Conference committee likely after House OKs $14 billion human services bill

Minnesotans with disabilities and those caring for them demanded legislative action to address the ongoing workforce shortage.

The omnibus human services finance and policy bill is one of the Legislature’s answers.

Sponsored by Rep. Mohamud Noor (DFL-Mpls), HF2847/SF2934*, as amended to include House language, would appropriate $14.09 billion over the 2024-25 biennium, including $1.31 billion in new spending.

The House passed the omnibus package 70-60 Tuesday and sent it back to the Senate, where Sen. John Hoffman (DFL-Champlin) is the sponsor.

A conference committee is expected to settle disputes with the bill passed 63-4 by the Senate April 18.

“The House DFL Human Services Budget makes historic investments in nursing homes, long-term care, and in Minnesota’s care workforce. Our budget invests more than $6 billion in nursing homes overall — $847 million more than the last two-year budget,” House Speaker Melissa Hortman (DFL-Brooklyn Park) said in a statement.

“The people doing some of the most important work in our state to care for seniors and people with disabilities are paid the least. A system that doesn’t support the workers who care for our most vulnerable is not sustainable. Our budget takes much-needed steps to invest in this workforce.”

[MORE: Read about the original House bill and the committee-approved proposal]

Financial provisions

Long-term care workers could get a raise under one of the bill’s provisions.

Noor noted that personal care assistants, for instance, would earn $19 per hour in 2024 and $20 per hour in 2025. Step increases could provide an hourly wage of up to $22.50.

Most of the budget, $12.01 billion, would maintain forecasted funding levels for medical assistance.

Other proposed spending includes:

• $100.25 million worth of chemical dependency treatment support grants, including $55.49 million for organizations to establish safe recovery sites and $10 million for start-up and capacity-building grants;
• $83.7 million worth of long-term care grants, such as $24 million for capacity grants targeting rural and underserved communities and a yet-to-be-determined amount for supporting new Americans in the long-term care workforce grants;
• $33.3 million for home- and community-based workforce inventive fund grants to assist with recruiting and retaining direct support and frontline workers;
• $24.2 million for grants to community based HIV/AIDS support services providers; and
• $1.2 million to create a public awareness campaign targeting the stigma of opioid use disorders.

[MORE: Look at total appropriations; Download the spreadsheet]

Policy changes

Additional updates with specific deadlines include:

• transitioning to a minimum daily operating rate of $260 by Jan. 1, 2024 for Intermediate Care Facilities for persons with developmental disabilities (ICF/DD), to-be-updated for inflation every two years;
• altering the disability waiver rate system to increase payment rates by 15.8% for chore services, homemaker services, and home-delivered meals by Jan. 1, 2024 or upon federal approval, whichever is later;
• adding “life sharing” services under medical assistance disability waivers by Jan. 1, 2026, or upon federal approval, whichever is later; and
• phasing out subminimum wage for people with disabilities by Aug. 1, 2028.

Rep. Anne Neu Brindley (R-North Branch) offered, then withdrew, an amendment that would have left subminimum wage untouched and intact.

Other major provisions intend to:

• allow personal care assistants to drive clients;
• provide a rate increase for certain home and community-based services;
• modify alternate overnight supervision in community residential settings requirements;
• ratify the self-directed worker contract between the state and SEIU Healthcare Minnesota; and
• change the personal care assistance and Community First Services and Assistance payment methodology.

[MORE: Bills in the omnibus]

Nursing homes

Both sides of the aisle addressed nursing home spending in separate press conferences earlier Tuesday.

“Republicans are not voting ‘no’ on this bill today because of what’s in it. We’re voting ‘no’ on this bill today because of what’s not in it,” Neu Brindley said.

They want more funding for nursing homes, which House Minority Leader Lisa Demuth (R-Cold Spring) said currently accounts for only about 0.01% of the total budget.

“We’ve had 15 nursing homes close over the last couple of years. We had two close just in the last couple of months,” Neu Brindley said.

Noor stressed that the bill would invest more than $10 million into critical access nursing facilities that will serve an estimated 550 people in Greater Minnesota.

On top of that, the value-based reimbursement in nursing homes will have $853 million baked in over the next four years, he said.

“I’ll give you an example. For a CNA in a nursing home, they are earning, right now, $19 an hour. In 2025, they’re going to be receiving $25 an hour,” Noor said.

“By 2025, CNAs in a nursing home facility will not exist,” Neu Brindley said on the floor. “They’ll be paid nothing because those jobs won’t exist. The nursing homes are closing. I don’t know how to say it more plainly.”

She proposed an amendment that would appropriate $230.97 million during the next four years for nursing facility grants, but a Noor amendment to that amendment cut it to $20 million to avoid defunding HIV/AIDS support services and direct care and treatment services.

“Twenty million [dollars] is better than nothing,” Neu Brindley said. “It’s a really sad day, but it’s better than nothing and I’ll take it.”

A Neu Brindley amendment to provide a $26 per day rate increase for nursing homes, which, she said, would amount to $2 per hour for the workers, was not adopted.

Other amendments to the bill that were adopted would:

• create a work group to address opioid treatment programs to make recommendations on opioid use disorder including case management rates;
• allow the Department of Human Services to contract with a third-party vendor, as amended, for the auditing process for the nursing home cost reports; and
• provide a one-time, two-year rate increase for a nursing facility in Red Wing, as amended.