DFLers built a Human Services budget that is the largest investment in the state’s history aimed at supporting the caregiving industry, the elderly, people with disabilities, and people living with substance use disorder.The 2023 legislative session directed money to people caring for others and those using care services, with $1.35 billion in new spending for the first biennium. The 2023 Human Services budget valued person-centered programs and is the beginning of the state acknowledging that this sector is deserving of significant investments.
AUTONOMY AND INDEPENDENCE FOR PEOPLE WITH DISABILITIES
MA-EPD Asset Elimination
Eliminates the $20,000 asset limitation for people in Medical Assistance for Employed Persons with Disabilities (MA-EPD). Before this change, people with disabilities who work and required services not covered by traditional health insurance (like PCAs) were forced to limit their wealth for fear of losing their services. By eliminating the asset requirement in MA-EPD, people with disabilities in Minnesota can now achieve professional success without risking their health.
Incentivize Competitive Integrated Employment
The culture is shifting in the advocacy community toward competitive integrated employment for people with disabilities. Minnesota will help providers make the transition to this new employment structure and a statewide disability technical assistance center will be created. This budget item also includes data collection and performance measures to track outcomes for people being paid subminimum wage. To address the concerns of families of people with disabilities currently earning a subminimum wage, Minnesota will establish a disability-inclusive worksite training and certification program. This will create a preferred contractor designation to ensure the safety and inclusion of people with disabilities working in community businesses.
Technology for Home Grants
Increased funding for the Technology for Home grant program will allow this program to reach more people with disabilities and help them to live more independently. This program helps people with disabilities live where they feel is the best place for them by offering in-home assistive technology consultations and technical assistance services. Technology supports can range from communication devices, wheelchair ramps, large print books, and devices to assist with light switches.
Supported Decision-Making Grant Programs
Helps promote informed choice for people with disabilities instead of directing them toward restrictive guardianship or conservatorship situations.
Policy changes will allow remote overnight supervision in a community residential setting in lieu of on-site direct support staff and remote PCA supervision for recipients with chronic health conditions or severely compromised immune systems.
PROMOTING DIVERSITY OF CARE OPTIONS
Life-Sharing Services Benefit
The Human Services bill establishes a formal Life Sharing Medical Assistance (MA) benefit. Life Sharing will allow Minnesotans with disabilities to live in homes with a family-like atmosphere rather than living in settings more akin to community residential services (CRS), sometimes called “group homes.”
This is a relationship-based living arrangement between an adult with a disability and an individual or family member. This enables them to share their lives and experiences together while the adult with a disability receives support from the individual or family member using person-centered practices.
Shared-Services Program Modifications
Shared-Services is another program that provides flexibility and options for people with disabilities. Minnesotans on Brain Injury (BI), Community Alternative Care (CAC), Community Action for Disability Inclusion (CADI) and Developmental Disability (DD) waivers can share services with other participants in the waiver program. Shared services are services provided at the same time by the same direct support worker to people who have entered into an agreement.
Now there will be more opportunities for people to enter into these agreements through the program changes, such as increasing the number of people who can enter into Shared Services agreements. Shared Services also are expanded from PCA services to other services like chore, homemaker, and night supervision. Minnesotans can now enter into these agreements in unlicensed settings.
UNPRECEDENTED RATE INCREASES IN ELDERLY WAIVER SERVICES AND FUNDING COMMUNITY-CENTERED PROGRAMMING FOR SENIORS
More than $400 million is directed to Elderly Waiver rate increases and to Consumer Directed Community Supports. The Elderly Waiver (EW) program provides home and community-based services (HCBS) for people who need the level of care provided in a nursing home but who choose to live in the community. Consumer-Directed Community Supports (CDCS) participants direct and implement their own care plan and can also hire their family members to deliver those services and supports.
Elderly Waiver services were some of the lowest paid waiver services by the state and are now seeing significant rate increases thanks to the DFL budget. Elderly Waiver (EW) non-residential services increased by 32.03%, EW customized living increased by 44.78%, and EW homemaker services increased by 56.67%. These targeted rate increases will ensure that elderly Minnesotans have a workforce with competitive wages to help them live in their community.
Nearly $22 million is for grants directed at senior programming providing non-medical social services for older Minnesotans and their families to allow older adults to stay in their own homes and avoid institutionalization.
