Current Federal Issues

Sustainability of Medicaid
Background Information
According to ANCOR, “roughly two-thirds of Medicaid spending is attributed to elderly and disabled beneficiaries although they make up just a quarter of all Medicaid enrollees, and Medicaid is the single largest source of coverage for nursing home and community-based long-term supports and services.”

ANCOR goes on to state that “in the current political climate where long-term debt/deficit reduction is at the forefront of conversation, Medicaid is at risk of losing federal funding.” “Because of the system of matching funds, a $1 reduction in federal funding contribution will likely result in a $2 reduction in state spending, as most states are not likely to be able to make up that shortfall.

Three different proposals that are being discussed to reduce federal Medicaid spending include:
•    Converting the program to a block grant system, wherein states would get a fixed (lower) amount of money rather than receiving matching federal funds.
•    Implementing per-capita caps, which would provide states a set amount of funding per Medicaid enrollee
•    Reducing the rate of, or eliminating, provider taxes, which states use to fill in gaps in their Medicaid programs with federal dollars.

Additional Resources
ANCOR's "Save our Services" Campaign
ANCOR Guide to Medicaid for Advocates

Housing Options
Background Information
According to ANCOR, over 730,000 people with developmental disabilities live with aging parents. Across the nation, people with disabilities are facing a crisis in the availability of safe, affordable, and accessible housing. The American with Disabilities Act (ADA), as interpreted by the U.S. Supreme Court’s Olmstead decision, requires public entities such as states to administer services, programs, and activities in the most integrated setting appropriate to the needs of individuals with disabilities.

On the Federal level, the Frank Melville Supportive Housing Investment Act of 2010 reformed the Section 811 Program, which assists the lowest income people with significant and long-term disabilities to live independently in the community. Under the Frank Melville Supportive Housing Investment Act of 2010, the new law specifies that one purpose of the Section 811 program is to expand the supply of supportive housing that “promotes and facilitates community integration for people with significant and long-term disabilities.”

In Minnesota, Governor Dayton issued an Executive Order in 2013 establishing an Olmstead Sub-Cabinet to develop and implement a comprehensive Minnesota Olmstead Plan. Minnesota’s plan, “Putting the Promise of Olmstead into Practice: Minnesota’s 2013 Olmstead Plan” was release November 1st, 2013. For more information on Minnesota’s Olmstead plan please see the third link listed below. Olmstead Sub-Cabinet meetings continue to meet and are open to the public.

Additional Resources
Resource Center on Supportive Housing

Living Well Individualized Housing Options Resource Guide for Persons with Disabilities

Minnesota Olmstead Plan

Indexing, Minimum Wage
Background Information
DSPs are among the nation’s most vulnerable workers, typically receiving low wages and having limited access to health insurance and other benefits. According to ANCOR, “the DSP workforce has been plagued for decades by turnover rates ranging from 40-50%, a rate far exceeding most other industries.”

Medicaid is essentially the only payer for services for people with intellectual and developmental disabilities. As a result, community providers cannot simply raise prices or shift costs to meet an increased minimum wage or other labor rules. Provider rates are determined by individual states.

Minnesota recently passed a new minimum wage law during the 2014 Legislative Session, mandating that large employers pay $9.50 by August of 2016 and small employers pay $7.75 by August of 2016, and beginning in 2018, the minimum wage will be set to inflation. The law however does not adjust provider rates to reflect these changes.

Additional Resources
ANCOR's Minimum Wage White Paper

Managed Care
Background Information
Most Medical Assistance recipients with disabilities receive services on a fee-for-service basis. However, some disabled MA recipients receive Medicaid services through a managed care program. In Minnesota that program is called the Special Needs Basic Care Program. People are automatically enrolled in special needs plans, unless they choose to opt out of managed care enrollment and remain in fee-for-service.

According to the Arc of Minnesota, Special Needs Basic Care (SNBC) plans promote access to primary and preventive health care including coordination of Medicare and MA benefits. SNBC plans also provide navigators, care coordinators or care guides to assist their members with accessing benefits. SNBC plans also waive state MA copays and deductibles. In Minnesota, SNBC does not include home and community-based services provided under the MA waiver programs, personal care assistance or private duty nursing services. These services will still be provided under MA fee-for-service generally through the county.

Additional Resources
MN Department of Human Services Special Needs BasicCare Site

For more information:
Sara Grafstrom,
Director of State and Federal Policy
651-291-1086, ext. 8