Shutdown 2011 Category Archive: Health

Judge: State can rehire mental health workers

Posted at 4:02 PM on July 19, 2011 by Madeleine Baran (0 Comments)
Filed under: Health

Some of the state's mental health workers can return to their jobs. Judge Kathleen Gearin issued the order today.

Mental health providers have been hoping for a ruling for 19 days. They've said the delay has disrupted care for people with severe mental illness.

"I'm so happy right now," said Jim Riebe, who manages a mental health crisis response team in St. Cloud. "If they're going to come back, that will be a great thing."

Providers in Duluth and St. Cloud rely on state workers to provide about half of the staff for crisis response teams and intensive in-home services. The employees respond to calls from people who are suicidal or in other crisis situations. Other employees work on Assertive Community Treatment teams with psychiatrists, nurses and case managers to provide in-home services.

Gearin's order clarifies that the Department of Human Services can rehire workers for crisis services and the Assertive Community Treatment teams.

Providers say they don't know why the workers weren't deemed essential in the first place. The court documents released today shed some light on the matter.

The documents say that the Department of Human Services interpreted the initial shutdown ruling to not include state mental health workers who provide care at county and community health centers.

Here's an excerpt from the recommendations by Special Master Kathleen Blatz, the former state Supreme Court judge who was appointed to hear petitions about shutdown funding:

Since the beginning of the shutdown, DHS and the Special Master have learned that the layoff of these SOSD employees has had a dramatic effect on many county-based mental-health providers throughout the state. There has been a 50% reduction in crisis and ACT services because of the lack of SOSD staffing. At least one crisis-response team is no longer able to offer mobile services because it lacks sufficient staff. Mobile services are essential to ensure that seriously and persisently mentally ill people continue to take necessary drugs and medications.

In Northeast Minnesota, programs have closed their crisis beds because they lack sufficient staff. In addition, they are no longer providing on-call services between midnight and 8:00 a.m. In Southwest Minnesota, there are programs that have lost all both one county staff member, and thus, cannot provide any services.

There's no word yet on how soon the employees might be able to return to work.

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Health and human services bill is finished

Posted at 2:26 PM on July 19, 2011 by Madeleine Baran (0 Comments)
Filed under: Budget , Health

Updated at 2:50 p.m.: Bill will allow the expansion of Medical Assistance to continue, but will make changes to MinnesotaCare.

Lawmakers say the Health and Human Services bill is finished. But it's not available online yet. Lawmakers finished discussing the bill at a news conference a few minutes ago.

Rep. Steve Gottwalt, R-St. Cloud, responded to concerns that the public doesn't have enough time to review the bill before it comes up for a vote.

"There are not dramatically new things that will be seen in the bill," Gottwalt said.

The bill's release is being watched closely -- and for good reason. It's the largest section of the state budget. And it's been the source of sharp partisan disagreement for months, or years, really.

The GOP released a statement a few minutes ago saying the bill "leverages innovation and reform to make Minnesota's HHS system accountable, responsible and sustainable."

The statement quotes Senate HHS Chair Senator David Hann saying:

Our reforms have changed the structure of the HHS budget. We are now anticipating growth in the next budget to be less than 5 percent. The average forecasted growth in spending per biennium over the past decade has been 15 percent.

We'll post more details about the bill once it's available.

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Mental health provider: 'People are starting to crack'

Posted at 2:19 PM on July 18, 2011 by Madeleine Baran (1 Comments)
Filed under: Health

It's day eighteen of the state shutdown, and providers of crisis mental health services are still waiting for a response to their request to rehire state mental health workers.

The delay has come at a price, said Jim Riebe, who manages a crisis response team in St. Cloud.

"People are starting to crack, fall apart," he said today.

Over the weekend, three clients with severe mental illness had to be transported to an area crisis facility. In at least one of those cases, Riebe said, the crisis would've been avoided if state mental health workers were on the job.

"These people don't realize that we're running a 24-hour operation," he said, "And each day makes a difference in people's lives."

Providers in St. Cloud and Duluth rely on state workers to provide about half of the staff for crisis response teams and intensive in-home services. The employees respond to calls from people who are suicidal or experiencing a mental health crisis. Others work on teams with psychiatrists, nurses and case managers to provide intensive in-home services.

The goal is to be "a hospital without walls," one provider told me. The teams serve 78 clients, and they see many of their clients every day, sometimes twice a day - at least they did before the shutdown.

