2008 legislative action ends with a smile
Disability community sees gains and losses
by Anne L. Henry
Extended negotiations
among legislative leaders from both parties and the governor brought
the 2008 session of the Minnesota Legislature to a close on May 18.
The $935 million state budget deficit was closed by spending cuts,
across-the-board state agency administrative reductions and use of
substantial funds from the state’s budget reserve. In addition,
health care reform legislation and a number of other significant
policy bills affecting persons with disabilities were adopted.
Budget cuts will limit waiver services
The biggest challenge for persons with disabilities during the session
was the significant budget deficit of $935 million, because health
and human services spending areas were targeted for substantial cuts
to help balance the overall state budget. Governor Tim Pawlenty proposed,
and the House and Senate agreed, to limit home and community-based
waiver services for persons with traumatic brain injury (TBI) to
200 persons per year. Services for those eligible for nursing facility
care through the Community Alternatives for Disabled Individuals
(CADI) waiver will be limited to 1,500 persons per year, beginning
July 1, 2008 for three years. Included in these caseload caps are
limits for persons participating in the integrated managed care program
known as Minnesota Disability Health Option (MnDHO).
The total funding cut for these important services for the coming
three years is nearly $68 million which includes the dollar-for-dollar
federal match available under Medicaid. Waiver service funding is used
to pay staff, buy equipment or items and support people to live as
independently as possible in the community and avoid institutional
placement.
Previously, the CADI and Traumatic Brain Injury (TBI) waiver programs
had caseload limits imposed, beginning in 2003 for four years. During
that time, a waiting list developed for both programs. While persons
eligible for CADI and TBI are likely eligible for Medical Assistance
Home Care, such as personal care assistant (PCA) services, they will
not be able to access the wider array of more flexible services which
are crucial to maintaining independence and improving functioning in
the community, such as home modifications, equipment, and supported
employment services. Department of Human Services (DHS) projections
indicate that more than 2,400 eligible persons will not be able to
access home and community services due to these caseload limits over
the next three years.
For those with Medical Assistance or General Assistance Medical Care,
hospital payments will be cut approximately $109 million dollars, most
of which would have been matched with federal Medicaid funds over a
three-year period. Mental health services are exempt from this hospital
payment reduction.
Additional cuts and changes
The Omnibus Tax Bill provides that counties will be released from
maintenance of effort and matching fund requirements while the
taxing authority of the county is limited (“levy limit”) through 2010.
This problematic provision was part of a late-night, end of the session
property tax negotiation between state lawmakers and the governor.
Among programs which require county funding are case management services
for children and adult mental health, vulnerable adult and developmental
disabilities, children’s mental health residential treatment,
chemical dependency services and numerous other corrections and public
health programs. Key legislators have agreed with the governor to
repeal this language at the beginning of the 2009 session retroactive
its effective date in order to avoid any lapse in county funding
and to correct what is now regarded as a mistake.
A 1.8 percent cut for all state-funded grant programs operated by
the Department of Human Services and the Department of Health, except
children and adult mental health services, was imposed for the next
three years. Among the programs which will be cut are Semi-Independent
Living Services (SILS), Disability Link Line, family support grant
services, Region 10 Quality Assurance and various aging and chemical
dependency services. These services are among those slated for a 2
percent cost of living increase on October 1, 2008. After the 1.8 percent
cut, the Cost of Living Allowance (COLA) will be effectively reduced
to .2 percent, leaving staff and programs without enough funding to
cover increased costs.
Changes to targeted case management,
including relocation services, children and adult mental health and
child welfare case management became effective in March 2008 due
to federal changes. Federal legislation to stop the federal agency
limitations on case management services is pending in Congress now.
Because of uncertainty over federal action, legislation which is
contingent on federal action was adopted so that Minnesota would
be in compliance with federal law. Relocation service coordination,
mental health targeted case management and vulnerable adults/developmental
disabilities targeted care management will be more limited when assisting
persons to move out of institutions effective July 1, 2008, unless
Congress delays the federal interim rules.
All state agencies are required to reduce administrative spending
by 4 percent, which means vacant staff positions will not be filled.
Other activities and services will be reduced.
The 2 percent COLA increase for community service providers, which
the governor proposed to eliminate, was maintained. But its implementation
will be delayed for three months, until October 2008.
Cuts proposed
but not adopted
Cuts were proposed by the
Senate to PCA providers which had high administrative costs. Because
there is no way to determine administrative costs in the PCA program,
this proposal could not be implemented and was not adopted. Also,
a proposal to eliminate specific medical services for persons with
particular diagnostic conditions was adopted in the conference committee,
but later removed and not included in the supplemental budget bill.
This proposal was based on a method used in Oregon. But it was very
complex, had no hearings and was strongly opposed by disability advocacy
groups, especially those concerned with mental health services.
