Breaking down the three health and human services proposals

Last week, the Senate and House passed their plans for the Health and Human Services (HHS) portion of Minnesota’s budget, which funds critical services that make basic necessities like health care and child care affordable for more Minnesotans.

The Senate HHS Budget Division has proposed a plan that would allocate $129 million in FY 2017 and $409 million in FY 2018-19, strengthening Minnesota’s supports for child care and health care aimed at financially struggling families and individuals. The Senate’s plan has many similarities to Governor Mark Dayton’s budget, though it contains many key differences outlined later in this post.

In contrast, the House HHS Finance Committee’s proposal does very little, opting mainly for policy changes rather than significant investments. The House plan would increase HHS funding for some initiatives by $20 million in FY 2017 and $40 million in FY 2018-19; these spending increases are funded by an equivalent amount of cuts to MNsure.

Two very different approaches towards supporting our state’s most vulnerable children

The House plan for Minnesota’s child care affordability problem draws on feedback heard at community hearings held by the Select Committee on Affordable Child Care. It would form a task force and take other steps to begin streamlining licensing and regulation of child care providers. However, these policy changes don’t address the 7,200-family waiting list for Basic Sliding Fee Child Care Assistance, or the low provider rates in the broader Child Care Assistance Program (CCAP), which limit parental choice.

By contrast, the Senate plan invests $8.1 million in FY 2017 and $40 million in FY 2018-19 to increase child care provider rates. An additional $15 million in FY 2017 and $38 million in FY 2018-19 would be invested in other services for children, including grants to increase access to affordable child care in Greater Minnesota, raising foster parents’ payment rates through Northstar, expanded mental health services in schools, support for homeless youth, and improved care for children with asthma covered through Medical Assistance.

Dayton’s budget funds an increase to the monthly cash grant through the Minnesota Family Investment Program (MFIP). MFIP is intended to provide families experiencing dire financial struggles with the bare necessities; most of the people who benefit are children. However, the MFIP grant has been stuck at $532 for a family of three for 30 years, a failing that neither the House nor the Senate addresses.

Senate builds on Minnesota’s health care successes; House would move in the wrong direction

Health insurance is another area of sharp contrasts between the House and Senate. The Senate focuses on efforts to provide more Minnesotans with access to affordable, high-quality health insurance. Like Dayton’s budget, the Senate would seek a federal waiver to expand eligibility for MinnesotaCare to those earning between 200 and 275 percent of the federal poverty guidelines — or $24,000 to $33,000 for a single adult.

The Senate waiver would also attempt to simplify health care enrollment for families with children, and allow people earning more than 275 percent of the federal poverty guideline to purchase MinnesotaCare coverage. The Senate joins the governor in spending $4.6 million in FY 2017 and $27 million in FY 2018-19 to protect the assets of spouses whose partner applies for home- or community-based services through Medical Assistance. The Senate bill also includes a policy aimed at making it easier for people to obtain prescription drugs.

The governor and Senate include provider rate increases for mental health care, and for preventative medical and dental care. Both would also fund overtime pay for home health care workers. Federal policy changes have resulted in an overtime threshold for these workers of 40 hours; it was previously 48 hours in Minnesota. With funding for the new overtime pay, fewer Minnesotans with disabilities will have their care disrupted.

The Senate HHS proposal funds a portion of Dayton’s proposed investments in direct care for people with mental illness, devoting $47 million in FY 2017 and $71 million in FY 2018-19, compared to the governor’s $89 million in FY 2017 and $165 million in FY 2018-19.

Meanwhile, the House bill provides access to more expensive private health insurance plans for working families with low incomes by allowing them to opt out of MinnesotaCare when shopping on MNsure. The House would also place a $20,000 asset limit on married couples who access affordable health care through MinnesotaCare or Medical Assistance.

Limited common ground

Very few policy changes or new expenditures are found in all three proposals. One notable exception is a plan to enhance Minnesota’s mental health system by investing $8.4 million in FY 2018-19 in certified community behavioral health clinics, which would likely be supplemented by $15 million in new federal money. All three plans would also transfer and support some human services to tribal governments, though the Senate and governor allocate $1.5 million in FY 2017 and $3.8 million in FY 2018-19 more than the House.

Many of the investments in the House plan are also found in the Senate’s proposal, though not Dayton’s. Beginning in 2014, people over 55 who enrolled in Medical Assistance had liens placed on their property; both the Senate and House spend about $2 million in FY 2017 and $5 million in FY 2018-19 to limit the services that result in lien placement. The Senate and the House would also both fund a mental health project in Southeast Minnesota, and increase resources for ambulance service providers and Safe Harbor for Sexually Exploited Youth.

What’s next

With every HHS plan now articulated, policymakers will soon begin negotiating a supplemental budget bill, which will combine the HHS budget proposals along with the proposals for education, public safety and other areas of the state budget.

Policymakers should build on Minnesota’s strengths by investing in vital supports that enable Minnesotans to thrive.

-Ben Horowitz

About Ben Horowitz

Ben Horowitz is the Minnesota Budget Project's policy advocate.
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