by Anne L. Henry
Minnesota’s enormous budget deficit dominated and defined the
2009 legislative session. The fiscal chasm of $6.4 billion was reduced
by federal stimulus money, resulting in a $4.6 billion gaping hole
for the Legislature to fix. State spending is projected at more than
$35 billion for the coming biennium (two years). After adopting cuts,
shifts, and tax increases to balance the budget, the Legislature adjourned
on the required date, May 18. Governor Tim Pawlenty then vetoed the
tax increases and other aspects of the Leg-islature’s appropriations,
vowing not to call a special session but to use his unallotment powers
to make further cuts of $2.7 billion on his own and balance the budget
for the next biennium beginning July 1, 2009. Despite the overall
budget standoff, the Legislature passed and Governor Pawlenty signed
many substantial cuts in health and human services programs affecting
persons with disabilities.
PCA Cuts and Changes
The personal
care assistant (PCA) program cuts will affect more than 8,000 Minnesotans
of all ages and types of disabilities who now use PCA services. In
addition to the cuts made due to the budget crisis, the recommendations
from the Office of the Legislative Auditor for more than 25 specific
changes to improve the integrity of the program and prevent identified
problems were adopted.
The PCA cuts which will have
a major impact on people with disabilities who use PCA services include:
1) a change in the way PCA hours are authorized resulting in an average
cut of two hours per day for about 6,500 persons, effective January
1, 2010; 2) a cut in eligibility phased in over two years resulting
in 500 persons cut from PCA service eligibility beginning January
1, 2010 and another 1,600 people cut off PCA services July 1, 2011;
3) a limit of 310 hours per month for which a PCA can be paid, effective
July 1, 2009. The funding of PCA services which will be cut for the
coming two-year period, beginning July 1, 2009, totals $58.6 million
in state and federal Medicaid dollars.
As part of the PCA cuts, the
Legislature reserved nearly $8 million, beginning July 1, 2011 to
be used as match for alternative services for those cut off PCA services
with mental health diagnoses or behavioral issues who need some assistance
to remain independent in the community. A stakeholders’ group will work
to develop alternative services and report to the Legislature by
January 15, 2011.
In addition to
the cuts made to meet Minnesota’s budget crisis,
major changes were made in the way PCA agencies will have to do business,
the assessment process and the operation of the program, such as
specific definitions of the tasks a PCA is allowed to perform, training
requirements and required documentation. Many of these changes are
consistent with recommendations made by the Office of the Legislative
Auditor to improve the integrity of the PCA program. Other changes
were made in the name of simplification, which will mean PCA services
in the future will be far less individually designed to meet a person’s
specific needs in their home environment. Because of changes in the
way PCA hours will be provided to eligible recipients beginning in
January 2010, people will be divided into 10 categories and given
the same amount of basic time which can be increased by 30-minute
increments based on a person’s need for complex medical procedures
or allowed behavioral monitoring. The PCA program will be much diminished
in its capacity to meet the individual needs of a wide variety of
persons in the community.
While the PCA cuts enacted
will be devastating to many, the Legislature didn’t adopt all the PCA cuts proposed
by Pawlenty. A requirement for persons who have a responsible party
designated to oversee their care, to live with that responsible party
was defeated. This cut would have eliminated more than 500 more people
from PCA services, some with very complex needs. Also, the cut in
eligibility for 1,600 people was delayed for 18 months, until July
2011. PCA cuts of more than $14 million in state dollars ($32 million
in state and federal Medicaid funds) proposed by Pawlenty weren’t
adopted by the Legislature. The efforts of the disability community
were crucial in the Legislature’s
decision not to adopt over 20% of the Governor’s PCA cuts.
GAMC Funding Vetoed for July
1, 2010
Gov. Pawlenty used his line
item veto to eliminate funding for the state-funded General Assistance
Medical Care (GAMC), beginning July 2010. The elimination of funding
for GAMC will have significant negative consequences for hospitals
and have an adverse impact on mental health services, since about
70 percent of GAMC recipients, low income adults without children,
use mental health services.
Disability Waiver Cuts
The
Legislature adopted Gov. Pawlenty’s proposal to limit disability
waiver growth by cutting funding for the Community Alternatives for
Disabled Individuals (CADI), the Developmental Disabilities (DD)
and the Traumatic Brain Injury (TBI) waivers, eliminating funding
for at least 530 people who would have become eligible for these
services over the next two years. The disability waiver programs
were cut in an unallotment action at the end of 2008, but this funding
had to be restored due to the federal stimulus maintenance of efforts
(MOE) requirements.
Provider Rate Cut and Adult
Foster Group Homes
Community supports and long-term
service providers will be cut 2.58 percent beginning July 1, 2009.
These services include all disability waivers, including consumer-directed
options, intermediate care facilities for persons with mental retardation
(ICF/MR) services, semi-independent living services (SILS), aging
and disability continuing care grants. Most mental health services
were spared the rate cut.
The Legislature
also cut more than 900 adult foster homes funded through the disability
waivers by requiring that homes with a higher rate be reduced to
the 95th percentile for all homes’ rates.
This is in addition to the 2.58 percent provider rate cut which will
mean that a significant number of four-person group homes will experience
a significant reduction in funding in the coming biennium. This cut
will remove $7.8 million (state and federal Medicaid funds) from
about 900 four-bed waiver group homes for persons with disabilities
in the next biennium. Also, a moratorium on additional adult foster
group homes will be in effect.
