Subminimum wages prohibited, safe recovery sites included in $14 billion human services omnibus package

Give an hour. Get seven cents.

Not many would take that deal, but, according to a report from the Minnesota Disability Law Center, some people with disabilities working subminimum wage jobs earned that little for their labor.

Among many other policy changes, HF2847 would prohibit the subminimum wage.

Sponsored by Rep. Mohamud Noor (DFL-Mpls), the omnibus human services finance and policy bill would spend $14.02 billion — $1.3 billion in new spending — over the 2024-25 biennium to the Department of Human Services for direct care and treatment, aging and disability services, the long-term care workforce, and behavioral health.

[MORE: View the spreadsheet]

The House Human Services Finance Committee received a walkthrough and heard testimony Tuesday. Including a delete-all amendment, and maybe other amendments, the package is likely to be adopted Thursday.

Elimination of the subminimum wage is perhaps the most highly anticipated and controversial policy change.

Rep. Mohamud Noor

“(It) will likely require an increased workforce of direct support professionals. No one can calculate those costs for today nor for the future,” wrote Sue Hankner, president and co-founder of A-Team Minnesota.

Human services appropriations

The overwhelming majority of expenses — a little over $12.01 billion — would maintain current levels of medical assistance.

Because the labor shortage has so negatively impacted direct support professionals and frontline workers, home and community-based workforce incentive fund grants would receive a onetime infusion of $33.3 million in fiscal year 2024 to assist with recruitment and retention. A bill heard earlier sought $43 million.

Other new spending includes:

• $55.49 million in onetime funding during fiscal year 2024 for start-up and capacity-building grants for organizations to establish safe recovery sites that offer harm reduction services and supplies, including but not limited to safe injection spaces; sterile needle exchange; naloxone rescue kits; fentanyl and other drug testing; street outreach; educational and referral services; health, safety, and wellness services; and access to hygiene and sanitation;
• $24.2 million in fiscal year 2024 is for grants to community-based HIV/AIDS support services and payment of allowed health care costs;
• $10 million in onetime funding in fiscal year 2024 for start-up and capacity-building grants for family substance use disorder treatment programs;
• $9.9 million for a temporary grant for customized living providers that serve six or fewer people in a single-family home and that are transitioning to a community residential setting licensure or integrated community supports licensure;
• $4.18 million more for the Council on Disability, an increase from its initial budget request, to continue providing services, such as outreach, training and technical assistance for website accessibility;
• $3 million for the African American Child Wellness Institute in fiscal year 2024 for culturally specific, trauma-informed care, as well as supervision and training;
• $1.8 million onetime in fiscal year 2025 for establishment of a caregiver respite services grant program “to increase the availability of respite services for family caregivers of people with dementia and older adults and to provide information, education, and training to respite caregivers and volunteers regarding caring for people with dementia”;
• $1.5 million for the new Office of Addiction and Recovery;
• $1.2 million in onetime funding during fiscal year 2024 to establish a multitiered public awareness and educational campaign on substance use disorders; and
• $270,000 in fiscal year 2024 to complete the initial actuarial and administrative work necessary to recommend a financing mechanism for the operation of PACE, a program under Medicare that provides comprehensive medical and social services to certain frail elderly individuals who live in the community, most of whom are dually eligible for Medicare and Medicaid benefits.

The bill would also increase payment rates for community living assistance and family caregiver services and, although, not exactly what was brought forward in committee earlier, Elderly Waiver payment rates would be increased.

Policy changes

The Human Services Department would be charged with preparing a proposal for the 2024 legislative session to create a Department of Direct Care and Treatment. It would also need to “conduct a systemic review of acute care hospitalizations for people on medical assistance with disabilities, behavioral health conditions, and older adults.” A report would be due to the Legislature by Jan. 15, 2025.

Other proffered changes include:

• improving the quality of substance use disorder treatment;
• adding sober home regulations and consumer protections;
• modifying adult foster care moratorium exceptions;
• requiring school districts to maintain a supply of opiate antagonists;
• modifying the opioid prescribing improvement program;
• the Council on Disability is to annually submit a report to the Legislature specifying the number of cities and counties that received training or technical assistance on website accessibility, outcomes of website accessibility training and outreach, and costs incurred by cities and counties to make website accessibility improvements;
• human services must conduct a systemic review of acute care hospitalizations for people on medical assistance with disabilities, behavioral health conditions, and older adults;
• establishing requirements for remote overnight supervision in a community residential setting; and
• allowing personal care assistants to drive clients.

“This small change will have a major impact on the lives of people with disabilities who access PCA services. This bill ensures people have access to their communities,” wrote Julia Page, public policy director for The Arc Minnesota.

Provisions left out of the omnibus

Multiple testifiers expressed disappointment with the reform of Medical Assistance for Employed Persons with Disabilities being dropped as a priority.

Representatives of This is Medicaid, a coalition of nonprofit organizations who seek to protect Medicaid, said participants have trouble saving money because of the lack of adjustments to asset limitations.

“For over 20 years, Minnesota has been taxing disability through unaffordable premiums for many to receive the support services they need to live in the community through the MA-EPD program,” wrote co-conveners Erin Sutton and Michelle SanCartier.

The Minnesota Coalition for Family Home Visiting had also requested a direct reimbursement for doula services to “lower racial disparities in health care” that was omitted, and a task force on disability services accessibility was left out too.

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What’s in the bill?

The following are bill that have been incorporated in part or in whole into the omnibus human services finance and policy bill:

• HF339 (Curran)
• HF480 (Elkins)
• HF813 (Hicks)
• HF1067 (Hanson)
• HF1298 (Edelson)
• HF1596 (Reyer)
• HF1851 (Hicks)
• HF2215 (Noor)
• HF2772 (Stephenson)
• HF2847 (Noor)
• HF2876 (Becker-Finn)