The Minnesota House and Senate have wrapped up committee work on their omnibus budget bills. They present starkly opposed visions for Minnesota – and this is reflected in two very different health and human services (HHS) budget targets and bills.
In the House, Representative Tina Liebling’s omnibus HHS bill includes important investments in healthy people and thriving communities, and is balanced with sustainable revenue sources. The Senate’s goals are focused on limiting spending, and their health and human budget slashes services, such as child care assistance and some health care coverage, and would result in significant harm to Minnesotans.
Provider tax
Minnesota’s provider tax is a proven and time-tested way to ensure Minnesotans have affordable health care. This crucial source of revenue raises about $700 million per year for affordable health care and healthy communities across Minnesota. However, the provider tax will sunset this year unless policymakers take action. The House HHS bill includes a repeal of the provider tax sunset, whereas the Senate HHS bill allows the sunset to go forward, putting the future of affordable health care for Minnesotans at risk.
Affordable child care
Minnesota’s Child Care Assistance Program (CCAP) puts affordable child care in reach for about 30,000 Minnesota kids. Safe and affordable child care allows parents to work while kids are in a supportive environment, and helps employers to find and keep the workers they need. The House bill includes funding to reduce the waiting list ($26 million for FY 2020-21), implement family-friendly provisions ($8.2 million for FY 2020-21), and update provider rates ($11 million for FY 2020-21). The House also includes program integrity provisions to make sure that CCAP dollars go to help families and kids.
In contrast, the Senate bill eliminates CCAP, putting the well-being of 30,000 Minnesota kids at risk. Under this proposal, the Department of Human Services would propose a new child care assistance system by January 2020. After legislative approval, the newly designed program could operate, but the Senate only provides one-time funding – creating real questions about how families’ child care needs would be met.
Minnesota Family Investment Program (MFIP)
The House budget proposal includes $45 million for a $100 per month increase for families participating in Minnesota’s welfare-to-work program. The basic cash grant amount has not changed since 1986, and the long-overdue increase will allow Minnesota’s most struggling families to live with greater dignity as they work towards economic security. The Senate does not include an increase in cash assistance.
Health care
The House includes Governor Tim Walz’s OneCare plan, a set of proposals to ensure that more Minnesotans have access to affordable health insurance at a coverage level that works for them. In contrast, the Senate does not include any of the OneCare provisions, and it eliminates dental and vision coverage for people who have affordable health care through MinnesotaCare and Medical Assistance while also increasing the out of pocket costs for Minnesotans with coverage through Medicaid.
The Senate also proposes limiting projected growth for some health care costs. While this reduces projected spending on the budget tracking spreadsheets, it fails to recognize the true cost of providing existing services and is unlikely to be approved by the federal government.
Long-term care and vulnerable adults
Both bills respond to concerns about caring for elderly and vulnerable Minnesotans. Some of the few budget increases in the Senate are for electronic monitoring in long-term care facilities. The House includes funding for the Ombudsperson for Long-Term Care as well as to support civil and criminal coordination for the protection of vulnerable adults, an assisted living report card, and increased protections for vulnerable adults.
Workforce
The House includes $34 million to increase pay for workers who care for people living with disabilities, and Senator Jim Abeler’s bill includes $40 million for this purpose. The House also includes $37 million for approval of the self-directed worker union contract to support personal care attendants (PCAs). The Senate does not include the increase for these workers, and actually reduces spending on PCAs by limiting the number of people and conditions that would qualify for PCA help.
Transfers
The House bill transfers unused dollars from health care reinsurance back to their original funds. This results in nearly $400 million reverting back to the Health Care Access Fund (HCAF) and $142 million back to the general fund. The Senate bill does not include these provisions. However, by shifting over $73 million in spending from the HCAF to the general fund and juggling other transfers, the Senate bill is able to keep the HCAF solvent for a few years after the scheduled expiration of the provider tax. Without the sustainable revenue from the provider tax, the long-term result will be a shortage of health care funding.
Other issues of concern
The House bill includes funding to expand community behavioral health clinics, mental health standards, children’s intensive services reform, school-linked mental health, improvements to substance abuse treatment, and a reform of behavioral health financing. Of these, the Senate includes only timely access to substance abuse treatment and the reform of behavioral health financing. Additionally, the governor, House, and Senate all include a proposal for substance abuse disorder treatment waivers to improve services.
Liebling’s bill includes funding for a child welfare training academy, tribal child welfare initiatives, and additional protections for kids in foster care, including background studies and affordable health care. The Senate proposal does not include these provisions.
The Senate proposal includes a 9.8 percent reduction (about $20 million per year) for the Department of Human Services and a 15 percent reduction (about $1.5 million per year) for the Minnesota Department of Health. These cuts are undefined and would be up to the departments to implement.
Looking forward
The House and Senate bills present dramatically different visions. With the House and governor investing in healthy people and thriving communities, the Senate’s insistence on limiting spending fails to meet the needs of many Minnesota neighbors, colleagues, and friends. An additional wonky point of concern: the Senate HHS proposal uses shifts and savings that are unlikely to materialize in order to balance their bill.
As legislators and the governor work to create a budget for the upcoming biennium, we urge a focus on expanding access to affordable health care, child care, and other services that make Minnesota a place where all can thrive.
-Betsy Hammer