"Every morning, we're trying to figure out who's having the most difficulty," Riebe told me last week. "But sometimes the people you worry about the most are the people you don't hear from."

The shutdown also forced the closure of Bridge House, a mental health crisis facility in Duluth.

Providers petitioned Special Master Kathleen Blatz on July 7 to request that the 135 state mental health workers be deemed essential and allowed to return to work immediately.

Gov. Mark Dayton included the funding request in a long list of recommendations sent to Blatz on July 13.

Any recommendation would also need to be approved by Ramsey County District Court Judge Kathleen Gearin. The judge issued orders today regarding liquor licenses, administrative judges, training of peace officers, and birth certificates.

Court spokesman Christopher Channing says Special Master Blatz submitted her recommendation regarding the state mental health workers last week. But he wouldn't say what Blatz recommended or when Judge Gearin might take up the matter.

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Anti-abortion leader calls budget deal devestating

Posted at 4:20 PM on July 15, 2011 by Paul Tosto (3 Comments)
Filed under: Health

Striking a no-new-taxes budget deal with Gov. Mark Dayton required Republican legislators to withdraw all non-budget "social issue" proposals, including a ban on cloning and an end to taxpayer funding of abortion.

But while it's led to an agreement to end the state government shutdown, the leader of Minnesota Citizens Concerned for Life calls the budget compromise devastating.

MPR's Lorna Benson writes:

Executive Director Scott Fischbach says his group lost everything that it worked for this session. MCCL backed several pieces of legislation that would have banned human cloning, along with taxpayer funding of abortion and family planning groups that provide abortion. Another bill would have banned abortions at 20 weeks gestation and later.

Fishbach says Republican leaders didn't follow their mandate.

"We had operated under the assumption that we had pro-life leadership in both the House and the Senate. I think that there are many pro-lifers that are devastated now to the point of questioning some of that leadership. And we're going to have to address that down the road."

Republican leaders agreed to drop their social policy demands as part of a global budget agreement with Gov. Dayton

Benson adds that University of Minnesota stem cell researchers were relieved the compromise preserves their ability to clone human embryonic stem cells.

The university has no interest in cloning a human being but researchers do want to pursue some therapeutic cloning techniques that may lead to treatments for diabetes, heart disease and other conditions, a spokeswoman said.

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DHS: A complex agency at the heart of budget impasse

Posted at 1:00 PM on July 8, 2011 by Catharine Richert (1 Comments)
Filed under: Budget, Health

Madeleine Baran's analysis of the Department of Human Services, which has found itself in the middle of the states budget impasse and of the government shutdown, is a must read.

Madeleine's done a fanastic job of sorting out where DHS gets its money, and why it has become a political flashpoint in this epic debate over the state's finances.

I feel smarter having read it. Here's her entire story.

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Food inspectors scarce at fairs, festivals

Posted at 10:00 AM on July 8, 2011 by Catharine Richert (0 Comments)
Filed under: Health

Fairgoers beware: food inspectors will be scarce at Minnesota's summer fairs and festivals.


With only 20 percent of its food inspection staff on the job, the Minnesota Department of Human Services says they'll only be focusing on inspecting food at the largest events around the state.

MPR's Lorna Benson writes,

Inspectors will only go to fairs and festivals that are expected to draw 10,000 people or more, said Health Department spokesman John Stieger.

State food safety inspectors will visit food vendors at all the big festivals and fairs, including Moondance Jam in Walker next week and WE Fest in Detroit Lakes in early August.

"We'd actually be able to get out to those events with the staffing that we have," Stieger said. "So that's basically how we arrived at that number."

Read the entire story here.

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Shutdown closes Duluth mental health facility

Posted at 6:47 PM on July 7, 2011 by Madeleine Baran (6 Comments)
Filed under: Health

A shutdown ruling last week appeared to preserve funding for state hospitals that provide treatment for people with mental illness. But at least one state facility that provides inpatient treatment has closed due to the shutdown.

The closure of Bridge House, a crisis facility in Duluth, surprised Rachel Scott. She relies on the center for outpatient services. Scott struggles with depression and short-term memory loss caused by a traumatic brain injury. She has trouble remembering to do basic household tasks and relies on a social worker at Bridge House for emotional support and practical assistance with benefits and other paperwork.

A few days before the shutdown, Scott's social worker told her the facility might have to close down. When Scott tried to call Bridge House on Friday, she was redirected to a generic state voicemail message.

MPR News called Bridge House today. The voicemail says:

"Welcome to the State of Minnesota voicemail system serving the Duluth area. Please re-enter the seven-digit number of the person you're trying to reach. Or if you're a subscriber on the system, please press the pound key. Thank you."

Scott says the facility should at least provide a voicemail message with information about other resources.

"Being routed to a state agency by an automated machine might be enough to put (some people) over the edge," she said. "I mean it's possible people could die because of this, and I think it's very serious."

A court ruling last week preserved funding for many programs that provide mental health services. It also continued funding for Medical Assistance, a state-run health insurance program that provides reimbursement for hospital and outpatient health care, including mental health treatment.

But the ruling did not include all mental health programs, creating confusion among providers and people who receive services. The closure of Bridge House highlights the complexity of the state's mental health services and the uncertain status of funding for certain programs.

Bridge House provides at least 12 crisis beds for people with severe mental illness, according to the Department of Human Services' website. It also provides outpatient services to help clients live independently.

The facility falls under the broad category of State Operated Services, a division of the Department of Human Services. The division provides services for people with mental illness, developmental disabilities, chemical dependency and traumatic brain injury at nearly 200 sites around the state.

Department spokesperson Terry Gunderson said the ruling did not preserve funding for the entire State Operated Services budget.

"Much of State Operated Services is open, but some services are not," Gunderson said in an email. "Bridge House is closed - it was not designated a critical service by the court. There is currently a petition before the court that may impact Bridge House."

The department's website may have contributed to the confusion. It includes State Operated Services department included the programs on its list of "open services," without qualifying that some services may have closed.

Here's what it says:

"State Operated Services (direct care for people with disabilities) - prioritize critical services and treatment."

Gunderson, via email, said, "The key words on that bullet are 'prioritize critical services and treatment' which is intended to show not everything is open."

The department was not immediately able to provide a list of all open and closed State Operated Services. Check back with the Shutdown Blog for updates.

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What we know

Posted at 6:00 PM on July 7, 2011 by Catharine Richert (2 Comments)
Filed under: Budget, Courts, Health

On day seven of the government shutdown, there was no headway on budget talks, but lots of news coming out of Ramsey County District Court Judge Kathleen Gearin's office.

Today, she ruled that licensing operations at the Department of Human Services should continue. That means background checks for doctors and professionals who work in child care, for instance, will continue.

We also know that Gov. Mark Dayton wants Special Master Kathleen Blatz to rule homelessness programs and child care support critical after all.

The GOP is using Dayton's list of essential staff as ammunition in the battle over who's responsible for the shutdown. In addition to his chief of staff and press officer, Dayton's list includes his chef and housekeeper. But it's important to point out that Dayton's paying his chef's salary with his own money during the shutdown.

And a group of budget experts say they've got a deficit solution.

As this point, there are no budget talks scheduled for tomorrow.

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Judge's ruling relieves senior care givers

Posted at 3:20 PM on June 29, 2011 by Paul Tosto (0 Comments)
Filed under: Health

Ramsey County Judge Kathleen Gearin's "essential services" ruling today means Minnesota seniors who depend on subsidized care will continue to get services even if state government shuts down Friday.

Gearin ruled the state must fulfill its obligations to the federal government and continue to administer federal programs, including food stamps, welfare payments and Medicaid.


Care Providers of Minnesota and Aging Services of Minnesota, the state's two long-term care trade associations, applauded the move as a decision that averted potential disaster for thousands of seniors and those who care for them.

"We are relieved by the court's ruling...However, a shutdown will not be pain-free," Gayle Kvenvold, president and CEO of Aging Services of Minnesota, said in a prepared statement.

Patti Cullen, president and CEO of Care Providers of Minnesota, says many places that care for older adults have little or no budget reserves and so could have been devastated without state funds.

"These are frail elderly who do not have the resources to pay privately they qualified for medical assistance or medicaid because they didn't have adequate income or assets to pay for that care themselves," she said. "They passed multiple screenings to be able to a access that level of service so these aren't people who can live at home independently."

On average throughout the entire state, nursing facilities are operating on pretty thin operating margins -- no reserves and about 22 days of cash on hand throughout the whole state, she added. "That means if we don't get paid by medicaid we don't have enough money to make more than one payroll."

