The Governor’s budget for the 2010-2011 biennium can be found on the Minnesota Department of Management and Budget website:  http://www.mmb.state.mn.us/doc/budget/narratives/gov/human-svcs.pdf

The governor has unveiled his state budget proposals to eliminate the state deficit. The section on Human Services Department is 357 pages long. General observations changes:

It reduces eligibility for Medical Assistance to 100% of the federal poverty level. Right now, that's $10,400 for a single person, $21,200 for a family of four.

It provides less state reimbursement to hospitals and long-term care providers.

It proposes that adults without children will no longer be covered under MinnesotaCare.
Repeals recent coverage expansions and premium reductions, some of which have yet to be implemented, in Medical Assistance (MA) and MinnesotaCare.
Proposes merging the Health Care Access Fund with the General Fund.

Replaces the 87 counties handling human services program with 15 regional entities.  

 Increases fees for hospitals and ambulatory care facilities to participate in the mandated program to report to the state whenever one of 28 serious health incidents occurs. Proposes a $100 increase plus a $3 increase per bed.

It’s important to note that the Governor’s budget is the opening salvo in what is sure to be a contentious and arduous legislative budget process. At this point nothing is written in stone. These recommendations and their fiscal impact could change based on the Federal economic stimulus package and the continued reassessment of state revenue forecast.
 
1.   Personal Care Assistant (PCA) Services Changes, pp. 63-66.

•   Cuts $85 million in PCA services (state and federal Medicaid funds) for biennium.

•   CUT IN ELIGIBILITY for PCA:  Requires recipient to be dependent (need for hands-on assistance OR constant cuing and supervision during Activities of daily living (ADL)) in two activities of daily living (dressing, grooming, bathing, eating, positioning, transferring, mobility and toileting).  It appears that persons needing assistance with independent activities of daily living, complex medical needs  or behavior issues who do not need physical help or constant supervision with at least 2 ADL’s will not qualify for PCA services

♦   2,100 individuals would be cut off PCA beginning January 1, 2010.  Cuts $18 million state dollars, $36 million in services state + federal Medicaid funding.

•   Changes assessment and authorization for PCA.

♦   Changes to home care rating (21 ratings collapsed into 10), complex medical redefined, dependencies in activities of daily living, defined and simplified.

♦   Authorization of time for personal care assistance will be changed.

♦   The MT rating (Regional Treatment Center level of care) which allows up to 24 hours of service per day will be eliminated and will apparently be replaced with some funding under the DD waiver.

♦   Cuts $12.2 million state dollars and $24.4 million in services (state + federal Medicaid match) for the biennium.

♦   6,000 projected to be cut two hours of PCA service per day and 5,500 expected to get an additional 1 hour PCA service per day.

♦   Assessment and time allowance changes cut $25.2million (state and federal Medicaid) in PCA services and cost over $800,000 to implement for 18 months from January 1, 2010 through June 30, 2011.

•   Simplify statute and service delivery.

♦   Allow 180 licensed home care agencies to qualify as Medical Assistance (MA) PCA enrolled providers without additional forms, reduce conflict of interest.

•   Change PCA on where and how PCA can be used.

♦   Restrict use of PCA in housing with services.

♦   Limit providers from providing both housing with services and PCA.

♦   Restrict who can act as responsible party.

♦   Require a responsible party to live with consumer who cannot direct their own care, effective January 1, 2010.

♦   Expected to affect 350 to 400 people who don’t live with their responsible party.  This change is expected to save $5.8 million state dollars, $11.6 million in services (state + federal Medicaid) over 18 months.

•   Implementation of provider standards.

♦   Require training.

♦   Require standards and certification for agency and agency staff.

♦   Require fidelity and surety bonds.

♦   Increase criminal background checks for managerial staff and qualified professionals.

♦   Require communication between provider agency and consumer.

♦   Standardize training required for all.

♦   Limit hours per month PCA can work to 310 per month.
Hours limit projected to save $6.2 million state $, $12.4 million (state + federal Medicaid) in 18 months.

•   Administrative cost of implementing the PCA changes is $1.5 million (most eligible for federal Medicaid match).

•   CUTS $85 million (state + federal Medicaid) in Fee-for-Service PCA Services from January 2010 – June 30, 2011.  Cuts rise to $75 million (state + federal) for 2012 and $81 million (state + federal) for 2013.

•   Cuts $36 million state ($72 million Medicaid for biennium).

•   Changes ELIGIBILITY for  nursing facilities and the Home and Community Waivers persons with disabilities  and the elderly use to obtain community services instead of nursing facilities(CADI, EW, TBI).  The change results in 4,300 persons not being eligible for nursing facility care, CADI or EW in the next biennium, beginning January 1, 2010.

•   Due to of loss of eligibility for NF level of care and the financial eligibility standards associated with long-term care, 1,100 seniors will lose eligibility for BOTH long-term care services (NF or EW waiver) and for Medical Assistance (part of the 4300).

•   Implements COMPASS, a new comprehensive assessment tool across all long-term care programs (all waivers, PCA, PDN, ICF/MR, NR) and populations by December 30, 2009 for 80,000 individuals each year. COMPASS implementation administrative and systems costs $5.7 million in state funds (federal Medicaid match available for most of the cost).

♦   Many Department of Human Services (DHS) staff needed to implement this major change.

♦   This proposal increases the threshold for home and community waivers and nursing facility level of care, but PCA level of care, though increased, appears to be different from the nursing facility and waiver level of care.

•   Establishes a rate methodology for uniform statewide rates for service providers in order to eliminate disparity in rates paid for the same services across the state, effective January 1, 2010. 

•   Implements consistent provider standards for all service providers, effective January 1, 2011.

•   Eliminates lead agency (county) contracts with providers; automate provider enrollment and compliance information.

