May 20, 2015

Summary of HHS Omnibus Bill

For months, the single biggest difference between Republicans and Democrats at the Minnesota Capitol was health and human services. More than a billion dollars separated the two major proposals, to say nothing of controversial ideas: repealing MinnesotaCare, a deep purge of public program rolls, making MNsure a state agency and huge differences in nursing home funding.

But as the door closes on the 2015 legislative session, HHS was resolved with a whimper, not a roar. Almost no controversial provisions from either side got adopted in the final deal, which a committee adopted shortly before 5 a.m. Sunday morning after a marathon but largely non-contentious hearing.

Most significantly, the bill directed $138 million to a Long Term Care Payment reform Bill. This is a fundamental change to the system by which Nursing Homes get paid, as well as ensuring that elderly waiver caps rise with the increases, allowing more people to be served in housing with services settings. The bill also included much sought after scholarship monies to help develop the pipeline of workers for long term care.

Other controversial items in the House and Senate proposals were also resolved.  MinnesotaCare will continue providing health care for Minnesota’s working poor. MinnesotaCare continues to exist despite a fierce Republican push to repeal it. But the health program will shift about $65 million in costs to its 90,000 enrollees by raising premiums and the share of medical costs paid by members. MinnesotaCare enrollees currently pay 2 percent of their health care costs, which will rise to 6 percent under this shift.

Those shifts were originally proposed by Dayton in January when they seemed necessary to close a deficit in the program, but the governor abandoned them in February when more money became available.

MNsure will remain largely the same, with neither DFL nor Republican proposals to seriously change the health insurance exchange’s governance adopted. MNsure sees only minor reform: a requirement to release rates on the exchange to the public sooner. Another change could have a big impact or lead to nothing: a Republican proposal ordering the state to try to let people get tax credits for health insurance bought outside of MNsure. Currently federal tax credits for health insurance are only available through official exchanges such as MNsure. But to open this up would require permission from the federal government, which many experts believe is unlikely. A proposal from Democrats to transform MNsure from a quasi-independent board to a state agency didn’t make it through. Neither did Republican proposals to add more members to MNsure’s board and remove the board’s power to appoint an executive director.

A task force will also study the future of MinnesotaCare and MNsure over the next year, providing recommendations for future reforms. The primary funding source for MinnesotaCare is due to expire in several years, creating a sense of urgency for the program.

 Mental health advocates are also cheering millions of dollars in investments for their priorities. These investments include suicide prevention, behavioral health homes, mental health crisis teams, inpatient psych units and more than $30 million in new spending.

Overall, both parties claimed victory, with Republicans extolling the extra money for nursing homes and some of the cost savings. Democrats touted investments in nursing homes, child protection and investments in Mental Health.

Toby Pearson, CHA-MN