Rep. Tina Liebling hugs Rep. Hodan Hassan after the passage of SF2995, the health and human services finance bill, May 22. Photo by Catherine Davis/Minnesota House Information.
Minnesota Democrats this session passed a behemoth health and human services budget on the last day of the legislative session, arguing that the nearly $1.1 billion in new general fund spending over the next two years will give more Minnesotans access to the health care and social services they need.
Democrats said the health and human services budget addresses longstanding inequities in Minnesota health and wellness outcomes.
“This bill is truly born of a commitment to our shared humanity,” said Rep. Tina Liebling, DFL-Rochester, on the House floor.
Here are some of the significant provisions from the health and human services bill:
Undocumented Minnesotans can enroll in MinnesotaCare
Over 40,000 Minnesotans are eligible to enroll in the state’s publicly subsidized insurance program for low-income residents, known as MinnesotaCare.
Minnesota is now the second state to allow all low-income residents to enroll in public insurance, regardless of immigration status. The state aims to begin enrolling undocumented residents in 2025.
About 17% of Minnesota’s uninsured are undocumented, and the expansion is estimated to cost Minnesota about $8 million in the first two years and will jump to $100 million in the following two years as enrollment increases.
Immigrant rights advocates heralded the expansion of MinnesotaCare.
“Workers without status have made enormous sacrifices to our state, paying the highest toll to keep our state running during COVID-19. All people deserve access to health insurance,” said Emilia Gonzalez, executive director of Unidos Minnesota, in a statement.
Lawmakers originally proposed expanding MinnesotaCare eligibility to residents above the income cap to buy into the program, but legislators ultimately delayed the expansion by at least one year to study its impact. The state must conduct an actuarial analysis to determine state costs, premiums, and projected enrollment, among other details.
Minnesota could be the first state to offer a government-run public option health care, but the earliest Minnesotans might be able to enroll is 2027.
Abortion restrictions repealed
The bill repealed most of the state’s restrictions on abortion, many of which were already ruled unconstitutional by a district court judge. Those included requirements that women wait 24 hours before having an abortion, that abortions after the first trimester be performed in a hospital, and that doctors recite a list of medically dubious claims about the risks of abortion. Lawmakers also repealed the state’s restrictions on abortion after viability, which existed in a legal gray area because of a 1970s ruling that found it was more restrictive than the since-overturned Roe v. Wade decision allowed.
Progressive democrats aimed to strike virtually all abortion regulations off the books, but were forced to leave some in place. Abortion providers will still be required to collect and report data on abortions to the Department of Health, albeit with far fewer details. Health care providers will have to record how the abortion was performed, the approximate gestational age and the age of the woman. They won’t have to record if the woman’s physical or emotional health was at stake, the number of previous abortions the woman had or if the pregnancy was the result of rape or incest.
Lawmakers also left in place a version of the “Born Alive Act,” but changed the mandate that doctors “preserve the life” of babies to “care” for babies “consistent with good medical practice.” Proponents say the change is compassionate to parents who have to induce pregnancy early because of severe complications. Those parents will be able to spend time with their babies for whom no medical interventions will save their lives.
The requirement that both parents be notified if a minor seeks an abortion was also left in place, even though that law is not in effect because it was ruled unconstitutional by a Ramsey County judge last year.
Lawmakers also eliminated the “Positive Alternatives” program, which funded so-called crisis pregnancy centers that encourage women to carry pregnancies to term and provide resources to them. Under Minnesota law, grant recipients under the program were explicitly prohibited from counseling clients on abortion or referring them to organizations that provide abortions.
The health bill instead funds a new initiative called “Healthy Beginnings, Healthy Families,” which supports nonprofits that implement data-driven, culturally relevant activities to improve infant health.
A watered-down health care affordability board
Democrats sought to tackle skyrocketing health care costs. Then Minnesota’s big hospital systems stepped in.
As originally proposed, the health care affordability board would have set health care spending targets for health care entities in the state. The board would have been able to fine hospitals and insurance companies for growth that went beyond the spending targets created by the board.
The Minnesota Hospital Association was opposed to the fines.
“Creating a new body to analyze health care spending in Minnesota may be necessary to better understand the shared goal of sustaining access to care, but it does not require establishing punitive regulatory power and severe civil penalties,” MHA said in an April letter to lawmakers.
Weeks after the MHA’s letter, Mayo Clinic sent a letter to Walz threatening to pull billions in investments from the state in part over the creation of the affordability board.
Lawmakers appeared to acquiesce to Mayo’s demand, and the affordability board was ultimately replaced by a center within the Department of Health that will analyze escalating costs, but does not have the power to fine or penalize hospitals or insurers.
A telecommunications fee for the 988 suicide lifeline
On top of a slew of tax increases passed in other budget bills, lawmakers approved a law in the health bill that will add up to 25 cents per month onto monthly phone bills to fund the state’s 988 suicide prevention lifeline.
Beginning January 2024, the state will impose a monthly fee on each subscriber of a landline, wireless or IP-enabled voice service to fund the 988 lifeline.
