The Department of Human Services (DHS) is experimenting with new care delivery and payment models for Medicaid recipients. However, people with disabilities have been largely excluded from these pilot programs. Demonstration projects to provide better care for those with disabilities and complex health conditions in the Medicaid program have been authorized and encouraged. They should be implemented today. The opportunity for cost savings and better integration of medical services and non-medical (waivered service) social supports is great. People with disabilities deserve better than the current fractured system of care.
Since the Health Reform Act of 2008, great progress has been made in developing quality indicators and measures of success for the general population and high-incidence chronic conditions like asthma and diabetes. With the assistance of organizations like Minnesota Community Measurement and the Institute for Clinical Systems Improvement, the provider and payer communities have worked hard to develop a rigorous quality infrastructure that has resulted in more transparent reporting and tools for consumers to select health care professionals.
But there is significant work to be done to measure the success (or failure) of people with disabilities in our health system. This is true when it comes to medical services and even more so in the case of non-medical social supports – especially Medicaid waivered services. If we can’t define the value these services have and the difference they make in the lives of Minnesotans with disabilities, they will continue to face the threat of budget cuts. New measures must be adopted, compiled, and reported for this population – the most expensive and hardest to serve in the taxpayer-funded Medicaid program.
When the state began to look for new program models to better serve people in community – rather than institutional settings – Courage Center founded its Independent Living Skills (ILS) program. We set the standard for this low cost, in-home service and have the outcomes data to prove it.
The Department of Human Services has spent two years developing a new payment methodology for these and other publicly funded services. However, the proposed restructuring would slash current ILS payments by 30-40 percent. As Medicaid reform efforts continue, services like ILS will be critical in maintaining the health of individuals with disabilities and complex medical conditions. As the largest provider of ILS services, with 34 percent of the metro area market share, Courage Center believes better rates are needed to ensure the viability of this program.
Minnesota’s safety net for the poor, aging and disabled is inefficient, often ineffective, and financially unsustainable. Individuals with disabilities of all ages are driving the costs even higher. Change is needed this year to preserve Minnesota’s commitment to its most vulnerable citizens. Opportunities for significant improvements to support Medicaid 2020 include: