Cuts to unique disability waiver program leave questions for disabled Minnesotans

NINA MOINI: This session, the legislature voted to cut funding for nursing homes and the state's disability waiver system to help balance the budget. The disability waiver system is linked to Minnesota's Medicaid program and provides home and community-based services to those with disabilities, helping them live in a community rather than an institution.

In 2023, around 70,000 Minnesotans used disability waivers, and lawmakers say the cuts will slow the growth of the program. Joining me to talk about the impact of these cuts is Linda Wolford, the government relations director for the Minnesota Council on disability. Thank you so much for your time this afternoon, Linda.

LINDA WOLFORD: Thank you for having me on.

NINA MOINI: I know that you have a big platform. You interact with a lot of people. And I did just want to start by talking with you a little bit about Senator John Hoffman, who, of course, continues to recover following the shootings that injured him and his wife, Yvette, and killed Representative Melissa Hortman and her husband, Mark. He's a very strong advocate, his whole family, for disability rights and services. Anything that you want to share about your relationship with them, or anything you just want to say?

LINDA WOLFORD: Sure. Senator Hoffman has been a very strong ally to the disability community and leading a lot of legislation, including their own waiver services, PCA services. And yes, I've known John for a long time, as he's been the chair of the Health and Human Services committee.

And John, if you're listening, I hope you're doing well and recovering out there because what happened to you is so very sad. And just so sorry. And so I wish you and your families, and obviously that of the Hortmans the best, because you're great people who care about people like us. I, myself, have a disability, a significant disability in which I am reliant upon staff 24 hours a day. So thank you for your service. And this is just such a tragic thing.

NINA MOINI: Thank you for sharing that, Linda. And disability is something that, many people, it will touch their lives at some point. Would you describe how does a disability waiver work for those who may not know?

LINDA WOLFORD: Sure. Yes. Waiver services, which is separate from what they call state plan services, are those provided to people. What is usually referred to are at an institutional level of care, like, for example, a nursing home or an intermediate care facility for Developmental Disabilities. So these individuals' needs cannot be met by less extensive Medicaid in Minnesota.

We call that medical assistance, but it's really Medicaid on the federal level, like maybe PCA services, which is now moving to a program called Minnesota Community for Solutions and Supports, or CFSS, or semi-independent living skills. So these are people that have the greatest disability needs, probably, out there.

And so the waiver, there are four different disability waivers. I want to stress that the funding is split equally between the state and the federal to fund these programs, of which there are four right now, the brain injury community alternative care, also known as the CAT waiver.

Community access for disability inclusion, or the CADI waiver, and the developmental disabilities waiver. There's also two for people who are elderly, which is the elderly waiver and the alternative care waiver. Those are what we have in Minnesota currently.

NINA MOINI: Yeah, lots of people impacted. And of course, we're talking about money that won't come to the program, at least not in this budget cycle. But Minnesota, generally, I understand, does have more generous disability waivers programs in the country. Can you talk about what makes Minnesota services unique and perhaps why you still need more resources, though?

LINDA WOLFORD: Sure. Yes, I can explain that. Minnesota is known to be one of the most generous states, as far as services to people with disabilities, their families, as well as people who are aging. But however, the budget forecast this year showed that these waivers, in part, along with special education services was going to cause Minnesota to start having a negative, or being in the red for our fiscal, looking forward for our budget forecast.

There's the word I was looking for. And so that was why it was the decision that we had to do something to reduce the spending in the waivers. And to do this in several ways. And if you want me to talk about those, or do you have another question?

NINA MOINI: Well, I do think that the numbers here, I just want to share. It was on course to rise from around $5 billion to $8.5 billion. So a significant detour that you're taking there. But I really want to know, too, Linda, what are the on the ground impacts here? We're hearing so much right now about funding cuts and the budgets at a federal and a state level.

But it's hard to conceptualize how it impacts people. Are there people who will no longer be able to get these services? Or people who are perhaps on a waiting list, who now won't be? What is the effect on the ground, do you think?

LINDA WOLFORD: Sure. Yeah. Well, I will say, I'm going to give credit to DHS because I think the proposal they put forward will have the least amount of impact on the actual people receiving the services. Of course, that's yet to be seen.

But what they did was they reduced things in three areas. First of all, that was reducing the cost of living adjustments that were scheduled to happen for providers of waiver services, of which there are hundreds, from a 6% cost of living to a 2 to 4% cost of living. So that's one way. So that will be kind of an across the board. And each provider can decide how those are going to be implemented.

But because these services are a little costlier, a percentage increase means that they keep getting even more expensive. So that's why the cost of the increase that you see forecast in the budget to bring it down a bit, and therefore impacting everyone the same because a lot of programs are not reimbursed at the higher level.

