A report last week from Minnesota health plan companies, Minnesota’s Healthcare Imperative, recommended cuts in services for people with disabilities, and “a fundamental reinvention of the payment system.” In plain English, that means that state Medicaid payments, which now go directly to doctors and health care providers, would instead go to insurance companies and other managed care groups.
Steve Larson, public policy director of The Arc of Minnesota, denounced the report at a press conference called by The Arc and and the Consortium for Citizens with Disabilities at the State Office Building on January 31. He said that people with disabilities and their advocates “strongly support changes in the service system to be more consumer directed and cost effective,” but that managed care plans would not accomplish this:
The HMOs and commercial insurance have used many mechanisms over the years to keep out persons with disabilities such as pre-existing conditions. They simply don’t have experience serving high need complex persons with disabilities. They have never wanted to provide coverage, but it now seems that doing business with public programs is a revenue generator for them and those with disabilities are the way to expand that profit center.
Nichole Villavicencio, a citizen lobbyist for people with disabilities, said she was “frustrated by the continued cuts to services for citizens with disabilities.”
Because of the Personal Care Attendant services I received over this past summer, I was able to work a part-time job for the Office of the Secretary of State as a Voter Outreach team member. … For myself and the other disability advocates that I work with, these proposed cuts are frightening. I’m tired of the legislature telling me to compromise the quality of my life. The proposed cuts before us will jeopardize not ony my freedom, but also my ability to be a tax-paying contributor.
The proposal also calls for cutting dental care for adults who are on Medicaid, and for moving low-income Medicaid recipients to managed care plans, instead of the current direct payment to doctors (fee for service).
Larson said that the 37-page report (see pdf below) has “factual errors on almost every page” and ignored legislation that was passed two years ago. “They wrongfully accuse MN’s PCA program of not requiring prior authorization and that it does not provide limited hours on a fixed schedule,” Larson said. “This information is on the DHS website, so the researchers on this report didn’t do their homework.”
The “confidential and proprietary” report was prepared for seven companies: Allina Hospitals & Clinics. Blue Cross and Blue Shield of Minnesota, Fairview Health Services, HealthPartners, Medica, Park Nicollet Health Services, and UCare. A Star Tribune editorial pointed out that the report does not reveal how much these seven companies would profit by the adoption of the report’s recommendations, noting that:
Administering state government plans is now a bigger part of insurers’ portfolios than is commercial business. In 2009, it was also more profitable — something the report should have disclosed.
The Minnesota Medical Association issued a statement applauding “this constructive attempt,” but also warning that “The lack of accountability in how state dolalrs are spent by health plans today does not bode well for further expansion of public enrollees in HMOs.”
Larson said that disability advocates agree with the report’s call for a Medicaid Institute to look at opportunities for savings, particularly through federal funding, but that any planning should have input from persons with disabilities – a crucial omission in the preparation of this “confidential” report.
Corbett Laubignat, who receives Medical Assistance, said, “It is infuriating when decisions are made about us, without us.”
In a written statement, Jenna Johnson, age 28, noted that, although she has disabilities, she can still get private insurance. She lives in a separate apartment of her parents’ home, and has worked at Target for 11 years:
If I lived in a group home it would cost more for services and I wouldn’t get to direct my own life like I do now. … I work at Target in Woodbury, sing in my church choir, do volunteer jobs at The Arc of Minnesota and attend Our Choice, an alternative option for adults with disabilities to socialize and do community projects.
Both Johnson and her mother, Cindy Johnson, noted that cuts in funding impact on her caregiver of seven years, who had a wage cut last year and has no pension and no benefits. They expressed concern that further cuts would mean a loss of services and loss of independence. Cindy Johnson noted that, “Our family’s experience personally with managed care – Group Health, Blue Cross Blue Shield, Medica – every time it has meant rationing of care.”
The report also calls for “pilot alternative housing and day centers,” which Larson said “is really suggesting that Minnesota pilot congregate care institutions, most of which are now closed.” He asked whether the health plans remembered “Minnesota’s ugly and unfortunate past experience with segregated and isolated congregate care for persons with disabilities in state hospitals.”