Nibbling around the edges: The Legislature’s Health and Human Services proposals fail to fully address critical issues

Sarah Orange
May 11, 2018

With just over a week left in the legislative session, lawmakers have finalized their supplemental proposals for the state’s health and human services budget. Both the House and Senate proposals start to address important issues, such as child care, the opioid crisis, and abuse of vulnerable adults, but miss big opportunities to protect and expand affordable health care in Minnesota.

The supplemental budget gives lawmakers the opportunity to adjust the two-year state budget that was passed last session. The House and Senate health and human services budget proposals are comparatively small: the House bill has a net $67 million General Fund impact through 2021, and the Senate bill has a net $69 million General Fund impact.

The legislative proposals do include some important investments. First, both the House and Senate authorize family-friendly changes in Minnesota’s Child Care Assistance Program, including expediting the application process for homeless families; allowing continuous access to child care assistance for families that move into a county with a waiting list; making it easier for families transitioning off of Minnesota’s welfare-to-work program to retain access to child care; and increasing provider reimbursement rates. However, the federal funding these state proposals rely on won’t fully fund these child care improvements in the future. Additional state investment, such as what is included in the Governor Mark Dayton’s supplemental budget proposal, is necessary to fully address the child care crisis in Minnesota.

Additionally, both proposals include some new funding to address the ongoing opioid crisis. They also start to address the threats to vulnerable adults, though the Senate proposal is expected to move as a standalone bill.

These Legislative proposals also do not include solutions to ensure Minnesotans have affordable health care options in 2019 and beyond. Dayton’s supplemental budget proposal includes an important step to sustainably fund affordable health care by repealing the scheduled sunset of the health care provider tax, the largest state funding source for public health and affordable health care. However, the House and Senate would allow the sunset to go forward, and fail to address the more than $600 million annual shortfall that the state’s Health Care Access Fund will face starting in 2021.

Dayton’s MinnesotaCare buy-in option would allow people who are in the individual market the option to buy an affordable MinnesotaCare plan. This would provide more affordable health care choices for approximately 100,000 Minnesotans. This proposal is particularly timely, considering that health insurance premiums in the individual market are expected to increase in 2019. Neither legislative proposal includes the MinnesotaCare buy-in, and in the House finance proposal and the Senate tax bill would prohibit this option.

The House bill does seek to expand affordable health care options by permitting the sale of short-term, limited-duration health insurance plans. However, these plans fall short of meeting Minnesotans’ needs. The plans are not required to cover important services such as maternity care or substance abuse treatment, and they allow discrimination against people with pre-existing conditions.

While neither legislative proposal contains the harmful provisions heard earlier this session to take health care away from people who are unable to comply with burdensome paperwork requirements, this provision may move ahead as an individual bill before session ends on May 21. Estimates indicate that 25,400 people could be pushed off of their health care through Medical Assistance if this provision becomes law.

However, the House proposal places more barriers to seeing doctors through Medical Assistance and MinnesotaCare, and putting healthy food on the table through SNAP. A provision included in the House proposal is designed to double-check that Minnesotans are eligible for these supports through a third-party vendor. If a person is flagged by the vendor, it puts the person at risk of losing their health care or assistance to buy nutritious food. This double-checking will likely cause eligible Minnesotans to lose access to food and health care because of data entry errors or having an old address in the system.

Overall, the legislative supplemental health and human services budget proposals miss opportunities to help Minnesotans thrive. They fail to provide more affordable health care options, and only nibble around the edges of the opioid crisis, protecting vulnerable Minnesotans, and ensuring affordable child care is available around the state.

-Sarah Orange