The new budget holds out the hope of major reforms -- but first thousands who are aged or disabled must absorb another round of cuts.
Rob Gendreau has no grasp of the fine points that Gov. Mark Dayton negotiated with state lawmakers last month as they struck a long-awaited deal to balance Minnesota's budget and end the 20-day state government showdown.
But the deal will change his life.
Gendreau, now 39, was driving home from work in 1999 when his convertible was T-boned by a truck. His ribs and facial bones were smashed, his brain traumatically injured. Doctors suggested that his parents remove him from life support.
Changes in the state's $11 billion budget for health and human services mean that his current transportation provider, like the previous one, could go out of business with yet another rate cut. His services at Courage Center in Golden Valley will be re-evaluated as the nonprofit seeks to stem a $2.5 million loss on state programs. The sole income for his mother, Linda Gendreau -- the $11 an hour she earns as his personal care attendant -- will be cut by 20 percent.
Across Minnesota, thousands of people are still poring over the budget deal, trying to figure out how thousands of services and clients will be affected by the complex changes in payments and policies.
What they know is that the budget cuts $1 billion from projected spending on health and human services for the next two years, primarily through cuts to service providers. The range of cuts is broad, affecting mental health, hospital and doctor care, health insurance, dental care, transportation, ambulance services, personal care and other help for more than 1 million Minnesotans.
Taken together, they are yet another measure of the difficult choices Minnesota faces in an era of seemingly chronic state deficits.
State officials, mindful of the deal's complexity and rapid conclusion, have told counties to delay payment cuts until Sept. 1.
"We need a little more time to analyze the new budget and write instructions," Assistant Human Services Commissioner Loren Coleman said in a recent interview.
Some note, however, that the cuts generally are smaller than those in the Republican-drafted bill that Dayton vetoed weeks earlier.
"Things could be worse," said Jan Malcolm, a former state health commissioner and now CEO of Courage Center, which offers a broad range of care to about 11,000 people with disabilities. "We will continue to dip into our reserves this time. But if the next budget in two years is no better, we'll have to rethink our mission."
A source of hope is a portion of the law that requires the state to seek federal permission, called "waivers," to change the way services are financed in an attempt to improve care and slow cost increases.
"As a state, we've talked about this forever, and we've nudged it a couple times, but the government still basically pays providers for giving services, not necessarily for achieving anything," said John Tschida, Courage Center's vice president of public affairs and research.
"It would be nice for the Legislature to get control of the budget by paying us to do good work," he said, "not just making many small cuts that add up to a whole lot of pain for us and the clients we serve."
Saving the state money
At home, Rob Gendreau mixed up a batch of chocolate chip cookies with his mom's coaching. "He's my miracle boy," said Linda Gendreau, whose husband, Bob, died of heart disease 16 months ago. "They didn't expect Rob to come out of his coma. Then they didn't think he'd walk again, or talk, but he can."
Rob receives help from three primary providers under a state-federal Medicaid program called the TBI Waiver. It pays for a range of medical and personal care services for people with traumatic brain injuries and costs an average of about $61,000 per person per year. A report by legislative researchers says the program cost about $100 million last year, but saved $68 million by avoiding more expensive hospital and nursing home care.
One service is behavioral counseling from Courage Center, which sends a specialist to the house twice a month to help Rob and his mom cope with his anger, which can flare up if he feels threatened or criticized.
Another is a day program in Richfield, Opportunity Partners, to help people with brain injuries learn social, physical and home skills. Rob had attended four days a week, but that dropped to three in 2009 when his benefit was cut to help balance the budget.
Rob's primary support comes from his mother, who asked that their city not be named because her son's disability makes him vulnerable to abuse. She has been his aide since 2000.
Rob was named after his maternal grandfather, who died in 1953 of a brain injury at age 20, after a car accident.
'We live paycheck to paycheck'
Like about 7,000 other Minnesotans helping relatives with disabilities, Linda Gendreau, 59, is paid to provide a range of personal care for her son.
A special education paraprofessional in a school for 17 years, Gendreau quit to care for Rob after his accident. Most of her life now is taken up providing him with physical therapy, speech therapy, and helping him exercise his physical and mental skills. Starting Oct. 1, her pay will drop from $11 an hour to $8.80 "and I'll have to find some way to make a little more," she said. "We live paycheck to paycheck."
Rob receives $1,005 a month from a federal Social Security disability benefit, but $499 of that goes to a "spend down" so he qualifies for Medicaid to cover his medical bills.
"We'll make it work. God's been helping us every step of the way," Gendreau said.
"OK, here's my long-term goal," she said: "I stay healthy until I'm at least 85. Rob is 65 then, and we'll go into the nursing home together, so I can still take care of him."
Warren Wolfe • 612-673-7253