Category Archives: Issues Advocacy

Wrapping Up

The 2010 Legislative session was an extremely active and difficult session.  While the primary goal was to pass a bonding bill for long-term projects, spending on health and human services came into sharp debate.  Looking back at everything that happened, what will be the impact on mental health services?

We see four areas of major importance.  GAMC was the big concern early and late in the session, and we expect more news to come soon.  For more detailed history on what happened, you can read our previous entries here.  Right now, letters are going out informing people that GAMC is changing and that they must select a hospital home for clinic care.  Otherwise, they will be restricted to emergency only treatment.  What we don’t know is how the proposed patient limits will affect this process, or how many previously eligible individuals will complete their paperwork.  We suspect that this will be a major barrier.  What we do know is that this is bad news for people living in outstate Minnesota.  The four hospitals that agreed to this plan are all in the Metro area.  People can still go to the ER, but only for emergency treatment.  We are working to find other resources for people who need assistance with obtaining medication or other non-emergency care, but the outlook is not great.

Guardianship law was one of the few “wins” we had this session.  You can read our summary here.  This change introduces a basic level of accountability for guardians and protects the rights of individuals to make long-term choices about their health care.  We believe that it is an important piece of working towards models of care that better involve and respect the person’s wishes.  In addition, it showed that we can still make important policy changes, as long as they do not require funding.

MA expansion was brought up several times in the session, and has an uncertain future, even though it is strongly favored by providers.  We view it as the best long-term solution to the GAMC issue and it is required to happen in 2014.  At the end of session, the final compromise budget did not include early expansion of MA, but authorizes the Governor to trigger entry at a later time.  Gov. Pawlenty has staked out a public position against federal health care reform and is unlikely to do so.  However, the next Governor may not be opposed or simply not have any choice to refuse so much federal money.  You can read about the candidates’ stances on MA expansion here.

Funding for basic mental health services came into jeopardy this session.  When the state invested an additional $34 M in spending in the mental health system in 2007, it was seen as a major move forward.  Yet, we are now seeing major cuts that will quickly dwarf that investment.  It’s hard to interpret this as anything but a step backwards.  Some of these cuts are set to expire in 2011, but we know that it will take a lot of political will in order to resist sustaining those cuts as the budget crisis deepens.  State Operated Services will be redesigned and face cuts, despite delaying the inevitable by refusing to follow legislative and community input.  MHAM is pleased to be included with other advocates and stakeholders in helping outline what SOS truly needs to deliver.  While the cuts will be significant here, we are hopeful that an intelligent redesign process will limit the impact on consumers.

As these conversations continue through the election season and into the next session, we think that the State needs to face facts about budget cuts.  We believe that many of these shifts and cuts do not really last.  Property taxes are up sharply as counties try to recover from reduced aid from the state, and cuts to low-income health care typically raise the rates for those with insurance.  Supportive housing, PCA services, drop-in centers, and other long term/lower intensity services have all been on the chopping block.  But hospitalization, crisis response, and police involvement are far more expensive.  When these services are cut, the trade-offs have both human and financial costs, and we will work hard to push back against the band-aid approach to budgeting in the state.

Working towards the next legislative session, a few things are going to be different.

  • There will be many new faces.  We will have a new Governor, but we will also have many new legislators as well.  Many retirements were announced as the end of session, and many elections will be hotly contested.  We see this as an opportunity to educate and inform new lawmakers about why mental health services are important and can reduce long-term costs.
  • The deficit will be larger.  The funding “shifts” for K-12 education will come due, one-time funding has been used up, and tax revenues are still lower than in previous years.  The new Governor and the Legislature will have difficult decisions to make about how to balance the budget.
  • Lastly, we hope that more of you will join us in calling, writing, and staying involved.  We know that contact from constituents made a big difference in outcomes this session.  We will continue our outreach across the state to LAC groups and other communities, and we would love to hear from you about getting involved.

Down to the Wire

With the regular session fast approaching its end, the Legislature and the Governor have still not come to a budget agreement.  Gov. Pawlenty vetoed the Health and Human Services bill that we recently wrote about.  However, most observers see signs of potential compromise, that the veto letter indicated a willingness to compromise.  What we are concerned with is that the Governor is looking for other funding sources to pay for Minnesota’s share of MA expansion.