•   This proposal will cost $2.5 million for the next biennium, all of it eligible for federal Medicaid match.

•   Cuts $21 million state, $42 million in services for biennium (with federal Medicaid match).

•   Cuts Community Alternatives for Disabled Individuals (CADI) funded slots for new recipients from 1500/yr to 1140/yr, developmental disabilities (DD) waiver slots from 300/yr to 180/yr, and traumatic brain Injury (TBI) slots from 200/yr to 150/yr. 

•   Establishes a moratorium on foster care shift staff settings for community alternatives for disabled individuals (CADI), traumatic brain injury (TBI) and developmental disability (DD) waivers.  Exception for community alternative care (CAC) and traumatic brain injury - Neurobehavioral (TBI-NB) and elderly waiver (EW) in housing with services with home care license.

•   Establishes technology grants to develop personally-designed living situations to increase independence and reduce human assistance.

•   Three percent cut to all health care providers (including mental health, dental, physician and all other basic care providers) and all long-term community support providers (waivers, PCA, DT+H, ICF-MR, Nursing Facility, Semi-Independent Living, Consumer Support Grant, Aging, Deaf and Hard of Hearing Services).  Children and Adult Mental Health community support services and chemical dependency service providers are not included in this 3% rate cut. Nursing facilities are not subject to the 3% cut, but are subject to other reductions.

•   The community support services cut is over $160 million for the biennium in Medicaid funding, over 75% of this figure pays wages for staff.

•   The rateable reduction for Medical Assistance (MA) and General Assistance Medical Care (GAMC) basic care cuts over $96 million in state funds and $148 million for the biennium when federal Medicaid match is added.  General Assistance Medical Care (GAMC) is a state funded program with no federal Medicaid match.

6.   Group Residential Housing Changes, p. 45.

•   Eliminate Difficulty of Care Payments under group residential housing (GRH) April 1, 2010 and transfer costs to:

♦   The developmental disabilities DD waiver for those who qualify for Supervised Living Services (SLS) under the developmental disabilities DD waiver.

♦   Shelter needy payments for those who do not qualify for the developmental disabilities DD waiver supervised living services.

•   Requests federal waiver to get food payments for for-profit group residential housing (GRH) settings.

•   Cuts Personal Needs Allowance by $32 for 10,000 group residential housing (GRH) residents and $12 for another 6,000 GRH residents.  Personal needs allowance will fall to $89 for all.  Those with SSI will lose their $20 general income disregard and everyone will lose the $12 community living adjustment (offset to the pharmacy co-pay begun in 2005).  Cuts $7 million dollars from 16,000 group residential housing (GRH) residents.

•   Saves $21.4 million, $14.4 million is from Difficulty of Care Foster Payments which  are replaced by federal funds.

7.   Eliminate Region 10 Quality Assurance, Epilepsy Project and Delay Community Service Development Grants, p. 78.
 
   Cuts $1.8 million in state funds from these three programs, effective July 1, 2009.

•   Increase minimum premium from $35/mo to $50/mo and increase required payment of unearned income (mainly Social Security) from .5% to 2.5%, beginning January 1, 2010.  Collects $1.6 million per year from MA-EPD recipients.

•   Cuts $1.7 million state, $3.4 million Medicaid for biennium, but fiscal impact grows over time as population ages.

•   Eliminates OT, PT, Speech, Audiology from MA, GAMC and MNCARE for all adults, number affected not in budget, effective January 1, 2010.  Cuts $6.8 million for biennium in state funds and unknown Medicaid match (detail not in budget).  Will affect disability waivers and other services as well.

•   Eliminates dental care for adults (21 and up) on MA, GAMC, MNCARE except for emergency dental care in hospital ER, effective January 1, 2010.  Cuts $38 million in state funds (and unknown amount of Medicaid).

•   Eliminates critical access payments for MA and MNCARE dental care, effective July 1, 2009.  Cuts $12.2 million state dollars and unknown Medicaid amount from MA and MNCARE recipients.

•   Hospital payments for mental health admissions are reduced 6% for MA and GAMC.  DHS admits that this will result in an increase of commitments to state facilities.  Therefore, funding is increased by 4% for state operated services.  (No specifics provided in budget).  Effective July 1, 2009.  $16.7 million in state spending reduction, no information on amount of federal Medicaid lost.

•   Allow DHS to again contract with a broker for special transportation services (STS) services in the 11-county metro area.  Effective date not provided, apparently July 1, 2009.

•   Cuts $1 million in state funds, $2 million with Medicaid match for biennium from special transportation services (STS) services.

•   Increase rates for wheelchair accessible van from $1.30 to $1.80 per mile and decrease ambulatory special transportation services (STS) rate from $1.30 to 1.00 per mile, effective July 1, 2009.  Cuts $211,000 state dollars and $ 422,000 with Medicaid match.

•   Adds a Neurodevelopmental Program for evaluation of brain disorders with mental illnesses, a Dialectic Behavioral Treatment Program and Trauma Care for $506,000 for the biennium.

•   State-Operated Clinics served 5,349 persons with disabilities in 2007.  The cost for this change is $3.1 million in state funds.

18.   Eliminate Children and Community Services Act and Replace with Protecting Children and Strengthening Families Act Grant, p. 41.

Redirects 55% Federal Title XX and state appropriation to child welfare and 45% to services for adults who are aging, disabled, need mental health services or detox.  No budget details on number affected.  Effective January 1, 2010.

19.   Cut $125 per month from Minnesota Family Investment Plan (MFIP) Grants for Low

Cuts $125 per month from 7000 low-income families using the Minnesota Family Investment Plan (MFIP) who have a parent or a child with a disability who receives Supplemental Security Income (SSI).