Legislative Priorities - 2013
Accelerate demonstration projects for those with disabilities and complex health conditions
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.
Measures of success desperately needed
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.
Viable payments for hourly, low-cost, community-based services
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.
Comprehensive Medicaid Reform
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:
- Payment reform: Without significant changes in how we pay for Medicaid services, we will continue to limit access to care and short change the providers trying to meet the complex needs of individuals with disabilities. Rewarding providers who can improve care will save money today. Legislation already on the books (MS256B.0755) encourages this approach.
- Expand care coordination options: Minnesota’s health care home initiative (HCH) assists those with the most complex medical and social service needs in coordinating all their care. Courage Center data on the 200 individuals now being seen in our HCH clinic shows a significant reduction in hospitalizations. Everyone with a disability should have access to someone to help coordinate their medical and non-medical social supports.
- Put consumers in control: Today, a few thousand people take advantage of the consumer-directed community supports (CDCS) option, which grants people tremendous flexibility in what services they buy to meet their care needs. Expansion of this program, with appropriate fiscal oversight and accountability, would encourage service providers to compete on price and quality. Lutheran Social Services spent months engaging multiple stakeholders, including Courage Center, studying ways to improve the Medicaid system and save money in the long run. CDCS, which we strongly support, became the center of their reform proposal.
- Case management: Historically a county-administered and delivered service on behalf of Medicaid waiver recipients, private and nonprofit organizations should be allowed to perform these services. A DHS study group (that included Courage Center representation) will soon release a report to recommend increased choice of case management provider.