As the details of Gov. Mark Dayton's biennium budget come to light, it comes as a surprise that the budget targets long-term care -- a long-term survivor of serious budget cuts through the years by both parties.
Overall, the Dayton budget would save $775 million in health and human services programming through a manipulation with federal Medicaid funds. The actual cut in payments to nursing homes and other long-term care facilities would be $383 million through budget gimmicks such as surcharges on nursing homes, hospitals and health plans that by and large are reimbursed through the federal Medicaid program.
Still, there are real cuts to long-term care facilities that will be felt in each lawmaker's community. Some facilities, already on the edge, will close. In other circumstances, elderly waiver programs that help keep frail elderly in their homes longer will fold, forcing them into long-term care facilities.
In perspective, the Democratic governor had no choice. He pledged during the campaign to increase K-12 funding, and his budget leaves state aid to cities intact. With two big pots of money protected, the third -- aid to long-term care facilities -- is an open target.
It's not one we like, but we doubt that the Republican-controlled Legislature can do better without hurting a different population. The Legislature could protect nursing homes by eliminating Local Government Aid, but that would force up property taxes and hurt those seniors who are in their homes and living on fixed incomes. The GOP Legislature could also cut spending to K-12 education, but that is our future; it is the tool upon which we compete in a global marketplace and put our people back to work.
What other options are there? State law prohibits charge private-pay residents more than Medicaid-paid residents, so the private pay can't subsidize the public paid.
Dare we say raise taxes on the wealthy to help take care of our vulnerable elders? That answer isn't as easy, either, as the Dayton budget raises taxes by $4 billion and still makes Draconian cuts to nursing homes. But it does serve as another example that solving the state's $6.2 billion budget gap won't come without some form of revenue increase.