(MPR News reporter Jessica Mador contributed).

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Minnesota shutdown: What'll be open, what'll close

Posted at 1:06 PM on June 29, 2011 by Paul Tosto (1 Comments)
Filed under: Health

MPR News reporter Catharine Richert's been doing great work answering reader questions and digging up vital information on the consequences of a potential state government shutdown.

Here's her scorecard so far:

Generally speaking, Ramsey County Judge Kathleen Gearin agrees with Gov. Mark Dayton's petition that state correctional facilities, nursing homes, public safety, and payment of medical services are all "core functions" of government.

Here's a quick look at how the court's ruling affects individual government programs and departments, and how many employees will continue working in each area. This list is not exhaustive. You can read the entire ruling here. Dayton's initial petition is here.

Corrections: 3, 601 workers

--Operation, support and basic security of correctional facilities will continue.

--Re-entry programs and placement coordination will continue, as will educational programs.

Department of Employment and Economic Development: 696 workers

--Unemployment insurance claims will continue, as will benefit payments and collections.

--Disability Determination Services will continue.

Education Department: 6 workers

--Support for critical services will continue.

--A system to report the mistreatment of minors will remain in place.

--Payments to school districts will remain in place.

Health: 189 workers

--Vaccination distribution, drinking water supply protection and food inspection services will continue.

--Response to public health emergencies will stay in place.

--Issuance of birth and death certificates will continue.

--The WIC program, which provides food and nutrition education to low-income pregnant and postpartum women will remain in place.

Human Services: 5,165 workers

--The Minnesota Sex Offender program will continue.

--Payment and administration of programs including food stamps, welfare, Medicare, and Medicaid will continue because all get federal dollars. As a result, the court concluded that it must live up to its federal obligations.

--The Temporary Assistance for Needy Families (TANF) program, which includes child care programs, will also continue. However, other child care programs not under the TANF umbrella were not deemed critical by the court. More information about these programs can be found in this petition submitted by the Amici Coalition of Child Care Providers and Supporters.

--Pharmacy payment authorizations will continue.

Judicial Branch:

--Judge Bruce W. Christopherson ruled Tuesday that courts should stay open. Read his ruling here.

Labor and Industry: 32 workers

--Construction industry inspection services and support staff will remain in place.

--Worker compensation claims and benefit activities will continue.

Military Affairs: 150 workers

--Duluth and Minneapolis airbase security, fire fighting and operations will continue. --Training at Camp Ripley will continue. --Security for military arms and equipment statewide will remain in place.

Minnesota Management and Budget: 183 workers

--State employee insurance administration will stay in place.

--State employee payroll will continue.

--Cash management - meaning the writing and administration of money to critical services - will continue.

Minnesota Zoo: 150 workers

--Staff to keep animals healthy and the property secure will stay in place. The court added that it's also necessary to fund staff that keep animals from escaping and becoming a danger to the public.

Department of Natural Resources: 220 workers

--Conservation law enforcement, water treatment and hatchery maintenance will continue.

--Dam safety and operations will continue.

--As MPR already reported, state parks - including camp grounds - will be closed.

Pollution Control Agency: 13 workers

--Emergency response will continue.

--The maintenance of four closed landfill sites and seven superfund sites will continue.

--Air quality index monitoring will continue. MPR reported more here.

Public Safety: 1,031 workers

--The state's cops and 911 workers will not be laid off.

--Homeland Security and emergency communications will continue.

--Security of the state Capitol complex will remain in place.

Revenue Department: 43 workers

--Tax payments will be processed, but refunds will not be sent out.

Transportation: 217 workers

--Emergency highway repair will continue.

--Truck permitting and aeronautic navigation will continue.

--In her ruling, Gearin singled-out a petition from the Associated General Contractors of Minnesota that takes the position road construction is critical; in it, the MAGC specifically singled out bridge construction. Gearin agreed that construction that prevents a bridge from falling is a core government function. However, she wrote that while a "government shutdown will significantly delay completion of present projects, increase costs and put numbers of employees out of work... Those things do not justify the Court ordering the funding of non-critical core functions." Read the MnAGC's petition here.

Veterans Affairs: 980 workers

--Veterans homes will continue to operate.

--Critical assistance for veterans will continue, though claims services will be limited.

--The state veterans cemetery will remain open and operating.

