New
Comprehensive Disability Package
by Joel
Ulland
We have all seen
it–some have even tried to stop it–but
the reality is some people with disabilities in Minnesota have faced
significant budget cuts and resulting changes in MinnesotaCare, Medical
Assistance, Metro Mobility and Greater Minnesota transit services,
just to name a few. After three years of budget deficits, the state
is facing another $700 million deficit this session. But now a comprehensive
plan is being developed to improve services to people with disabilities
and not continue to make cuts to key programs.
When you look at how the legislature is structured, you have health
issues in one committee, transportation issues in another committee
and employment issues in yet another committee and then housing in
another committee. For many people with disabilities, access to health
care, transportation, employment and housing are issues of equal
importance. Maintaining these issues is a constant balancing act,
and for many, the budget cuts of the past three years have decreased
access in these critical areas. Many legislators never see the whole
picture because they only see a narrow slice of the issues, such
as transportation or health care.
The Minnesota Consortium for Citizens with Disabilities (MN-CCD)
is developing a comprehensive plan to help legislators see the whole
picture of both the negative impacts of budget cuts and the positive
solutions we are proposing for 2005. The MN-CCD is a coalition of
nearly 40 disability organizations and providers that work at the
capitol on a variety of disability issues. The coalition has been
working since April to identify key issues for people with disabilities
and how changes in public policy could improve their lives. In September,
the MN-CCD approved almost 65 pages of position papers with solutions
to some very complex problems.
For some individuals,
there is a role for government to help support them in their home
and community. It is the strong belief of the MN-CCD that public
policies should support the cost-effective delivery of these services
with results that produce positive health and independence outcomes
for the individual with disabilities. The 1999 U.S. Supreme Court
Olmstead decision mandated that states deliver services to individuals
with disabilities in the ‘least restrictive setting.’ The
State of Minnesota has made great strides toward this goal of delivering
community-based care, but needs to do more. While 48 states have
adopted comprehensive plans to address the Olmstead decision, Minnesota
has not. The following outlines a multi-pronged approach that is
based on a few fundamental principles:
Access to Needed Services:
Individuals with disabilities have the same hopes and desires as
their non-disabled peers. They want to be healthy, safe, and participate
actively in their communities. Doing so often means reliance on multiple
public programs and services, such as Medical Assistance, Metro Mobility,
or Vocational Rehabilitation Services. In many cases, a person may
need all three of these programs to be functioning properly in order
to keep a job and earn a paycheck. Access to essential programs and
services is critical for individuals to be successful in the community
and to remain independent. The recommendations here reflect a holistic
approach and acknowledgment that coordinating these systems and understanding
how they interact is crucial to supporting Minnesotans with disabilities.
Empowerment and Choice:
Minnesotans with disabilities and those who support them ought to
be held accountable for their decisions, but need and deserve to
have enough financial control over the support services they require
to maximize their ability to function as productive and contributing
members of society. Certain options exist within the Medical Assistance
program, such as PCA Choice and Consumer Directed Community Support
options that are consistent with this philosophy. They must also
include enough policy oversight to ensure the safety of program participants.
Quality of Care:
Access to services
and choice of providers will only be meaningful if there are services
in the marketplace competing not just on the basis of price or
risk but on quality, particularly in the area of health care. Quality
must be demonstrated (and measurable) on the part of health care
and disability service providers, but for those who rely heavily
on state public program reimbursement, there is a limited ability
to affect quality of care. True market forces don’t
apply to providers who cannot raise prices to compensate for the
ever escalating fixed costs associated with running their businesses.
In many cases these reimbursement rates are directly linked with
the wages paid to employees providing care to individuals with disabilities.
Quality of care is not just a function of regulatory reform, but
also of targeted state investments in critical direct care services.
With these ideas as a framework, the MN-CCD has adopted several
recommendations that will advance the needs of Minnesotans with disabilities,
including:
* A state-level commission to formulate a plan in response to the
Olmstead decision. This body, similar in composition to the Long-Term
Care Task force of 2001, would formulate a comprehensive plan to
meet the program and policy needs of the non-elderly disabled;
* De-institutionalizing the non-elderly population of individuals
with disabilities in nursing homes. Currently, there are 2,600 Minnesotans
under the age of 65 who call a nursing home their home;
* A dedicated
funding source for Metro Mobility, the door-to-door para-transit
service for 18,000 individuals with disabilities. Currently, it
is fully funded through the state’s
general fund, unlike the regular route bus system which is a mix
of state and county dollars;
* Greater access to transit in Greater Minnesota. Currently, several
counties have no form of accessible transportation for people with
disabilities. Transit funding remains static or declining. People
with disabilities in rural Minnesota deserve transit options;
* Increase the
assets an individual with a disability can keep to qualify for
Medical Assistance. Today an individual can only retain $3,000.
A couple can keep $6,000. These amounts haven’t increased
since 1983;
* Better coordinate
the state’s employment
efforts for people with disabilities. Currently, both the Department
of Human Services and Department of Employment and Economic Development
share some programs and responsibilities, but have little interaction
and no comprehensive vision;
* Choice of case management provider. Currently, Minnesota counties
authorize services and provide case management services for individuals
with disabilities. Qualified community service providers should be
able to compete for this service coordination responsibility;
* Expansion of
Minnesota Disability Health Options, the state’s
voluntary managed care program for people with physical disabilities.
Currently, it’s only available to individuals in the Metro
Area. This program saves money and produces better health outcomes.
More people deserve access to it;
* Lower parental fees for families with children with disabilities
enrolled in the TEFRA program. Premium increases in 2003 were too
steep and too punitive;
*Provide additional protections for special education students,
including additional certification of qualified teachers and standards
on the use of locked time out rooms.
Passage of this legislative package will depend upon legislators
hearing from their constituents about the need for changes outlined
in this article. Make sure that you contact your legislator and focus
in on one or two of these topics and why they are important to you.
Joel Ulland is the Public Policy Director for the National Multiple
Sclerosis Society, Minnesota Chapter, and serves as co-chair for
the Minnesota Consortium for Citizens with Disabilities.
