtag* #MnAbilityMatters in its legislative work this session.
The purpose is to show that when it comes to advocacy, all abilities matter. The group is using pictures of Minnesotans with disabilities, their family members and other supporters to make the case for a number of legislative initiatives.
MN-CCD and other advocacy groups aren’t holding capitol rallies due to renovation work. One large rally is set for 10-11 a.m. at the state armory. Details can be found at www.arrm.org/arrm/training-events/arrm-dac/arrm/event/arrm-day-at-the-capitol.aspx
Of the many bills making their way through the legislative process, one likely to draw interest centers on spinal cord injury and paralysis research. Efforts to fund research in the past have fallen short, and have started debate about “care versus cure.” The Get Up Speak Up group has championed the call for research funding in the past. This session, Hennepin County Medical Center is a bill sponsor. The bill didn’t have a number as Access Press went to press.
Anyone hoping to track a bill as it goes through the legislative process can use the bill tracker featured offered on the state website, at www.leg.state.mn.us/leg/trackbill.aspx
DHS makes spending cuts
All of the debate over spending takes place against a backdrop of other issues. Just as Dayton released his budget, media reports described spending cuts at DHS. Millions of dollars are being cut to address a $19.3 million agency deficit, which is attributed to spending increase for state hospital staff, staff training and facilities in St. Peter as well as litigation centered on treatment of people with disabilities and treatment of sex offenders.
The cuts were outlined in a memo released to staff in late January. Cuts include the closing of a state psychiatric hospital for children in Willmar by year’s end. The agency will cut 43 managerial positions by mid-February and make cuts to other programs. DHS has about 4,700 workers and a biennial budget of about $28 million.
The cuts met opposition from state employees and advocates for the mentally ill. The cuts were also questioned in light of the state surplus.
One big program cut is to the Community Addiction Recovery Enterprise. Known as CARE, this program helps people who live with both chemical addictions and mental illness. It is known as a program that helps people who don’t fit into community-based or acute care programs.
Under the DHS plan, the CARE program will downsize from 174 to 70 beds by June 2016. A center near Duluth will close by April, with reductions at treatment centers in Brainerd, St. Peter and Willmar. The program has had budget shortfalls due to inadequate reimbursement rates, but Dayton’s budget would increase those rates.
The Willmar hospital closing is in Dayton’s budget, and is part of a larger change in the way children with mental illnesses are served. The 16-bed hospital has served children who have a combination of mental illnesses and developmental disabilities. The closing, which is expected to save more than $1 million per year. The beds will be replaced by contracts with hospitals.