Hospitals received a 1% rate
cut and other reductions, payment delays and shifts. Health care
providers’ rates
were cut 3%, except dental, mental health services and primary care
physicians and medical specialists’ rates were cut 5%, raising
concerns about whether specialists will continue to serve persons
with disabilities who have Medical Assistance coverage.
Personal Needs Allowance Cut
More
than 16,000 people who live in Group Residential Housing (GRH) will
have their personal needs allowance (PNA) reduced to $89 a month,
with no additional funding. This is meant to cover all clothing,
hygiene items, individual transportation and any other personal needs.
This cut to very low-income persons with disabilities and seniors
in group residential housing will save the state $7 million for the
next biennium.
Region 10 Quality Assurance Funding Eliminated
The Region 10 Quality Assurance Program which began in southeastern
Minnesota was eliminated in the Health and Human Services Omnibus
Bill. The elimination of an important quality assurance program comes
just as the state is under increased scrutiny from the federal oversight
agency, CMS, to increase quality assurance measures for disability
services. A last minute provision allowing federal matching dollars
for quality assurance activities was adopted, leaving some possible
options for continuation, depending upon efforts at DHS.
Tightened
Eligibility for Disability Waivers, the Elderly Waiver and Nursing
Facilities.
Also included in the Health
and Human Services Omnibus Bill are major changes to the eligibility
threshold for home and community waiver services and nursing-facility-level-of-care.
Because of the federal stimulus maintenance of effort requirements,
these changes were delayed until January 2011. Nonetheless, it is
important for disability advocates and others concerned to focus
on these significant changes which will tighten eligibility criteria
for the CADI, TBI and Elderly Waiver (EW) waivers as well as for
nursing facility care. These changes are projected to result in the
elimination of eligibility for over 900 persons who would have been
eligible for CADI and TBI services. In addition, these changes are
tied to Minne-sota’s adoption
of a new comprehensive assessment for all long-term and community
support services.
New Assessment — MNCOMPASS
A
new assessment, entitled Minnesota COMPASS, will be implemented beginning
in January 2011. Before then, DHS will develop training to begin
in January 2010, for lead agencies, including counties, managed care
plans and tribes, for assessment staff to be trained and certified
to use the new assessment process. The Minnesota COMPASS assessment
will be required for anyone who wants to access home and community-based
waiver services, personal care assistant services or institutional-level-of-care
including nursing facilities beginning January 1, 2011.
Dental Services for Adults
Reduced, Therapies Not Cut
Gov. Pawlenty’s proposals to eliminate
rehabilitative services (occupational therapy, physical therapy,
speech and language services and audiology), dental services, chiropractic
and podiatry services for adults weren’t adopted by the Legislature.
However, substantial limitations for dental services which will adversely
impact persons with disabilities were adopted, resulting in a savings
of over $7 million in state funds and $17.6 million in state and
federal Medicaid for dental services for adults with Medical Assistance.
Also, funding for state-operated dental clinics was increased.
MNDHO Reduction
The Minnesota
Disability Health Options integrated managed care program operating
in the seven-county metro area had its funding cut by $4.6 million
in state funds for the next biennium with a much greater cut for
the following biennium, 2012-13.
MA-EPD Premiums Not Increased
Gov.
Pawlenty’s proposal to increase premiums and unearned
income payments from those using Medical Assistance for Employed
Persons with Disabilities (MA-EPD) were not adopted.
Policy Changes
While the major
focus of this session was the catastrophic budget deficit, a number
of important policy changes affecting persons with disabilities were
adopted. Minnes-ota’s private guardianship
statute was changed to require a bill of rights for persons placed
under guardianship, improved reporting by guardians, increased
court oversight and registration of guardian and conservators beginning
in July, 2013. The Vulnerable Adults Act was strengthened to protect
individuals from financial exploitation which has been reported
at an alarming rate. Numerous changes have been made to licensing
and other regulations affecting residential services. Increased
use of technology to assure safety for individuals who want to
be more independent in their residential programs will be more
available under new provisions adopted. Also, important new legislation
to create standards for technology accessibility was adopted.
Finally,
a bill to require that private insurance cover services for children
diagnosed with autism was not included in the final Health and
Human Services Omnibus Bill. A provision establishing the Autism
Task Force was adopted, as well as authorization of a joint proposal
to obtain federal stimulus funds for research on autism spectrum
disorder by the commissioner of health and a Minnesota research
institution.
Impact for Years to Come
The
cuts and many of the changes described will mean that many persons
with disabilities will not be able to obtain the services they need.
It is clear that our state is on a path to tighten eligibility criteria
for support services for persons with disabilities to remain as independent
as possible in their homes and communities. Over the next few weeks
the threat of unallotment continues the fear and uncertainty for
persons with disabilities who rely upon Medical Assistance and other
publicly funded health care and community support services. A major
challenge for disability advocates will be to work to develop appropriate
alternative services for those eliminated from home and community
waiver services, PCA services and even health coverage (GAMC). Specific
information about legislation is available on the legislative website www.leg.mn.state.us and
through various disability advocacy groups and the Minnesota Consortium
for Citizens with Disabilities, www.mnccd.org ![end of story]()
Anne L. Henry is an attorney at Minnesota Disability Law Center
