4/18/2013 11:52:00 AM Healthcare mandates coming soon; county commissioners told
by DENISE MARTIN
Minnesota is rolling right along (so far) in taking steps to meet federal mandates under reforms spelled out in the Health Care Act, including legislatively establishing the state insurance exchange, that the governor recently signed. (All local GOP lawmakers opposed this exchange bill.)
At the county level the healthcare dominoes are beginning to line up and officials are expecting them to begin to fall not long from now. Health and Human Services Director Nancy Dahlin, assured the county commissioners recently that not all foot soldiering on healthcare rollout will be up to counties-- but a good percentage of work will fall on county social workers and financial support staffers. Dahlin said they are poised to do their best to stay ahead of the healthcare system revamp, that directly affects about 500 county residents on MnCare and medical assistance, Dahlin added. (The new name for these programs is MnSure) State-published guidelines for “navigators” who will assist people with healthcare questions and applications were due out out this month. Dahlin explained there are currently no county workers on staff prepared to act as navigators. It depends on how the rollout progresses and the labor pool available to fill navigator positions before she’s prepared to suggest how to tackle this staffing issue.
At this time counties have the option of filling this function. Dahlin anticipates about 1,600 as the number of overall “case increase” as residents on medical assistance with enough assets, shift to the insurance exchange and as first time policy seekers investigate affordable plans expected to be provided. “We will structure our operations to maximize the federal revenue available for this conversion,” Dahlin promised the County Board. Starting about now, until well into fall, Dahlin expects some aspects of implementing federal reform will be “messy.” October and November is when open enrollment into the insurance exchange begins. The county may still be running two record keeping systems during this transition, she explained. Dahlin warned commissioners to not be surprised if they are asked for at least two fulltime equivalent (FTE) employees to be added to facilitate casework that’ll accompany this paradigm shift in how the United States makes healthcare available. There is a 75 percent funding (reimbursement) included in the Act for conversion costs.
In another issue-- the Minnesota legislature enacted a bill in the 2012 session that becomes effective in a couple of months, requiring drug tests for people seeking to enroll in cash assistance programs. The concern at the county level is who performs the testing and who pays for them. Dahlin said she expects state rules on this to be released in coming weeks. State facility costs Also: Chisago county has been funding 10 percent of the cost for housing persistently mentally ill and dangerous persons committed to a state facility by Chisago County. Dahlin said legislative action raised this to a 75 percent county share. To her knowledge Chisago County has six people in state facilities it is currently covering costs for. This has been as low as zero to two people. These are people who serve their criminal sentence but aren’t ready for release to an unsupervised environment. Anticipating costs in any year is difficult enough to budget, Dahlin added, and going to 75 percent “could push (local) costs to over $500,000.” Commissioner Walker noted state lawmakers are frequently heard to be advising local elected officials to “live within our means.” And yet state lawmakers shift costs like this onto counties at the same time, she noted.
County Attorneys have formed a task force, according to Janet Reiter Chisago County Attorney. They have no final recommendation on how to sentence or monitor these people indefinitely to present to the legislature, “But we’re working on it,” she concluded. One last HHS announcement-- the Supplemental Nutrition Assistance Program, dubbed SNAP (used to be food stamps) rewarded Chisago County with $9,000 for the county’s noteworthy outreach and follow-up identifying and serving those who are eligible. The award goes back into providing HHS programs.