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Feb
17
Written by:
Patti
2/17/2010 1:54 PM
Gov. Pawlenty released his plan to erase a $1.2 billion budget deficit on February 15, 2010. You already know the highlights/lowlights of the proposed budget reductions in our area in objective terms—here is a less objective perspective.
Keep in mind that, in spite of how much we dislike the budget proposal coming from the Governor this week, we don’t have high hopes that the Legislature will be able to counter with a proposal that will address the deficit through some sort of magic—unless legislators can convince the very resolute Governor that raising revenues is a good idea, there will be cuts made. We just need to re-cast older adult services as a public investment rather than a budget drain—small order, eh?
1) Where do the cuts come from? They will come disproportionately from health and human services, where the various constituencies are not united nor do they make up a huge voting block. Some provider groups who were cut last year are on the cutting block again, making it difficult for them to even climb their way up to zero. In spite of the age wave and the growing older adult demographic, older adult services has not “made it” into the “protected status” circle—rather than being viewed as a necessary public investment, older adult services is grouped into the burgeoning health and human services budget, where the growth rate appears unsustainable.
2) Who are the losers? Several categories of biggest losers exist in this budget proposal—the 22,000 individuals who would be kicked off of MinnesotaCare, individuals without money requiring therapy services, all sorts of human service providers including long-term care, local units of government.
3) Did K-12 get cut at all? It looks like K-12 education—which makes up 40% of the state budget—was deemed “sacred,” leaving a disproportionate amount of cuts to services for the poor, elderly and disabled.
4) Are these straight cuts or is he using any gimmicks? While “cleaner” than prior budgets, this proposal does include one category of “funny money”—$387 million in an extended federal Medicaid match that doesn’t exist yet. His budget is “banking” this money before any federal enabling legislation gets passed.
5) How does this budget change the debate in the Legislature re: taxes and spending? Based on the initial responses from legislative leaders, it appears that the game will be played out in a very familiar fashion—some legislators will advance revenue proposals (taxes) to minimize the cuts, but those will be rejected by the Governor. Others have already insisted that all programs and services—including K-12 education—must be considered for spending reduction. The politics of forcing “bad” votes on bills will be even greater this session because of the gubernatorial candidates who are now sitting legislators.
6) How will the nursing facility rate equalization repeal proposal play out? There is still significant opposition to making any changes to the nursing facility rate equalization law coming from a few key, long-standing legislators. The Governor proposed the repeal as a partial offset to the 2.5% reduction to nursing facility rates in his budget. It is a fine line we must walk—promoting the repeal of rate equalization as a very, very important policy change, but one that doesn’t mitigate the impact of any rate cuts. We know this battle will be tough—there should be no trade-offs. We need the rate equalization repeal for longer term payment reform reasons; we need no cuts for short-term stability purposes. Here are a few points to consider when framing the discussion around rate equalization repeal and rate cuts:
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Repealing rate equalization is a first step toward increasing personal responsibility for long-term care and reforming long-term care financing. There is no incentive currently for individuals to plan for their long-term care expenses, whether by insurance or savings, since the state policy of rate equalization will protect them.
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Repealing rate equalization brings Minnesota in line with the rest of the country. The state Medicaid rate is currently $20 a day lower than the cost of providing care. Only one other state in the US has rate equalization—and that state, North Dakota, has kept rates much closer to costs.
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Reforming long-term care financing should reflect today’s reality. Individuals should pay what they can toward the cost of their care, leaving more money available for those who truly need it.
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Fears of the past are no longer applicable: federal law ensures providers cannot discriminate against an individual based on the payer source, which means there cannot be a difference in quality of care based on Medicaid or private pay. Lengths of stay in care centers have changed dramatically since rate equalization became law in 1976. Individuals are now much more likely to have a short stay in a care center for rehabilitation purposes than live in a care center for more than 90 days.
Copyright ©2010 Patti
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2 comment(s) so far...
Re: Governor’s Proposed Budget Released as First Step in the Budget Debate
Maybe Care Providers of Minnesota along with other organizations should ban together and get the Boren Amendment reinstated. From 1980 to 1997, federal law directly linked Medicaid nursing home rates with minimum federal and state quality of care standards. As part of the Omnibus Reconciliation Act of 1980, the "Boren amendment" required that Medicaid nursing home rates be "reasonable and adequate to meet the costs which must be incurred by efficiently and economically operated facilities in order to provide care and services in conformity with applicable state and federal laws, regulations, and quality and safety standards" (Section 1902(a)(13) of the Social Security Act). State Medicaid officials overwhelmingly came to oppose the amendment as impossible to operationalize, believing that they were forced by the courts to spend too much on nursing homes at the expense of other services.
The federal Balanced Budget Act of 1997 repealed the Boren amendment, giving states far greater freedom in setting nursing home payment rates. The nursing home industry warned that Medicaid reimbursement levels already are too low, and that further reductions would adversely affect quality of care. Indeed, poor- quality nursing home care is gaining increasing attention. For example, in response to a recent General Accounting Office report identifying glaring quality of care deficiencies in California nursing homes, the U.S. Senate Special Committee on Aging held critical hearings on nursing homes and their regulators, and President Clinton unveiled tougher enforcement standards.1
As states gain freedom to cut nursing home reimbursement, it becomes more important to understand whether and how these changes might affect quality of care in nursing homes.