$400 MILLION IN DIRECT FUNDING TO STABILIZE LONG-TERM CARE BUSINESSES ACROSS THE STATE AND BOLSTER THE LONG-TERM CARE WORKFORCE
Nursing facilities across the state have expressed concern about the financial solvency of their businesses. The increased costs they’ve incurred due to inflation and COVID-19 mitigation and prevention, along with the direct-care workforce shortage, have left them struggling to keep their doors open. In response to addressing the financial distress of nursing facilities across the state, DFLers took a holistic approach to address this crisis by providing cash flow assistance, direct lump sum payments, long-term care workforce retention grants, and restoring a program dedicated to supporting rural nursing facilities.
Loan Forgiveness for Financially Distressed Nursing Facilities
A one-time $100 million investment that will help nursing facilities with cash flow issues. The loans are interest-free, and facilities can determine a repayment plan of up to six years. Facilities will have flexibility on the payment plan to fit their respective needs.
Re-establishment of the Critical Access Nursing Facility (CANF) program
DFLers have restored a program dedicated to geographically isolated nursing facilities that are facing imminent closure. This is an existing program that has not been funded in years. By re-establishing this program through program updates and ongoing funding, DHS will be able to move quickly to support nursing facilities facing the greatest challenges.
Workforce Incentive Grants for Long-Term Services and Supports
$175 million is directed toward a new grant program for long-term services and support providers, which includes nursing facility workers, that will assist with recruiting and retaining direct support professionals.
Eligible workers may receive payments of up to $1,000 per year from the workforce incentive fund. Grantees may use the money to provide payments to eligible workers for retention, recruitment, and incentive payments, postsecondary loan and tuition payments, childcare costs, transportation-related costs; and other costs associated with retaining and recruiting workers.
Direct Payments to Nursing Facilities
In this program, $173 million will be used to deliver two payments to every nursing facility in the state. The first payment will be by August 1, 2023, and the second payment will be by August 1, 2024. Nursing facilities will be required to spend this funding on specific costs, such as debt restructuring, avoiding receivership, rent or debt payments, or maintenance costs.
Nursing Facility Temporary Daily Rate Add-on (Temporary)
$51 million is used for a temporary daily rate add-on for nursing facilities for 18 months from July 1, 2023, through December 31, 2024. Facilities will receive an additional $12.35 per day per resident, resulting in additional revenue for nursing facilities equal to approximately $134 million.
Nursing Home Workforce Standards Board
The omnibus Labor bill included provisions for a Nursing Home Workforce Standards Board to provide greater voice for employees in Nursing Homes, as well as new Labor standards to protect workers from injury.
The Nursing Home Workforce Standards Board will be a rulemaking board with agency, employer, and worker representatives charged with setting minimum employment standards for nursing home workers including but not limited to wages. The bill would require that the board determine if the cost of new standards were to require a nursing home rate increase to implement, the standard would not be able to go into effect until a sufficient appropriation is available.
Workers would be required to receive safety training from worker organizations annually under this bill. These provisions will offer the generally low-wage workforce in Minnesota’s Nursing Homes a greater voice in their work and in the care residents receive.
As Senate DFLers continue to tackle workforce shortages and funding concerns in Nursing Homes and direct care services, providing workers a greater voice in their workplace is a critical step to meeting Minnesotan’s needs and uplifting workers.
COMPETITIVE WAGES FOR PROFESSIONAL CAREGIVERS
CFSS/PCA Rates & SEIU Contract
Senate DFLers made sure to include the SEIU contract ratification and wage increases in the Human Services budget, which passed with $889.5 million for the Community First Services and Supports (CFSS) rate framework (CFSS is the new name for PCAs). This brings the minimum wage from $15.25 to $20 over two years. DFLers went above the contract agreement and included money to cover the expenses for providers to administer the new benefits for employees.
Community First Services and Supports (CFSS) Rate Framework and Modification
- $341.6 million (FY 24/25) and $547.9 million (FY 26/27)
- Rate increase for CFSS/PCAs of 21.3% in FY 24/25 and 26.65% in FY 26/27
- Invests in rate increases, retention bonuses, and paid time off for PCA/CFSS workers
- Develops career ladders with corresponding tiered rates so workers can advance in their careers and be more willing to join and stay in the workforce
- Provides funding for provider training stipends and provider orientation
WAIVER SERVICES RATE METHODOLOGY SYSTEM CHANGES
Waiver service rates have different rate methodologies depending on the type of service. The Human Services bill incorporates system changes to several rate methodologies, which is necessary to simplify the funding process and ensure money is spent on the people providing and using the services instead of on administrative processing. Critical changes to the rate methodologies, along with rate increases, will help streamline the professional caregiving reimbursement process.