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Nonprofits seek loans to stay open if shutdown comes

Posted at 9:49 AM on June 27, 2011 by Paul Tosto (0 Comments)
Filed under: Health

As we wait for the next round of Minnesota budget talks today, we're seeing more tangible consequences of a potential state government shutdown -- Some nonprofits that depend on getting paid by the state are taking out loans to stay open for clients if the state government stops.

The Nonprofits Assistance Fund says it approved five loans on Friday worth between $20,000 to $150,000 to local non profits.

While the group won't disclose the names of those that got loans, they are organizations that provide primary care, services for crime victims and mental health services in the Twin Cities and rural Minnesota, says the fund's Kate Borman.

"These nonprofits are making plans to continue to provide some level of services in the face of the loss of state payments for the duration of a shutdown," she said. "All five organizations have also reduced expenses, cut staff hours and pay, and have considered which of their services are "essential" to their clients and community."

We have many more applications in process for about $2 million available to lend for these purposes."

The fund loans money to nonprofits in need and also provides financial advice and training to nonprofit boards in Minnesota. The group's been warning nonprofits for weeks to prepare for life in state government shutdown.

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Clinics treating poor face payment pain

Posted at 4:05 PM on June 23, 2011 by Paul Tosto (0 Comments)
Filed under: Health

A state shutdown that would bring spending to a halt is a frightening proposition to the people who need government subsidized health care. But it also has the potential to damage health care providers who meet the needs of low income people.

The Minnesota Medical Association raised that worry last week, warning, "clinics that serve state funded health care for low income Minnesotans could end up "closing their doors or turning away patients."

Following up on a tip from MPR's Public Insight Network, my colleague Molly Bloom discovered hospitals and health care providers are not only bracing for the financial hit from a shutdown but are also dealing with the ripple effects from last year's budget-balancing agreement.


Here's her report (We've also posted it on MinnEcon, MPR's economy blog).

One of the ways legislators balanced last year's budget was to delay some Medical Assistance payments during the last month of the fiscal year and then pay providers what they're owed at the beginning of the next fiscal year.

Normally this delay wouldn't cause a big headache for providers. But if the state shuts down, they will not get their delayed payments or payments for the new fiscal year until the shutdown ends.

Karen Smigielski, communications officer for the Minnesota Department of Human Services, says 9,158 health care providers are affected by this payment delay and the total amount of the delayed reimbursement payments will be about $157 million. The current payment delay does not affect MinnesotaCare payments or payments for in-home services.

One of the largest providers being affected by this delay is Hennepin County Medical Center.

Vice President for Public Policy and Strategy Mike Harris says their delayed June payments will total about $19 million. He says they can deal with a one-month delay without major problems since "their operating performance has been a little bit better than normal this year." However, if the delay continues after June 30, "it will be very challenging."

If the government shuts down July 1 and payments are delayed further, Harris predicts they will reduce service levels, seek relief from vendors and delay capital projects.

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Deal lets doctors renew licenses early in case of shutdown

Posted at 12:15 PM on June 23, 2011 by Paul Tosto (0 Comments)
Filed under: Health

You can't work as a doctor in Minnesota without a license and there's been worry that a state government shutdown would stop annual license renewals and force many doctors to stop practicing.

But MPR's Lorna Benson reports a deal is in place with the Minnesota Board of Medical Practice that will help affected doctors avoid any lapses in their license coverage if a shutdown happens.

She writes:

The deal is being offered to doctors whose licenses expire during July, August or September.

Robert Leach, executive director of the Minnesota Board of Medical Practice, says the board will only be able to process online renewals for those months.

"What we will not be able to accomplish are those individuals who submit paper renewals because the office will be closed. And we will also not be able to process new applications."

Doctors must submit an online application by no later than noon on June 30 in order to complete the renewal process before a possible shutdown. There are more than 3,800 Minnesota physician licenses set to expire in July, August and September.

The Minnesota Medical Association still worries about a shutdown's potential effects on payments to doctors.

While state subsidized health care programs would continue, "payments to providers and vendors for services would be suspended," Dave Renner, director of state and federal legislation for the MMA, wrote last week.

"Current Medicaid managed care contracts between the state and health plans will terminate July 1 if there is no legislative appropriation; the health plans are awaiting guidance from the state."

Clinics that serve state funded health care for low income Minnesotans could end up "closing their doors or turning away patients," he added.


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