The State of Minnesota is delaying a set of Medicaid rule changes that would have caused thousands of low-income elderly Minnesotans to lose government benefits covering home and nursing care.
The changes were due to take effect with the new year on Wednesday. But after an outcry from advocates for senior citizens and the poor, Gov. Mark Dayton ordered the state Department of Human Services (DHS) to postpone them for a year.
“I have asked my administration to delay implementation for at least one year, to assure that the necessary community supports are in place to ensure those seniors will receive alternative care,” Dayton said in a statement Tuesday afternoon.
The changes, which were adopted by the Legislature and signed into law by then-Gov. Tim Pawlenty in 2009 as part of a broader effort to rein in soaring Medicaid spending, would have made it more difficult for low-income senior citizens with more limited needs to qualify for government supports that help them stay in their homes.
The rules would have required senior citizens to demonstrate that they needed assistance in at least four activities of daily living, or “ADLs,” or at least one critical activity such as toileting, to continue receiving benefits through Medicaid’s “Elderly Waiver” program. Previously, low-income seniors only had to show a need in one daily living activity to qualify for the benefits.
DHS estimated that about 2,600 people, or 11 percent, of the 22,600 low-income Minnesotans currently receiving the Elderly Waiver would no longer meet the criteria. The reduction in services would save taxpayers $50 million over the next four years, according to state estimates.
However, in the final weeks of the year before implementation, advocacy groups raised alarms over whether the planned cuts in home care would force senior citizens out of their homes and put them at greater risk of illness or hospitalization. Others questioned the urgency of pursuing Medicaid cuts now that the recessionary budget crisis is over and the state is running a surplus of $1.09 billion.
The planned cuts also seemed to conflict with the state’s ongoing efforts to move people out of costly nursing homes and other long-term care facilities and into homes and the community. In October, the state released a detailed and ambitious plan, known as an Olmstead plan, that would dramatically expand affordable housing for people with disabilities and other vulnerable populations, among other changes.
Though state officials had insisted that no one would be pushed onto the streets as a result of the changes, there was fear among caregivers that elderly losing their Medicaid benefits would no longer be able to afford assisted-living centers and other kinds of housing.
“We don’t want to see seniors homeless, especially in this weather,” said Patti Cullen, president and CEO of Care Providers of Minnesota, an association that represents senior housing providers. “I’m glad that the governor and the implementing state agencies acknowledge that there is work to be done to ensure that people don’t fall through the cracks.”
In a memo issued to several state lawmakers, DHS Commissioner Lucinda Jesson acknowledged that the state needs more time to develop adequate community supports for people affected by the rule changes. “A one-year delay will allow for these systemic changes to be implemented to ensure the right supports are in place for the people we serve,” Jesson wrote.
The state had created a more limited program, called Essential Community Supports (ECS), for seniors who did not meet the tougher criteria. The ECS program pays for such services as home-delivered meals, cleaning and shoveling sidewalks. However, the monthly benefit was limited to just $400 — far less than the Medicaid Elderly Waiver program. In Minnesota, the average Elderly Waiver beneficiary gets $1,150 in benefits.
“Given that the state budget situation has improved, it makes sense for the Legislature to hit the pause button and re-evaluate these changes,” said Genevieve Gaboriault, supervising attorney for the Senior Law Project at Mid-Minnesota Legal Aid.
Though seniors’ groups cheered the delay, there is still widespread agreement among lawmakers on both sides of the political aisle that Medicaid spending must be reined in. Medicaid spending in Minnesota has mushroomed to $8.2 billion in 2012 from $4.7 billion in 2003. The number of Minnesotans in the Elderly Waiver program has more than doubled over the same period.
State and federal officials are concerned that the baby boomer population will overwhelm the Medicaid system, and make current benefits unsustainable, unless efforts are made to control costs.
A spokesman for Dayton said the governor still plans to include changes to Medicaid eligibility in his supplemental budget, which will be submitted to the Legislature after it convenes in February.