  • The hospital and insurance surcharges are a fundamentally fair way of collecting this money.  Most of the organizations affected will also benefit greatly from expanded MA.  This is a fair trade in which everyone benefits.
  • Previous funding sources included large cuts to the Adult Mental Health Grants.  We oppose these cuts strongly, as it is not wise to provide health insurance at the same time that we eliminate necessary mental health services.

We need a budget signed into law, and we know that this will involve compromise.  But we would strongly oppose a return to raiding mental health services to solve the budget crisis.

Back to the Governor

Once again, the future of mental health services are back in the hands of Gov. Tim Pawlenty. The House and Senate Conference Committee finally finished their negotiation of the final bill that would go to the Governor.  You can see the full details here.  These discussions have been long and tense, and many of the most important programs for our community were up for cuts.

The final bill is better than the Governor’s original proposal, and it is much better than the House proposal too.  But it still reflects the political and economic environment we’re in, and it will be a challenge to deal with in the coming year.  Please contact the Governor’s office and let him know what you think.  The compromise bill proposes:

  • Restored funding for the Adult Mental Health grants supports community programs such as CSPs, drop in centers, and case management.  These grants were cut earlier in the session to pay for the GAMC compromise bill.
  • Restored funding for ACT teams in rural areas.
  • Cuts to housing with support for adults with serious mental illnesses.  However, these cuts are for 2010 and are not projected to continue at this point. All the major proposals have cut this amount.

We are particularly concerned for out-state Minnesotans at this time.  The Governor has taken it upon himself to modify the conditions of the GAMC deal struck with legislators earlier in the session.  When no hospitals would agree to participate, he  managed to convince 4 metro hospitals to accept a limited number GAMC patients.  There are two serious problems with this.  Patient limits were not part of the legislated solution, and may cut individuals off from needed care.  Secondly, four metro hospitals do not replace a state-wide safety net.  This is an unacceptable plan to people who do not live near the Twin Cities.

We would like to thank the members of the conference committee for hearing the needs of Minnesotans with mental illnesses.  We urge the Governor to do the same,

At Cross Purposes

Since the MN Supreme Court decision reversing unallotment came down, we have known that budget negotiations would have to go into the final hours of the session.  But we are also facing new uncertainty about Federal funds that both sides were counting on to solve this biennium’s shortfall.

This means that the budget gap is now at about $3 B.  Obviously, this is a significant amount concentrated into the final year of the biennium.

The  plan proposed by the MN House and Senate majority addressed this new amount.  It would ratify certain parts of the unallotments, such as delays and shifts in K-12 Education funding and in local government aid.  What is significant about this plan is that it spreads the cuts more evenly that other proposals we have seen this yea. In addition, it plans on eventual restoration of the most important mental health related county grants and it raises new revenues through income taxes.  If the $400 M in Federal money does arrive, some money is put back into health and human services.

Passed narrowly last night, it met an almost instant veto from Governor Pawlenty.  There appears to be very little forward movement or compromise appearing.  Pawlenty has asked again for the Legislature to ratify his solution, but it was voted down by large margins in the House.

As we’ve said before, we hope that you will ask your legislators about what they have done to make a workable compromise possible.  There’s too much at stake to continue our present course of disappearing services and lost independence.

Unallotment Reversed and What Comes Next

Yesterday morning, the Minnesota Supreme Court ruled that Gov. Tim Pawlenty’s unilateral unallotment of funds earlier in the biennium did not meet the statutory requirements for using that power.  The majority found that the language of the statute and the design of the State government do not allow for a Governor to use unallotment prior to agreeing to a budget.  Chief Justice Magnuson wrote for the majority (Link goes to PDF):

…we cannot conclude that the Legislature intended to authorize the executive branch to use the unallotment process to balance the budget for an entire biennium when balanced spending and revenue legislation has not been initially agreed upon by the Legislature and the Governor.  Instead, we conclude that the Legislature
intended the unallotment authority to serve the more narrow purpose of providing a mechanism by which the executive branch could address unanticipated deficits that occur after a balanced budget has previously been enacted.

The court chose to rule on narrow grounds, and it was a 4-3 decision.  They intentionally did not take up the question of the underlying constitutionality of the unallotment statute.  However, the implications represent a substantial shift in the balance of power at the Capitol.  Just hours earlier, Gov. Pawlenty had vowed to cut an additional $500 M from the budget if the Legislature failed to do so, invoking unallotment.  This decision makes that threat less credible.

