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.

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.

By Ed Eide

While many mental health services are delivered through county or private providers, State Operated Services (SOS) forms an important part of the mental health system in Minnesota. Recent legislation and unallotments from the Governor have created uncertainty around the future of SOS. What started out as a partial reorganization has turned into a far-reaching redesign intended to cut around $15 million from the budget.

While we agree that these services could be provided differently, we strongly believe that such significant changes must be vetted through dialogue and shared decision making with those affected by the decisions, including consumers, family members, community providers, counties, hospitals, and other stakeholders.

We’ve pressed hard to make sure that consumer voices are heard when these changes are considered. In response, SOS has agreed to hold a series of meetings around the state to gather information and hear feedback. We hope that many of you will take the opportunity to attend these meetings.

Dates and locations have been set to receive community feedback, although some details are still pending.  To find out more, please visit our calendar of events or call us at 612-331-6840 or 1-800-862-1799.

We’re attending as many meetings as possible, but we also need feedback from consumers and family members so that we can work to ensure you’re being heard. If you go to a meeting, and have comments or information on how it went, please contact me. I can be reached at the phone numbers above or by email: [email protected].

-Ed

Kathleen Gearin, chief judge of Ramsey County, issued a temporary restraining order yesterday to restore funding to a program that provides food assistance to Minnesotans with complex medical dietary needs. The ruling specifically noted the constitutionality of unallotment as a law, but noted several issues with the way in which it was recently used by Governor Pawlenty. She interpreted that the use of this power is intended to be limited to addressing unforeseen budget shortfalls: “[unallotment] is not meant to be used as a weapon by the executive branch to break a stalemate in budget negotiations with the Legislature or to rewrite the appropriations bill.”

More coverage on this story can be found at MinnPost, the Star Tribune, and MPR News.

Judge Gearin also noted that simply reversing unallotment entirely is not within the boundaries of the judiciary, and that it will be necessary for the Legislature and the Governor to revisit the budget in a much more comprehensive way. While 2010 is scheduled to be a relatively calmer bonding session, this ruling could signal a much more active session as 2009 cuts are reconsidered. As we have said before, some compromise on the budget will continue to be necessary. However, we are greatly concerned by cuts that disproportionally affect Minnesotans with mental illnesses, such as the elimination of General Assistance Medical Care. GAMC is a much larger budget item, and is unlikely to be restored in a similar fashion. But we believe this underscores how critical it is to find a workable solution that acknowledges the necessity of these services.

There’s a long way to go before we know the final outcome. While the grant of a stay does send a signal about the judge’s assessment of the likely final outcome, the Governor has already announced his intent to respond. In addition, this suit is limited to one relatively small program of the many that were cut. But it reminds us that the budget of the state and many social services are still hanging in the balance. For anyone who cares about mental health services in Minnesota, it is critical to remain informed about the budget process and to talk to your legislators about the programs that you value.

Please check back soon, as we will continue to post here and send out email to our Public Policy Update subscribers. We expect to have more information shortly about cuts to the Personal Care Assistance program, which provides a measure of independence for many people with disabilities, including serious mental illnesses.

The 2010 Legislative Session has not formally opened, but action is already heating up. Yesterday, Sen. Linda Berglin and Reps. Erin Murphy and Tom Huntley set forth a proposal to help save General Assistance Medical Care. The event has been widely reported, including at MinnPost , the Star Tribune, and the PioneerPress.

As you may be aware, funding for GAMC was cut by Gov. Pawlenty through the un-allotment process. This program has helped Minnesotans who lack the means to pay for necessary medical care, but are not eligible for federal relief. Currently, the Governor has proposed transitioning GAMC recipients to Minnesota Care, but this falls short for several reasons. Low income patients are unlikely to be able to pay the premiums, and the Health Care Access Fund that supports MN CARE is already facing budget shortfalls.

With a mix of funding sources, the new plan for GAMC seeks to restore coverage to those who would have no other options, encourage transition to federal assistance for those who are eligible, and share the costs of this care in a fair manner. Federal funds, county contributions, and a surcharge on providers would all contribute, and the plan is currently tax neutral, an important compromise to the Govenor’s stated position on health care.

This proposal recognizes the unique health care needs of persons with mental illnesses. There are provisions for better urgently required care to avoid hospitalization, and payments for medication. This is what we’ve always known. We need better access to timely care and ongoing support. The alternative is waiting until a person is in even further crisis.

As the plan authors note, the federal proposals currently in discussion would likely solve these issues in the future by expanding federal Medical Assistance. But until then, we need to find real solutions for the populations served by GAMC. Cutting people off from necessary care and unleashing a wave of uncompensated care on hospitals and counties is the worst case scenario.

It’s likely that many proposals on this issue will emerge in this session and much will change before anything is signed into law, but at the Mental Health Association, we are pressing for stable sources of care for persons with mental illnesses, and cost cutting that focuses on preventive care, not slashing services.

Please contact your legislators today, and make sure that they know your priorities going into the 2010 legislative session. Minnesota needs GAMC. The cost of inaction is just too high.

Stay up to date with the issues with MHAM Public Policy Alerts. In the coming weeks, look for information on the critical issues for 2010, including more on GAMC, Personal Care Assistance, changes to State Operated Services, Maintenance of Effort Agreements, and the Acute Care Needs Report.

(This post was originally sent to our Public Policy Alerts email list. Sign up through MyMHAM to stay up to date with developments affecting persons with mental illnesses in Minnesota.)