Modifications to DWRS Framework
Over the next four years $312 million is directed to increase the competitive workforce factor (CWF) within the disability waiver rate system (DWRS), which will now automatically update every two years beginning January 1, 2026. The CWF ensures that Minnesotans providing services to people with disabilities are paid a competitive wage. The previous rate system lagged behind market changes.
Disability and Elderly Waiver Homemaker Rate Alignment
Over $100 million is dedicated to increasing the disability waiver rate system (DWRS) for homemaker services by 71%. This change creates parity between the disability and elderly waiver services. Homemaker services help people continue to live in their community by helping them with general household cleaning, activities, and management.
HOME AND COMMUNITY-BASED SERVICES (HCBS) RATE INCREASES AND TRANSPORTATION ASSISTANCE
Professional caregivers provide direct support to people with disabilities and the elderly in a variety of care settings outside of nursing facilities. Transportation assistance is another key workforce that helps people live where they choose. These services incorporate the Home and Community-Bases Services (HCBS) system and help people age in place or integrate within their community.
Historically, this essential workforce has been one of the most culturally diverse workforce in the state, with many direct care workers identifying as Black, Indigenous, people of color, women, and new immigrants. The 2023 DFL budget values the people working in the caregiving industry. This priority is reflected in the Human Services bill that provides historic rate increases.
|FY 24/25 % increase
|FY 26/27 % increase
|ICF/DD rate increase and rate floor
|NEMT Rate Increase
|Brain Injury (BI) and Community Access for Disability Inclusion (CADI) Customized Living Rate Increase
|Home Health Aide, Skilled Nursing & Therapies, EIDBI, ICF/DD Day Training & Habilitation, Home Delivered Meals, Chore Services, Community Living Assistance, Family Caregiver
|Rate Increase for Home Care Nursing
*Early Intensive Developmental and Behavioral Intervention = EIDBI
*Intermediate Care Facilities for People with Developmental Disabilities = ICF/DD
*Non-Emergency Medical Transportation = NEMT
Non-Emergency Medical Transportation NEMT (Rate Increase, Fuel Adjustments)
DFLers increased the base and mileage rates for NEMT and ambulance services. NEMT provides transportation for Medical Assistance and MinnesotaCare clients to and from covered medical service appointments. States are federally mandated to provide NEMT services to people enrolled in public health programs.
Fund Personal Care Assistant (PCA) Driving
For years disability advocates have asked the Legislature to allow PCAs to drive their clients and to reimburse them for this service. Despite bipartisan support for this change, gridlock prevented this easy fix. Now PCAs will be allowed to have their client accompany them on errands and take them directly to medical appointments. This change is especially important for Minnesotans living in Greater Minnesota.
SUPPORT FOR INFORMAL CAREGIVERS
Eliminate Parental Contribution Fees (TEFRA)
DFLers removed the requirement that parents pay a “parental fee” if their child is on Medical Assistance (MA) under the Tax Equity and Fiscal Responsibility Act (TEFRA). MA-TEFRA is a program for middle-class families to access services and supports for their children with significant disabilities. Traditional health insurance plans refuse to cover services such as PCAs and home health aides, which are critical supports for families on MA-TEFRA. However, the parental fee to access this program can exclude some families because of the exorbitant fees.
Because of the elimination of the TEFRA parental fee, Minnesota families won’t go into debt trying to pay for disability services or be forced to put their child’s health and well-being at risk by foregoing the services their child needs.
Respite Service Grants Extension
A temporary respite services grant program is now permanent and has ongoing funding. Grants will be used to provide free or subsidized respite services for family caregivers of people and older adults with dementia.
Establish A Hospice Respite and End-Of-Life Care MA Benefit for People Under 22 Years Old
This provision creates a Medical Assistance benefit for hospice respite and end-of-life care for children. Respite care will give the child’s parent/caregiver a break from the demands of 24/7 medical care during an emotionally and physically draining experience.