Cuts to Self-Advocacy Minnesota funding (SAM) and a proposal to require
a repayment by three counties for overspending of the developmental
disabilities waiver were opposed by disability advocates and not included
in the final budget agreement.
New programs with funding
As part of the significant cut to CADI and TBI services, the governor
proposed two modest but positive additions to funding for housing
for persons with disabilities. The Minnesota Supplemental Aid (MSA)
Shelter Needy Program has been expanded to include people eligible
for home and community waiver services. This change will also cover
persons who will use the new self-directed personal supports option
passed last session and not yet implemented. This new housing option
will begin July 1, 2008, and is estimated to provide nearly $2 million
in housing subsidies over the next three years. Also, the new housing
access grant program will be funded with $1.25 million over three
years, beginning July 1, 2008. This program will provide funding
for public and private agencies to assist individuals eligible for
home and community-based services, including home care services,
to access and maintain appropriate homes
A scaled back Health Care Reform bill, Chapter 358, was adopted after
the initial bill was vetoed by the governor in early May. Health coverage
will be extended to 7,000 Minnesotans due to improvements in MN CARE
beginning in July of 2009. The MN CARE income limit for adults without
children will be raised from 200 percent of the poverty level to 250
percent on July 1, 2009. Tax credits for private coverage for up to
5,000 persons was also included in the bill. The new legislation will
establish health care homes for persons on public health care programs,
including Medical Assistance. Beginning July 1, 2009, the Commissioner
of Human Services shall encourage those with Medical Assistance, General
Assistance Medical Care and Minne-sotaCare to choose a health care
home which has been certified by the commissioner. For persons with
complex conditions, care coordination payments will be made beginning
July 2010.
The Health Care Reform bill also requires the Commissioner of Health
to convene a work group. This group will make recommendations on the
design of an essential health care benefit set with a report due to
the Legislature by January 15, 2010. Also of importance to persons
with disabilities is the development of a health care affordability
proposal for persons under 300 percent of the federal poverty guidelines
($31,213 for one person in 2008) to assist with employer-subsidized
coverage. Additionally, $50 million from the Health Care Access Fund
will be used to help cover the budget deficit. But it is to be repaid
to the fund based on reductions in overall health care spending in
the future.
Policy changes which
did not require funding
Numerous policy changes were adopted which affect privacy, children’s
mental health and transportation. A bill which protects individuals’ privacy
in marketing of the new Special Needs Basic Care (SNBC) managed care
plan for persons with disabilities on Medical Assistance was adopted.
The bill prohibits DHS from providing the names and addresses of
persons with disabilities to health plans for mailing of marketing
materials. Instead DHS itself will mail health plan materials. Health
plans will pay the cost of the mailings as they do now.
Two important bills affecting children’s mental health treatment
were adopted. Aversive practices such as seclusion and restraint have
been limited in children’s mental health treatment programs
and facilities. Also, a bill which strengthens and clarifies the
voluntary placement rights of parents and children was adopted. The
new law allows parents to place children with mental health conditions
or developmental disabilities in residential treatment settings without
having to give up legal custody.
The statute governing the Office of
the Ombudsman for Mental Health and Development Disabilities has
been clarified to include a deceased person within the term “client” and
to assure that the office can obtain copies of documents needed for
investigations.
The Consortium for Citizens with Disabilities transportation planning
bill was included in the omnibus transportation policy bill. For greater
Minnesota, the bill requires the Department of Transportation (MnDOT)
to plan to meet 80 percent of the unmet need for persons with disabilities
for transportation by 2015 and 90 percent of unmet need by 2025.
A bill to improve election participation for persons with disabilities
was adopted, Chapter 295. The new law requires candidates who receive
public funding to use closed captioning for political TV advertisement
and have transcripts available on websites for radio and web ads. The
bill also, expands agent delivery of an absentee ballot to include
those who have incapacitating health reasons and individuals with disabilities
increases to seven days the time before an election during which an
agent can deliver an absentee ballot and requires an agent to have
a pre-existing relationship with the voter, effective for elections
held on or after June 1, 2008.
For information on changes to education
and special education, see Kim Kang’s article.
What’s ahead
While the $935 million budget
deficit was resolved; the projections for next legislative session
are dire. The state could well face a deficit of nearly $2 billion,
counting projected inflation due in part to the ever-increasing costs
of fuel and health care.
Disability services have already
been cut substantially in six of the past seven years.
Because health care, including long-term and community support services,
is a significant and growing portion of the state’s budget,
it is likely that even more painful cuts affecting disability services
will be proposed next session.
Persons with disabilities, families and organizations have much at
stake in the upcoming elections which will determine who makes the
decisions about how to balance the state budget for the coming biennium.
The Consortium for Citizens with Disabilities is working on candidate
forums and other election-related activities. Information can be found
at www.mnccd.org. Further information about legislation and your legislator,
can be found at www.leg.state.mn.us. ![]()
