Victories and Concerns As
Legislature (Finally) Adjourns
by John Tschida
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:
Dental Services
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.)
Parental Fees
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.
Managed Care
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.
