Probate & Trust Law Section Conference Manual ... - Minnesota CLE

I. INTRODUCTION
MEDICAL ASSISTANCE 2013
A. These materials are being finalized on May 22, 2013. On May 20, 2013,
the Legislature adjourned shortly before midnight, the constitutional
deadline for adjournment in the odd year of the biennium. Over the
previous weekend, the House and the Senate passed the Conference Report
on HF 1233, the Omnibus Health and Human Services Finance Bill for
2013. To finish these materials in time to get them into the book for this
Conference, there is no time to wait for assignment of a Chapter number to
the new Act and the Governor’s signature. Although no Chapter number
has been assigned as yet, these materials will rely on the contents of the
Conference Committee Report (hereafter “Conference Report”) to learn
what is in store for the medical assistance program for the coming year or
two. References in these materials to the Article and Section numbers of
the new Act will to the Conference Report. These references will be the
same in the new Act even though the Chapter number has not yet been
assigned.
B. As we enter the 2013-2014 biennium, the health care policy leaders in this
State continue to hope to contain the future costs of the medical assistance
program by pursuing policies first proposed and enacted during the
Pawlenty Administration in 2009. These policies have not yet been fully
implemented because of obstacles in federal law. The Dayton
Administration has accepted these policy directions and has banked heavily
on implementing these policies when federal law no longer blocks them.
These federal obstacles will be discussed in more detail below.
C. To understand the plans for future cost containment, one must first
understand the difference between medical assistance entitlement programs
and waiver programs. Under current federal law, the United States
matches state funding for medical assistance spending for nursing home
care (Skilled Nursing Facilities) regardless of the costs incurred. Spending
for nursing home care is an entitlement program. There are open
appropriations at the federal level to fund spending for nursing home care.
At the state level, the Legislature appropriates sufficient funds to provide
the payments required by the medical assistance programs. If the
appropriations run short, additional funds must be appropriated in the
following year. In effect, these commitments are open-ended with respect
to benefits available for residents of skilled nursing facilities. Although the
States have some flexibility in designing their medical assistance programs,
there are many requirements and restrictions set forth in federal law that
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