The measure in the Legislature would seek permission from the federal government to broadly revamp the state's approach to services and eligibility.
Legislative Republicans indicated Wednesday that they will seek broad federal authority to revamp Minnesota's major health care programs for the poor, in addition to broad but unspecified cuts in human services as they struggle to deal with the state's budget deficit.
The health and human services spending bill now taking shape in the House would seek flexibility to cut services, eligibility and, ultimately, costs of Medicaid programs, which are projected to cost the state $3.2 billion for the year starting July 1 and $4.5 billion the following year.
The bill's chief sponsor offered some hints at a legislative hearing Wednesday about where he hopes to cut $1.6 billion from projected health and human services spending over the next two years to help erase the state's $5 billion budget deficit.
Among the reductions would be 10 percent from the amount the state would pay HMOs to insure most people on Medicaid and MinnesotaCare -- a savings of $400 million. The plans could recapture the money by not using exceptionally high-cost health providers, said Rep. Jim Abeler, R-Anoka.
"Push is coming to shove," said Abeler, who chairs the Health and Human Services Finance Committee. "We're $5 billion in deficit in this cycle and the country is $1.6 trillion in debt. ... I'm pushing everybody, health plans, providers, everybody."
Other changes would give counties more flexibility in how they spend reduced pots of money for some programs and more closely target money used to keep disabled and elderly people out of nursing homes and other facilities.
The bill also would seek a "universal waiver" from the federal government to allow the state to change services and eligibility under the state-federal Medicaid program. While federal officials have said they want to let states experiment with health programs, it's not clear how this proposal would be received.
The bill is expected to be approved by the Legislature in coming weeks but faces the likelihood of a veto by DFL Gov. Mark Dayton, who has proposed shallower spending cuts and higher income taxes on the wealthy to balance the budget.
Big and small changes
The Abeler bill has scores of changes in state programs, including shifting money into tribal health clinics and requiring the poorest Minnesotans to do 20 hours a month of volunteer service to qualify for monthly $203 income stipends.
Advocates for the poor and people with disabilities said Wednesday that without actual budget numbers -- due next Monday -- they can't tell whether the House bill would be better for them than Dayton's proposal to cut rates by 1 percent to nursing homes and by 6 to 8 percent to programs helping people stay out of institutions.
"We're all waiting for the numbers," said Patti Cullen, CEO of the long-term-care trade association Care Providers of Minnesota. "Abeler told us that even some of this language is going to change, so we just don't know."
Abeler said the committee will post a new bill with budget figures on its website by 1 p.m. Monday, then take up to 9 1/2 hours of public testimony on Wednesday before voting on the bill Thursday. In the Senate, a similar budget bill is likely to be presented next week.
DFLers on the committee grumped that the process was moving so quickly that they will have little time to digest more than 200 pages of legislation and craft amendments, and that the public will have only one chance to testify.
Abeler said his bill is based on talking to more than 300 people, including lobbyists, state officials and legislators, "and this reflects a lot of input by a lot of people."
Warren Wolfe • 612-673-7253