Increase Paid Hours Limit of Personal Assistance Services Provided by Parents and Spouses
Many innovative policies were enacted because of the COVID-19 pandemic. This provision extends a popular provision that helped families by increasing the hours of care services that can be reimbursed. Now, each parent in a two-parent household will be paid for up to 40 hours of caregiving per week. A single parent, or one parent in a household where only one parent can provide care, can bill for 60 hours of caregiving per week and a spouse can bill up to 60 hours of caregiving per week.
INVESTMENTS IN SUBSTANCE-USE DISORDER (SUD) TREATMENT AND AWARENESS
Safe Recovery Sites
Harm reduction programming and methods help people with substance use director live with dignity and respect, while also accessing services and supports to help them through treatment. The DFL Human Services budget prioritized funding for up to 15 safe recovery sites in Minnesota. The sites could offer supplies and services, such as:
Safe injection spaces; Sterile needle exchange; Naloxone/Narcan (rescue, safety, emergency) kits; Oxygen, fluids, and health monitoring; Fentanyl testing; FTIR testing machines.
Education and referrals to SUD treatment and recovery services, mental health services, housing, nutrition, health care, holistic supports, and other services.
Dignified spaces for people to shower, access hygiene, and commune without shame.
Sober Housing Program Consumer Protections
Sober Homes are an integral part of the recovery process, but the current system doesn’t have oversight or safety guidelines. Now there is a clear definition of “sober homes” in statute. The law now requires residences to follow the sober living guidelines published by the federal Substance Abuse and Mental Health Services Administration (SAMHSA). The updated Sober Home laws now include:
- Residence requirements (occupancy, safety procedures, etc).
- Bill of Rights for an individual living in a sober home.
- Directs complaints regarding sober homes to the ombudsman for mental health and developmental disabilities.
- Provides right of action – an individual may bring an action to recover damages caused by a violation of these laws.
Office of Addiction and Recovery
This new officehas been created in the Department of Management and Budget. A Division of Youth Substance Use and Addiction Recovery is created in the Office of Addiction and Recovery to focus on preventing adolescent substance use and addiction.
Family Treatment Start-Up and Capacity-Building Grants and Establishing a Work Group
The workgroup will create recommendations to improve access to family treatment programs. The workgroup will also make recommendations on treatment and supportive services that foster family acceptance and support to prevent the development of substance-use disorders during adolescence and young adulthood.
Additional Funding for Project ECHO at Hennepin Health Care
Project ECHO is a tele-mentoring program that has focused on expanding the capacity for treating opioid use disorder (OUD) in primary care settings. The ‘hubs’ connect to providers across the state.
Overdose Surge Alert System
Nearly $400,000 is taken from the Opioid Settlement Account to implement a statewide opioid overdose surge text message alert system. This will be used to prevent opioid overdose by cautioning people to refrain from substance use or to use harm reduction strategies when there is an overdose surge in their surrounding area.
Did not pass:
MA-EPD Premium Elimination and Program Modification
The Medical Assistance for Employed Persons with Disabilities (MA-EPD) continues to have costly monthly premiums with no maximum limits for people enrolled in the program. This monthly expense is another added cost of living with a disability that unjustly burdens people enrolled in MA-EPD. The $20,000 asset limitation was removed, but the entire scope of S.F. 1272 (Maye Quade), which removed the premiums, was not included.
Medical Assistance Spend-Down
Medical Assistance provides nursing home and long-term care services for the elderly and people with disabilities, this is not a service that Medicare covers. The MA program limits the amount of income and the value of assets a recipient may have to receive these specific services.
S.F. 1637 (Fateh) increased the medical assistance eligibility income limit for older adults, adults with disabilities, and children with disabilities from 100 percent to 133 percent of the federal poverty guidelines. The proposed income limit for these populations would be equal to the income limits for Medical Assistance for people who don’t require long-term care services. The bill also increased the asset limit for this population from $3,000 to $20,000 for an individual and from $6,000 to $40,000 for a household.
Asset caps and strict income requirements force the most vulnerable Minnesotans to live without a financial safety net to protect them against an emergency. Disability and senior care advocates point out the inequality of demanding that people “spend down” their finances to poverty levels to access services they need to live.
Elimination Of Subminimum Wage
It is still legal to provide subminimum wages to people with disabilities in Minnesota.
Sober Home Registration and Certification No formal system to register and certify Sober Homes was included in the final Human Services budget bill.