State health care changes having unforeseen effects

Ying Xiong dabbed the watering eyes of her comatose son, Kee Vang, 34, then her own tears, as she struggled to understand how his nursing home care might change because of state budget cuts.

"When the money for his care ends on Jan. 1, will they let my son die?" she asked in Hmong, translated by an older son. No, she was assured by a nursing home social worker. That would be illegal and wrong. The state will no longer pay Bethany Care Center $81,000 a year for his care, but he can stay where he is, the cost borne by the St. Paul home.

Vang and 59 other non-citizens in nursing homes across Minnesota are among those affected by unintended consequences that have bedeviled thousands of Minnesotans since the state's special-session budget scramble in July.

Struggling to erase a $5 billion deficit without raising taxes, lawmakers and Gov. Mark Dayton met privately and chiseled cuts from dozens of health and human services programs -- some of them small, many obscure -- without hearings or testimony.

Since then, state agencies have scurried to interpret and implement the numerous changes. Some have been delayed because they're so complicated; others have turned out to be oversights, lawmakers now admit.

Pay cuts blocked

On Wednesday, a Ramsey County judge temporarily forbade the state from enforcing one of the new provisions, siding with a group of home-care agencies that objected to a pay cut for about 6,950 people who give personal care to relatives who are frail and low-income.

"We miss some things, or find out things we wish we'd known earlier," said Rep. Jim Abeler, R-Anoka, chairman of the House Health and Human Services Finance Committee. "We're going to have to fix a few things" -- including, perhaps, the cut that affects Vang and 59 other non-citizens and possibly 250 others being care for in other long-term facilities.

Abeler cautioned, however, that the difficult choices are not over.

"We're not talking about increased spending," he said.

"If anything, we may be facing another deficit and we'll probably be cutting more, from somewhere."

Ripple effects

Among other effects that have come to light in recent weeks is a 10 percent cut in payments for the care of about 1,800 "low-need" people with physical disabilities and 950 with developmental disabilities. Advocates say the cuts are falling disproportionately on people with mental illnesses because the state's need-assessment tool -- to be replaced next year -- was designed to measure problems of the elderly, not the mentally ill.

The cuts could force the closing of some small group homes that have clusters of low-need clients. The cuts have been delayed a month, to Nov. 1.

In a separate issue, Ramsey County District Judge Dale Lindman issued a temporary restraining order Wednesday to stop a 20 percent pay cut for relatives who are personal care assistants to people on Medicaid programs that help keep them in their homes instead of nursing homes.

Eight home care agencies brought the suit, arguing that the cut is unconstitutional and violates the federal Civil Rights Act because it discriminates against women and minorities. A hearing on a permanent injunction will probably come within 30 days.

Officials at the state Department of Human Services declined to talk about the lawsuit, but Abeler said before the judge's ruling that the payment reductions were reasonable.

"Nobody likes cuts. I don't. But we have to be responsible. This program isn't intended to provide a livelihood to people," he said. "It's supposed to make it easier for families to provide the care they want to give. Here, we cut $24 million but we're still paying them $100 million."

For their part, many care providers seem resigned to living with tight budgets.

"We recognize the state's dilemma with the bad economy," said John Tschida, a vice president at Courage Center. "But the fat in our budgets is long gone. We're rethinking everything we do to cope with shrinking state support."

'He knows when I am here'

Kee Vang breathes through a tracheostomy tube in his room at Bethel Care Center, where he has lived for about six years.

Vang, who came to the United States in 1984 at age 7 from a Thai refugee camp for Laotians, had a history of mental illness that typically was well-controlled by medications, said his brother, Blong Vang.

But Vang became disoriented one day while driving to pick up his wife in St. Paul, drove to Woodbury in a confused state and attacked police when they tried to intervene, his brother said. While hospitalized, he suffered a heart attack, and the resulting brain damage left him unable to communicate -- although his mother insists he whispers to her.

"He knows when I am here," said Xiong, 70, a widow who lives with a third son.

Despite reassurances that the nursing home will keep Vang in its care, Xiong remains troubled. If Vang had become a U.S. citizen, like others in his family, he might qualify for the regular state-federal Medical Assistance program. As it is, he qualifies for a special emergency supplement that covers non-citizens, cut in last summer's budget deal.

Could he become a citizen now, Xiong asked, even though he can't speak or understand? The social workers couldn't say.

Maybe there was one last option, she suggested -- an offer that left the social workers in stunned silence.

"I am an American citizen, and I am his mother," she said, stroking Vang's hair. "Could I give him my rights for care, and then I would die so it would be fair for everyone?"

Warren Wolfe • 612-673-7253