Lawmakers fight cuts to at-risk kids programs

Minnesota lawmakers say they will push legislation to head off a new federal Medicaid rule that would cut into a program aimed at helping abused and neglected kids and others, which could cost the state tens of millions of dollars in aid.

Republican Sen. Norm Coleman and Democratic Rep. Keith Ellison have authored bills that would require the U.S. Department of Health and Human Services to allow for 180 days of public comment before coming up with a final rule.

According to Coleman's office, the rule could lead to cuts of $45 million a year for Minnesota programs that help protect children in foster care, and as much as $38 million a year for programs for elderly and the mentally ill.

Although the department has already issued the rule, it won't be effective for another 90 days, and the lawmakers are hoping to get their bills passed before then. In a statement Tuesday, Coleman said he was working with members of the Senate Finance Committee to get movement on the bill.

"However, if we are unable to get this legislation passed before the rule is finalized in March, I will continue to seek a legislative fix to modify this rule and mitigate the effects it will have on vulnerable Medicaid beneficiaries," he said.

Ellison's legislative director, Minh Ta, had a similar strategy, saying if the bill doesn't get through, "We'll deal with this issue one way or another." He did say it was unlikely that the House would take up the bill before the end of the year.

Coleman introduced the bill with Sen. Amy Klobuchar, D-Minn. Ellison's bill was co-sponsored by the other four Minnesota House Democrats.

The revised rule would clarify the definition of "Targeted Case Management," a program that provides assistance to children in foster care, abused and neglected children, the elderly and mentally ill. The rule would change the program by prohibiting federal payments for certain services.

Federal officials did not respond to requests for comment Tuesday. But in a recent fact sheet about the change, the Department of Health and Human Services' Centers for Medicare and Medicaid Services said that Congress decided to address the problem of "widespread improper billing by states of the Medicaid program" in the Deficit Reduction Act of 2005. The release noted that the Government Accountability Office, Congress' investigative arm, has documented many accounts of inappropriate billing of Targeted Case Management by states.

An audit by CMS' Office of Inspector General this year asked Minnesota to refund $3.8 million for undocumented and unsupported Targeted Case Management services.

The release said that "certain refinements and clarifications" in the rule are expected to save the Medicaid program $1.2 billion over the next five years.

"At the same time, the rule ensures that Medicaid case management services include a comprehensive assessment and care plan that would not otherwise be available to beneficiaries," the release says.

Minnesota officials were still reviewing the changes to determine the impact on the state, said Chuck Johnson, a spokesman for the Minnesota Department of Human Services.

"We're certainly concerned," he said. "It's more than a small impact."

Patricia Coldwell, health and human services policy analyst for the Association of Minnesota Counties, said she was afraid that counties would have to raise property taxes to make up some of the difference.

"If not, and even if they do, we'll see an increase of families at risk, and increase of child abuse risk," Coldwell said. There will also be the danger of more people being placed in residential facilities if the counties can't step in earlier to prevent cases of abuse and neglect. And she said there would be less money for foster care as well.

"We're really concerned about the pressure it puts on county budgets, and the potential impact on families," she said. "We could be rolling back a lot of progress we've made in the last couple of decades."

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