Cuts For Disabled Minnesotans Ignore Priorities
Health care coverage for persons with disabilities is one of the most expensive. Yet, Minnesota has a tradition of going above and beyond the national average, providing more funding and more comprehensive coverage, according to the Kaiser Foundation. Facing a $5 billion deficit, will the state be able to maintain its valued commitment to this care and coverage?
Let’s look at some of the options.
The state’s Disability Services Division (DSD) “manages publicly funded programs that support people with a variety of disabilities, including developmental disabilities, chronic medical conditions, acquired or traumatic brain injuries and physical disabilities.”
The program seeks to enable people with disabilities to live where and with whom they choose and, if possible, maintain a job. This helps provide a sense of independence for those served and helps ensure fiscal efficiency for the state. The program has transitioned many Minnesotans from nursing homes, which cost three times more, to home and community-based care.
DSD, like most divisions of the state’s Department of Human Services, has seen major cuts to its budget in recent years.
For example, personal care assistance, which helps ensure people can stay out of nursing homes, is a cost saving program coming under the axe. By July of this year, nearly 2,600 Minnesotans with disabilities, roughly 1,300 children, are slated to lose their care assistance funding and may have to seek nursing home care. An additional 6,000 people younger than 65 are expected to have services reduced. This on top of an unknown number of lower income senior citizens losing at-home care coverage.
Another program helping Minnesotans with disabilities got completely cut: Minnesota Disability Health care Options program (MnDHO). Based in the state’s metro-area, the program combined funding and resources from the Department Human Services, UCare, and AXIS, a healthcare agency which specializes in disability casework. As part of the compromise with Governor Pawlenty, all 1,200 patients permanently lost MnDHO. This cut is estimated to cost the state an additional $120,000 a month in hospitalizations.
Another savings idea could wind up costing the state more in the long term and reducing services. It's changing the way the state pays for disability services.
Right now Minnesota pays providers through a "fee for service" system, by which doctors and caregivers are paid directly for the services they are giving.
However, Minnesota’s seven largest HMOs released a report recommending that disability programs shift from “fee for service” to “managed care,” which involves giving a pool of money to an HMO to pay for a variety of services.
While Minnesota does have some programs (none with disabilities) go through managed care, other states with a broad, 100% managed care systems tend to have lower rankings on health care over all (i.e. Tennessee, South Carolina). While Minnesota health care advocates feel managed care is appropriate in some medical fields, they say it could reduce services and increase costs when it comes to treating people with disabilities.
A majority of the non-profit HMO's operating in Minnesota (including the seven behind this push) now have a majority of their business in administering state health programs.
Critics such as Steve Larson with Minnesota Consortium for Citizens with Disabilities point out that the recommendation fails to mention just how much more HMO's would be making off of this sort of arrangement. Managed care would send the funds straight to them, giving insurers more discretion as to how state funds are spent and on whom they’d be spent.
Governor Dayton and Human Service Commissioner Lucinda Jesson met with the health plan CEO's and MN-CCD along with other advocates in the disability care community to discuss moving forward with this year's budget.
Due to budget constraints, Dayton initially purposed reducing funding for some services. However, with recent news that Minnesota's projected deficit has shrunk by $1.2 billion, Dayton now purposes to restore many of his Department of Human Services cuts.
Even with Dayton’s funding restorations, it’s likely the conservatives’ budget proposal will target health care cuts of some sort.
The question remains, what investments, policy directions, and budget decisions must we make to ensure Minnesota’s reputation as a high quality, high care provider of public health services? What’s the best way forward to ensure we can maintain this funding commitment?