Now, the pressing and serious question of how to balance the budget comes back to the Legislature. The full impact of this ruling is not yet known, but it is likely that it will create a substantial amount of conflict in the coming days.  The budget must be balanced, and Federal money that both Gov. Pawlenty and the Legislature was counting on has not yet arrived. They must agree to a  budget, but we do not expect the negotiations to be easy.  Deeper cuts and the potential for a government shutdown may be in the future, as Pawlenty as renewed his vow not to include revenue increases as part of the solution.

As the Health and Human Services budget is considered, this decision is going to play a significant role.  Many of the cuts made through the unallotment process were in this budget, and now must be renegotiated. We are already seeing strong signals that the Governor is unwilling to consider Medical Assistance expansion, even though hospitals have now refused to join in the replacement GAMC program.

Stay tuned and keep speaking up for mental health services in Minnesota.

Budget Hearing Monday

As we continue to examine the House Health And Human Services budget, the worse the news gets.  We do not see an effective framework for managing costs or promoting the well-being of our community.  What we see are cuts to long-term programs that will lead to more crisis situations and worse outcomes for consumers.

Ways and Means will take up HF 2614 this Monday morning, and we need to make sure these Representatives get a lot more calls and emails in regard to these shocking cuts to mental health services before then.

Please call or email members of the Ways and Means Committee, or whoever is your Representative. Ask them to share with the Speaker that they do not support these devastating cuts to mental health services and will vote against this budget both in committee and on the floor if necessary.
Make sure you call your Representative regardless of their committee assignments, but in particular, members of the Ways and Means Committee need to hear about our concerns immediately.

Thank you to everyone who is helping make a difference in a very challenging time!

Losing Ground

Mental health services in Minnesota unexpectedly lost ground today, as the House Health and Human Services Finance Division introduced their proposed budget. The bottom line is that the House is aiming to take more away from mental health services than the Governor.

We find it hard to believe that the same Legislators that worked so diligently to try to find some solution for GAMC would abandon the critical programs that help keep Minnesotans independent and prevent hospitalization or other high-cost crisis situations. This news requires our immediate and strong response. Please call your Representative immediately, and tell them what mental health services mean to you and what you think about these cuts:

  • Supportive long-term housing is important because it provides stability and a chance to recover. It is the single most important priority we have for our community.
  • Instead, State Operated Services hospital system escapes unscathed from cuts. This rewards them for ignoring the Legislature, and refusing to deliver the services that we need.
  • ACT Teams help defuse crisis situations, and find treatment for those who need it most.
  • Cuts to county mental health grants attack the backbone of mental health services in Minnesota, delivered in the communities where we live. They provide services such as clinics, case managers, and housing that help us recover.
  • These cuts come on top of 9 million of reductions to mental health grants in the GAMC compromise bill above and beyond lost reimbursement for services. GAMC was redesigned by cannibalizing the mental health system. In total, these grants will have been cut by over a quarter.
  • Mental health services stand alone in receiving additional cuts beyond what the Governor proposed. Nursing Homes and Disability services stand to retain 100 Million that would have been cut. Mental health services are valuable, too. We can’t be the only target.
  • Ultimately, this is a revenue problem. The dismantling of successful programs that help save money in the long-term is not an appropriate response to a temporary and politically exacerbated revenue shortfall.
  • Expanding Medical Assistance may be a positive part of extending services to those who can’t afford them, but other cuts to hospitals and providers will weaken the system at the same time we’re adding more patients.

Tom Johnson, one of our client advocates, puts it well. You can treat a disease, and that’s part of the solution. But you also have to believe in people, too.

These cuts hit the very services that help Minnesotans with mental illnesses believe in themselves again and find recovery. At the same time, this plan will overwhelm and erode the emergency safety net that is supposed to treat them when they need it most.

The House plan is unacceptable to our community. It represents more hospitalization, less management of our conditions, and more costs.

Please call today, and send this information on to anyone who wants better lives for Minnesotans with mental illnesses.

Shifting the Focus

As the SOS redesign continues, we have had many opportunities to speak about what is important to mental health consumers in Minnesota. Our refrain has been: long term care and housing with supports. We believe that supportive environments, aimed at long-term stability is what consumers need from the system. This puts the focus on the client and their independence, while hopefully reducing the need for acute services. In particular, we are hoping to reverse direction, and restore funding for CADI Waivers, and other options that put Minnesotans with mental illnesses back into their communities, and provide them with the support to stay there successfully. As Executive Director Ed Eide stated in a recent Star Tribune article, the alternative has been to warehouse patients indefinitely in restrictive settings.