And waiver services are reimbursed at different levels. So I mean, each service has a different cost to it. The second way they did this was they're reducing the number of rate exceptions that were becoming more common, when it's supposed to really be a rate exception, it's supposed to be based on someone's particular need for a higher rate.

So I'm going to give you an example. Someone with a behavior issue that might cause harm to themselves or others, they may have very much a reason to get a rate exception, meaning they might need a heavier level, higher level of staffing, like, two people to see that they don't cause harm to themselves or others.

But providers were just asking them for all of their folk-- not all, but some of them were-- instead of being an exception, it was becoming more commonplace. So that's one thing they're going to take a look at, is making sure that they really are individualized and that there is a need. So they're not saying that it's going to be eliminated.

It just may impact some individuals, but they're going to be looking at who really needs these. Or is it just providers are putting these through, expecting them to go through, because there really has been a shortage of staff at DHS to really examine these closely. So that's another way they're trying to do that. And then they're also looking at reducing the number of people in the future who might be eligible for waivers and divert them to more lower cost services. So it's really hard to say.

NINA MOINI: Sure.

LINDA WOLFORD: But I will say this. There's nobody currently on a program that may be able to even feel it at all, or it's yet to be determined. But if cuts had to be made, I think this was the best way they could do that.

NINA MOINI: OK. Thank you for that. That's a really good perspective. And what you're talking about is the truth that people are so individual in their cases and in their care and in what they need. So having the staff to be able to look closely and comb through all of that, we'll see how that goes. And we hope you'll keep us up to date. But we just have about a minute left, Linda, and I'd love to end on just a positive note of were there some wins at the legislature this year for Minnesotans with disabilities?

LINDA WOLFORD: Absolutely.

NINA MOINI: Wonderful.

LINDA WOLFORD: I love talking about wins instead of just losses.

NINA MOINI: Yeah. Tell us a few.

LINDA WOLFORD: Yes, yes. Some positive things that happened at the legislature was they increased the reimbursement rate for that PCA or CFSS program for people who receive more than 10 hours a day, or all people, people with 10 hours or more a day will see a 5% increase.

NINA MOINI: And just say what PCA is. Just say what that is.

LINDA WOLFORD: Personal care assistance program, which is transitioning to something called CFSS. And so those services are reimbursed at a much lower rate than waiver services. So it's kind of trying a good thing. They'll get more money because then maybe some people who were on waivers could move over to just getting help through the PCA program.

Another good thing is, and this relates to the wonderful late Melissa Hortman who was a service dog trainer. People will be allowed to bring these service animals in public, people who are training them. Before it was only the people who actually used them could bring them out in public because they have to learn how to socialize.

NINA MOINI: I didn't know that.

LINDA WOLFORD: But that's a big win.

NINA MOINI: Yeah. All right, Linda. Yeah, that's wonderful. No, tell me the one more.

LINDA WOLFORD: Yeah. OK. Yeah, I'll do one more. There are quite a number. But another thing is they're going to be looking at the assessment that determines services and be making some changes. And children under the age of 12 with autism who take adaptive swimming lessons, they will allow that to be reimbursed by waivers due to the high rate of drowning in youth with autism.

NINA MOINI: Yes.

LINDA WOLFORD: So that might be a whole other topic to explain because I've heard some really interesting testimonies about that.

NINA MOINI: Absolutely. We would love for you to come back and talk about that specifically because there have been drownings in recent years in children with autism.

LINDA WOLFORD: Right. A way higher level than the general public.

NINA MOINI: Linda, thank you so very much for stopping by Minnesota Now. We appreciate you.

LINDA WOLFORD: Yes. Can I say one more thing?

NINA MOINI: Sure.

LINDA WOLFORD: Can I add one more? Sorry. There was also a bonding bill that passed for $9.5 million, sorry, for making our capital tunnel that connects with the state office building wheelchair accessible, meaning that it's too steep right now. So people like myself who use wheelchairs, that that tunnel won't be so steep. So that was a big win seen at the end of the session. And I just visited with Senator John Marty about that last week.

So anyway, so those are some positive things that happened because it's nice to look at things that's not just all negative, but that can improve the lives of others in other ways. So I want to say that I feel like they took the most balanced approach they could take in trying to get the budget where it needs to be. I'm going to also add that, obviously, I just read that the bill, what's called the Big Beautiful Bill-- and I'm putting quotes around-- just passed the Senate. And that could mean that Minnesota could experience some more Medicaid cuts.

NINA MOINI: And we're going to talk about that. Yeah, we're going to continue to cover that was just passed within the last hour or so in the Senate, in Congress, and now has to go to the House again. So thank you very much, Linda. That was Linda Wolford, the government relations director with the Minnesota Council on disability.