Policymakers should do more for workers with disabilities

Becca O'Donnell
Apr 21, 2022

House and Senate bills take different approaches to human services and health care

Supports for workers who care for elderly folks, people living with disabilities, and those who are sick are among many positive provisions in the House Human Services omnibus bill passed by the House Human Services committee earlier this month. This bill is one of several moving through the legislative process that articulate the specific policy choices that each legislative body would like to get done this session.

House File 4579 increases the reimbursement rates paid to personal care assistants, allows them to be paid for driving their clients, and increases the limit on the weekly hours for paid parent and spouse caregivers. The bill also supports the direct care workforce by providing tools such as tuition forgiveness, workforce development grants, and incentive pay.

The bill also contains provisions so that more Minnesotans have the resources they need to make ends meet. This includes increasing General Assistance, which is modest cash assistance to individuals living on very low incomes, for the first time since 1986. Another provision would ensure that more Minnesotans can get the food they need by increasing the income limits to qualify for SNAP to 200 percent of the federal poverty guideline (that’s $4,625 per month for a family of four). These policy steps are sorely needed; low-income Minnesotans were hit the hardest by the COVID pandemic recession and have struggled more to recover.

The House Health omnibus bill (House File 4706), which was passed by the House Health Finance and Policy Committee and referred to Ways and Means on April 8, takes steps to expand the number of Minnesotans with affordable health care coverage and contains a wide range of provisions to make coverage more affordable. MinnesotaCare, Minnesota’s affordable health insurance for lower-income Minnesotans, currently limits coverage to those with incomes less than 200 percent of federal poverty guidelines who can’t get other health insurance. The bill would expand MinnesotaCare so that eligible Minnesotans can purchase health insurance coverage, regardless of income so that more Minnesotans can get high quality, affordable health care. The bill also makes children under age 20 eligible for MinnesotaCare regardless of immigration status so that more children can get the health care that they need.

Another provision in House File 4706 would help Minnesotans with lower incomes to better afford health care by eliminating copays, coinsurance, and deductibles for MinnesotaCare and Medical Assistance beginning in 2023. The bill would also expand dental coverage for adults who get health care through Medical Assistance. Additionally, the bill addresses a deeply important issue for children who get their health care through Medical Assistance by ensuring 12 months of continuous coverage. This would prevent unnecessary disruptions in health care coverage and would result in healthier children and families.

In all, House File 4579 and House File 4706 would allocate an additional $700 million in FY 2022-23 and $1.2 billion in FY 2024-25 of net general fund resources. In addition, the bills would allocate $259 million from the Health Care Access Fund (HCAF) in FY 2024-25. (The House bill also transfers $134 million from the general fund to the HCAF, resulting in a $71 million net increase in the HCAF in FY 2022-23).

Senate File 4410, which passed the Senate Human Services Reform Finance and Policy Committee, also places a heavy focus on strengthening the direct care workforce and includes rate increases to improve pay for direct care workers, grants aimed at keeping long-term care facilities open, an increased limit to the number of weekly hours allowed for paid parent and spouse caregivers, and other measures aimed at stabilizing the long-term care and direct care workforce.

The Senate bill is substantially smaller than the House’s, allocating an additional $262 million in general fund resources in FY 2022-23 and $738 million in FY 2024-25. While it includes a number of hugely beneficial items, it fails to capitalize on the opportunity the historic budget surplus affords to make strong strides forward in creating a healthier and more equitable future.

More action should be taken to support workers living with disabilities

A partial win for Minnesotan adults with disabilities in Senate File 4410 is the inclusion of part of Senate File 3645/House File 4273, which would make needed improvements to Medical Assistance for Employed Persons with Disabilities or MA-EPD. In Minnesota, MA-EPD helps over 10,800 working adults with disabilities who earn too much to qualify for Medicaid to pay for health care needs that aren’t covered by private insurance or Medicare, such as personal care assistance. Folks enrolled in MA-EPD pay a monthly premium based on their income in addition to what they pay for any private insurance offered by their employer, and for Medicare, if they qualify.

The Senate bill would adjust the MA-EPD premium schedule so that those with lower incomes can better afford coverage. Unfortunately, the House human services bill does not include any MA-EPD changes.

Minnesota simply can’t afford to leave any of our labor force behind. We urge policymakers to go beyond what’s in the Senate bill and enact the following additional improvements to MA-EPD:

  • Increasing the asset limit for those participating in MA-EPD from $20,000 to $40,000 and adjust for inflation in future years. The current asset limit makes it difficult for folks to save for a home, cover health care needs, and save for emergencies, and hasn’t been increased since MA-EPD began over 20 years ago.
  • Accounting for other health insurance payments in determining MA-EPD premiums and making Medicare premiums reimbursable for all participants.
  • Streamlining administration to reduce burdensome paperwork.
  • Ensuring folks maintain coverage and keep getting the health care they need when they are most vulnerable. Currently, just one missed MA-EPD premium payment results in loss of coverage.

These updates would make MA-EPD more accessible and affordable, and strengthen the workforce by supporting people living with disabilities to get health care services that aren’t covered by other types of insurance.