We strongly believe that this kind of focus is what needs to be at the heart of the redesign process. Preserving jobs and programs are important but the provision of quality services at an appropriate level is paramount. We are calling for many of the cuts to be reversed, but we’re also showing the need to get better results with that funding. We can only really talk about appropriate staffing once we know what services we need.

We have continued our conversations with policy makers in St. Paul as well as consumers and providers around the state, seeking to build consensus around what are the best options for positively transforming SOS. As the legislative process to decide what to do with SOS continues, we will continue to provide ideas and feedback.

Another recent development has been around the revised GAMC system. As you may remember, patients are being shifted towards hospital-based care organizations that would try to move care out of the Emergency Rooms and towards clinics and less intensive settings. However, recent roadblocks have come up. The House Heath Care and Human Services Finance Division heard testimony last Thursday that many rural hospitals would refuse to participate because they did not think they could set up services quickly enough or have enough of their costs covered. Now, HCMC has signaled that it will also decline to participate. As one of the largest providers of GAMC services in the state, HCMC has played a critical role in this program. It is hard to imagine a successful care plan for low income Minnesotans that does not involve them.

Under Federal Health Care Reform, the state has the option of covering single adults with up to 133% of poverty level income under Medical Assistance (Medicaid). There are some issues with this plan, namely timely implementation and fully understanding the costs until 2014 when that expansion will be required. However, as more hospitals refuse the GAMC compromise, this option may require a second look.

Expanded Rights

Gov. Pawlenty signed HF 3128 into law on Thursday, providing critical reforms to the guardianship process in Minnesota.

This bill denies guardians the right to void advance health care directives, and restricts the circumstances in which a court may do so. It increases the rights of persons under guardianship who have formalized their concerns and wishes into a Health Care Directive. It also requires notice if a proposed guardian has been removed with cause in the past.

These changes allow persons with chronic mental health conditions to make decisions about their care when they are capable of doing so, and formalizing those wishes in a way that must be respected even if they are placed under guardianship in the future. At MHAM, we believe strongly that people have the right to be involved in creating their own care plan, and that these agreements can be an important part of staying healthy in the long-term. It also makes it easier for courts to spot proposed guardians who have not lived up to their duties in the past, so that they are not assigned to new clients. We know that it’s critical for appointed guardians to be held accountable for the decisions they make.

MHAM is pleased to see these needed changes make it into law, and thanks the sponsors of the bill: Sen. Mee Moua, Sen. Linda Higgens, and Rep. Debra Hillstrom.

For more information about advance health care directives and planning your medical care, please contact us at 612-331-6840 or 800-862-1799.

Putting the Brakes on a Runaway Redesign

Sen. Linda Berglin announced a plan to slow and redirect the SOS redesign process. With a close eye to preserving some of the programs that were identified for elimination, she and other senators stated their intent to pass legislation requiring a different strategy from DHS and SOS. The group is mostly from the DFL, but some Republicans are joining in stating that the process must be slowed or changed. Jim Abeler (R-Anoka) noted that DHS has a tendency to answer to the Governor, and not sufficiently include direction from the Legislature.

Specifically, DHS failed to heed the Legislature’s requirement that they address the issues of lost federal money because of facilities not eligible for MA certification. Berglin stated: “They didn’t do it, so I’ve done it for them.” The plan would also preserve dental services within SOS, and seek to increase Federal billing in order to pay for the retention of services.

We still have concerns. The “PERTS” model of care is still being discussed, even though we have remarkably little information about how that will be different from successful models already in place.

The other concern is looking at what is driving these efforts. For SOS leadership, the primary concern seems to be in providing highly intensive and rapid services, and significant reductions in the budget. However, the truth of the matter is that most people receiving SOS services have long-term needs. For some of the legislators stepping up to slow the process, the concern is saving local jobs. We’re not unsympathetic to preserving jobs and keeping qualified providers in the mental health system. However, the primary driver here has to be the delivery of appropriate services to clients. After so many cuts in the last year, we need to get the absolute most services per dollar we can.

MHAM and other advocates are sending our counter proposal to the Legislature. We take these concerns, and try to show what a patient centered vision of SOS might look like. Please stay tuned as we move forward!