People may call or text the number 24 hours, seven days a week to receive help from one of the Department of Health’s lifeline centers, which offer assistance from professionals to people in crisis or aid people concerned about someone potentially in crisis.
The lifeline isn’t new, but the state says it needs funding to help keep up with an influx of calls.
The state will annually recommend a fee amount to the state’s Public Utilities Commission, but it cannot exceed 25 cents per month.
According to estimates, the telecommunications fee is expected to generate nearly $15 million in the next two years. States already implement a telecommunications fee to fund 911 services, with Minnesota’s fee currently sitting at 95 cents.
More funding for mental health in Minnesota
Throughout the 845-page bill, lawmakers allocated about $98 million in the next two years for mental health services, according to the National Alliance on Mental Illness — Minnesota.
Going into final negotiations, the House had nearly $130 million for mental health funding for fiscal years 2024 and 2025 and the Senate about $108 million. Walz had proposed in his budget about $123 million for mental health.
Lawmakers came to an agreement for $98 million in mental health funding behind closed doors in the conference committee, with lawmakers from both chambers appointed to iron out a compromise. Sue Abderholden, NAMI Minnesota executive director, said it was less than mental health advocates were expecting.
“We were a little disappointed knowing what we all know — that there is a mental health crisis,” Abderholden said.
Lawmakers allocated about $14 million in the next two years for school-linked behavioral health programs. These include community mental health providers partnering with their local schools to provide mental health services for students. The $14 million funds grants to the providers, who are then in a better position to aid uninsured and low-income students.
In addition, legislators allocated about $6 million for the next two years on grants for mental health facilities serving a cultural or ethnic minority population. The facility can use the funds for workforce development and outreach and expand their services into greater Minnesota, among other initiatives.
The bill also spends $18 million for mobile mental health crisis grants, which fund teams to respond to people suffering from mental health emergencies.
Funding for child care, homelessness services
Lawmakers allocated a chunk of funding — $316 million — for Minnesota’s Great Start compensation support payment program. This initiative sends money to eligible child care and early learning programs, to improve access to the programs and boost child care worker pay.
The state’s education budget also has millions for child care and early education, including more than $250 million for the state’s early learning scholarships program, which is targeted at 3 and 4 year olds.
In addition, the state allocated $100 million for emergency shelter grants and over $30 million in extra funding for the Homeless Youth Act, which was established in 2006. The Homeless Youth Act provides grants for community outreach, drop-in programs and emergency shelters to reduce the number of Minnesota children experiencing homelessness.
According to estimates, about 5,800 children under 18 experience homelessness over the course of a year.
A study of the Keeping Nurses at the Bedside Act
The so-called Keeping Nurses at the Bedside Act aimed to give nurses some say over hospital staffing, but lawmakers wound up passing a watered down version that will have no immediate impact on nurse staffing levels. It passed separately from the health and human services budget.
Lawmakers were concerned over the proposed carve out for Mayo Clinic, which the hospital won after it threatened to pull billions in investments from Minnesota.
“I’m very concerned by the Mayo carve out. It’s bad public policy. Everyone should play by the same rules and the same laws,” Sen. Kelly Morrison, DFL-Deephaven, told the Reformer.
The bill was made into a study after supporters capitulated to the demands of hospitals, which were fiercely opposed to the bill. The legislation will support violence prevention — another key concern of nurses, who suffer high rates of workplace abuse — and bolster nursing recruitment, but will be without the signature goal of giving nurses some say in how hospitals are staffed.
“Because of the power and influence of corporate health care executives, that bill has died,” said Mary Turner, the president of the Minnesota Nurses’ Association.
Legislators said they will attempt to pass the full Keeping Nurses at the Bedside Act next year.
A bill that could doom proposed Fairview-Sanford merger
The Legislature passed a bill that bans anti-competitive health care mergers, which could kill the proposed marriage of Minneapolis-based Fairview Health Services and Sioux Falls-based Sanford Health. The bill passed separately from the health and human services budget.
The bill also prohibits out-of-state entities from owning in whole or part University of Minnesota health care entities, as would be the case were Sanford to complete its merger with Fairview, which owns the university’s teaching hospital.
But Fairview and Sanford said they intend to continue with the merger — which has already been delayed — despite the legislation.
The legislation prohibits health care transactions that “substantially lessen competition or tend to create a monopoly.” Attorney General Keith Ellison is already investigating the proposed Fairview-Sanford merger for potentially running afoul of antitrust and charity laws, but the new law gives the Attorney General’s Office greater latitude in bringing a case in state court if the merger is deemed not in the public interest.
Democrats in the Legislature have criticized the proposed Fairview-Sanford merger. They say that it would create a health care monopoly in greater Minnesota and likely lead to clinic closures and higher costs for patients.
In a statement, Fairview said the legislation will not deter the health care nonprofit from merging with Sanford, and that the proposed merger meets the legislation’s requirements.
“This new law does not change our desire to combine with Sanford Health, and while it creates new regulatory processes, we strongly believe that the merger is in the public interest and that we can comply with the new requirements,” Fairview said.
Reformer reporter Max Nesterak contributed to this report.
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