Despite nursing home industry claims that low payment rates inhibit quality of care, Medicaid rates for nursing facility care are a logical target for states trying to reduce the growth rate of long-term care expenditures.
By Tom on
2/18/2010 1:18 PM
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Re: Governor’s Proposed Budget Released as First Step in the Budget Debate
Index of Wasteful Programs:
PROGRAM ________________ $ AMOUNT
2005 Legislature Special Session.............................................................$ 2,250,000
Archery in the Schools Grants .................................................................$ 75,000
Art Grants to North Dakota......................................................................$ 128,825
Avian Flu Preparedness ...........................................................................$ 5,000,000
“Bears of the Ussuri” Exhibit (Minnesota Zoo) ......................................$ 20,640,000
Becoming an Outdoorswoman.................................................................$ 45,000
Bemidji Regional Events Center..............................................................$ 3,000,000
Big Island Campsite.................................................................................$ 2,000,000
BioBusiness Alliance ...............................................................................$ 467,000
Bioscience Development Grants..............................................................$ 28,500,000
Birding Maps ...........................................................................................$ 100,000
Board of Architecture, Engineering, Land Surveying,
Landscape Architecture, Geoscience and Interior Design.............$ 1,570,000
Boxing Commission.................................................................................$ 50,000
Central Corridor Light Rail......................................................................$ 13,050,000
Character Education.................................................................................$ 1,500,000
Clean Energy Resource Teams/Wind Energy Rebate Program...............$ 700,000
Critical Habitat License Plate Promotion ................................................$ 26,000
Ethanol Producer Payments .....................................................................$ 34,013,000
FarmAmerica ...........................................................................................$ 256,000
Film & TV Board.....................................................................................$ 500,000
Film Production Incentives ......................................................................$ 1,700,000
Get Ready, Get Credit..............................................................................$ 4,133,000
Giants Ridge Golf & Ski Resort ..............................................................$ 1,768,537
Hiawatha Light Rail operating subsidy....................................................$ 9,350,000
Integration Revenue Program ..................................................................$115,337,000
Ironworld Discovery Center ....................................................................$ 1,550,794
Itasca County Steel Plant infrastructure...................................................$ 23,500,000
Job Opportunity Zones (JOBZ) ...............................................................$ 16,900,000
Legislative “Effectiveness” Forums ........................................................$ 37,000
Let’s Go Fishing ......................................................................................$ 325,000
Medicare Prescription Drug (Part D) Program ........................................$ 3,600,000
Met Council Livable Communities Grants ..............................................$ 8,184,000
Metro Greenways.....................................................................................$ 500,000
Minneapolis Teachers Retirement Fund bailout ......................................$ 36,000,000
Minnesota Agricultural Interpretive Center.............................................$ 200,000
Minnesota Horticultural Society ..............................................................$ 35,000
Minnesota Humanities Commission ........................................................$ 800,000
Minnesota International Center................................................................$ 85,000
Minnesota Inventor’s Congress ...............................................................$ 120,000
Minnesota Planetarium & Space Discovery Center.................................$ 22,000,000
Minnesota Twins Stadium .......................................................................$776,093,378
Mountain Iron Renewable Energy Park...................................................$ 500,000
Taxpayers League Foundation & Citizens Against Government Waste
-8-
MINNESOTA PIGLET BOOK 2006
Index of Wasteful Programs (continued):
PROGRAM ________________ $ AMOUNT
Northeast Minnesota Rail Initiative .........................................................$ 1,300,000
Northstar Commuter Rail.........................................................................$ 97,500,000
Ordway Center for the Performing Arts ..................................................$ 7,500,000
Perpich Center for Arts Education...........................................................$ 15,380,000
Polar Bear Exhibit (Como Zoo)...............................................................$ 9,000,000
Private Detective Board ...........................................................................$ 252,000
Public subsidy for campaigns ..................................................................$ 3,610,000
Quality Compensation (Q-Comp) Aid.....................................................$ 85,941,000
Red Rock Commuter Rail........................................................................$ 1,000,000
Rehabilitation of private shooting ranges ................................................$ 300,000
Renewable energy inquiries.....................................................................$ 75,000
Roseville Skating Oval ............................................................................$ 500,000
Rural Transportation Assistance Program/Bus “Roadeo” .......................$ 143,542
Rushford Institute for Nanotechnology ...................................................$ 600,000
Shubert Theater........................................................................................$ 12,000,000
Southwest Regional Events Center..........................................................$ 11,000,000
Taconite Aid to Non-Taconite School Districts.......................................$ 3,014,248
Taconite Economic Development Fund...................................................$ 20,784,000
University of Minnesota Landscape Arboretum (land acquisition).........$ 650,000
Winona Shakespeare Festival ..................................................................$ 310,000
Unlicensed Complementary/Alternative Health Care Regulation ……..$ 130,000
Union Depot Transit Station ....................................................................$ 3,500,000
Workers Memorial...................................................................................$ 100,000
WomenVenture........................................................................................$ 300,000
Vikings Ship.............................................................................................$ 1,000,000
STATE SPENDING TOTAL................................................................$636,385,946
with Twins stadium (state-approved, locally-funded).........................$1,412,479,324
Taxpayers
*and we are talking about a 2.5% cut to LTC - shame on Minnesota.
By Tom on
2/26/2010 7:23 AM
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