We Minnesotans used to be full of pride for our prudent government and our tradition of fairness and equality for all citizens. Minnesota is the home state of “Happy Warrior” Hubert Humphrey, a former vice president of the United States and a lifelong champion of civil rights. But our proud state is becoming a national embarrassment, and some of our personal care assistants are about to pay a heavy price for our political dysfunction.
Most of you have probably heard about our failure to pass a state budget by the due date of June 30, which led to a state government shutdown for several weeks earlier this summer. When Governor Mark Dayton reconvened the legislature for a special session, it was conducted behind closed doors. The secretly approved budget that finally emerged includes dramatically fewer resources to help our most vulnerable citizens because the “no tax increase for millionaires’’ philosophy ruled the day.
The budget included a 1.5 percent across-the-board cut for all health care funded by Medical Assistance, Minnesota’s Medicaid plan. In addition, several targeted cuts reduced payments for particular populations. The most unfair of these was a 20 percent cut for personal care assistants who provide services to a relative, which goes into effect on October 1. According to the law, “relative means the parent or adoptive parent of an adult child, a sibling aged 16 years or older, an adult child, a grandparent, or a grandchild.”
For example, a PCA providing care to a relative for $10 per hour will probably be earning $8 under the lower reimbursement rate, while other PCAs with the same amount of experience at the same agency will continue to earn $10. In addition, the agencies that employ these critical caregivers will have to find other ways to cut costs, since their reimbursement rate will be cut by significantly more than $2 an hour for PCAs who are related to their clients.
This will likely put some of these organizations out of business. Most are non-profits and small businesses, and nearly all are operating on very thin margins or spending every penny they earn while keeping wages and overhead low, which leaves little room for cost-cutting.
As anyone familiar with our work knows, many factors make it necessary to give people who need personal assistance care the option of hiring relatives. Recent immigrants who do not speak English need caregivers who speak their language, and if their language isn’t widely spoken in their area, it may be difficult to find anyone other than a relative who is fluent enough to communicate with them. Even for native English speakers, it is often next to impossible to find anyone other than a relative who can provide the needed help in isolated rural areas. And some people—particularly the members of certain ethnic communities—have a strong preference for kinship care. Statewide, DHS estimates that 28 percent of all PCAs fit the law’s definition of a relative.
We can’t expect the relatives who respond to these needs to abandon their obligations to themselves and their families, giving up other paying work to provide a service for less than fair market wage.
Since this news became public in late July, many activists in our community (mostly people from ARC and Legal Aid, service recipients and PCAs, PCA business owners, and state employees) have worked tirelessly to attempt to convince legislators, the governor and his staff, and our Department of Human Services (DHS) administrative staff that this action will unfairly and arbitrarily punish PCA recipients who prefer or require care by a relative. A coalition of agencies devastated by this news is currently developing a legal challenge in support of their clients, caregivers, and business rights.
In response to a recent public challenge, Governor Dayton said he deeply regretted the lack of oversight (both his own and that of DHS administrative staff) that led to passage of this cut, but he has not yet been willing to direct DHS not to enforce the cut pending review by the courts or legislative reversal in the next session.
Interestingly, DHS issued a request for public comments over the next 30 days last week, opening a new avenue for direct care workers and their allies to protest the cuts. You can add to the public comments by emailing your opinion to DSD.PublicComments@state.mn.us. Help us let the state know how wrong it is to try to balance the budget on the backs of our hard-working PCAs.
A summary of the coming cuts by The Minnesota HomeCare Association