County, provider advocates react to Walz plan to centralize administration of Medicaid programs

[MUSIC PLAYING] NINA MOINI: State leaders are reacting to Governor Tim Walz' announcement to centralize the way Minnesota provides Medicaid services. This comes as part of the governor's push for antifraud changes at the state Department of Human Resources-- I'm sorry-- Human Services. Walz said the current system, split among counties, managed care organizations, and the state, has become increasingly difficult to administer.

So he laid out a plan yesterday that would have DHS take over eligibility determinations for Medicaid programs. He also said the state would take the lead in modernizing what he called an outdated system.

TIM WALZ: We think this is a way of simplification. It's a way to use best practices. It's a way to use modern technology. It's a ways to use AI. And what that does is takes the burden off the counties, the managed care organizations and gives the state and the taxpayers a much more transparent view in how the system works.

NINA MOINI: The plan would need lawmaker approval, and it got immediate pushback from both Republicans and Democrats. Here for more reaction from the county perspective is Julie Ring, Executive Director of the Association of Minnesota Counties. Thanks for being on with us, Julie.

JULIE RING: Hi, Nina. Happy to be here.

NINA MOINI: It seems like a lot of different people have a stake, obviously, in what happens next here. From your position with the counties, what were your initial thoughts when you heard about the governor's proposed plan?

JULIE RING: Well, our first reaction, I think, was excitement at the opportunity to talk about modernizing the delivery system we have in Minnesota. That uses both state and county resources. We have a position in support of doing a study of the system and really thinking about how to best position it for delivering services now and into the future.

NINA MOINI: As you understand it, what would change for counties in terms of how Medicaid services would be provided?

JULIE RING: Well, I think initially, there isn't an initial plan for a lot to change out of the gate, at least from our perspective. The study is really the core of determining how we would realign those services. And I did hear the governor talk about some limited eligibility assistance from the state before the study is completed.

But those are details we still need to hear more about. As you know, it's a really complex system. And it takes a while to dig into. And so we think that doing a thoughtful study of the different functions is critical to getting it right.

NINA MOINI: What is it you think the counties really need? Or can you explain for folks who may not know about the inner workings and how different levels of government interact? Why do counties, so many of them, feel that they're taking on the brunt of responsibilities that are just too much to manage?

JULIE RING: That's a really good question. So in its essence, the way Minnesota does Human Services, we call it a state-supervised and county-administered system. And what that means is the legislature writes the rules for how the programs work and appropriates the funding.

DHS, our state agency, oversees and runs the technology systems that are the backbone of the system. And then the county's role is being on the front line and sitting down with clients and people who are coming in to our offices seeking services. So those are the key roles.

And I think the conversation we're having today is about the cost and complexity of delivering those services. And the reason it's really currently important to counties is we're seeing-- and I'm sure you've heard about increasing property tax pressures that are primarily due to more state and federal mandates in this arena but without corresponding funding. So that's why I think it's a current conversation and why we need to talk about how to ensure we're delivering those services most efficiently and effectively for people.

NINA MOINI: And what types of conversations are you having with other leaders and other counties about this as it unfolds? Because to your point, we here on Minnesota Now, we've had quite a few, actually, representatives from different counties across the state who have come on and who have expressed some of the concerns that you're talking about. So what are people really asking you for when you're reaching out to counties?

JULIE RING: Well, the number one priority we have this session and I know you've talked about is the need to update the antiquated technology systems that are the backbone of these programs. And it's definitely wonky. But it's one thing that all counties in Minnesota feel strongly about, that these systems are hindering our work.

They're making it take more time. It takes more time for the people who need services. And these systems, which are old, DOS-based systems, are really difficult to operate efficiently. There's tons of workarounds. So we think, in the midst of this conversation of transforming Human Services, that's still a core priority, in addition to or regardless or alongside this bigger conversation.

And we feel like there's strong bipartisan support to do something about that now. So to us, that's an area of agreement. We also think it's important to have this examination of, who does what? What could be done more efficiently if it had better technology or was done in a centralized way versus what really needs a local, hands-on approach, like direct client services?

I'm excited that there's an opportunity to have this conversation. We hope that there will continue to be an interest in studying this so that we can do better in the future.

NINA MOINI: All right, Julie. Thank you very much for your time. I appreciate it.

JULIE RING: Thanks so much.

NINA MOINI: That was Julie Ring, Executive Director of the Association of Minnesota Counties. And now for another perspective on the issue is Josh Berg, who's a Board Member with the Association of Residential Resources in Minnesota-- or ARRM. ARRM is a network of organizations that provide services to people living with disabilities. Thanks for coming back on the program, Josh.

JOSH BERG: Thanks so much for having me.

NINA MOINI: You've been in contact with us and on the air here for months now with just some of the concerns that you've had about how any type of restructuring to ensure transparency and compliance might impact the people who really need the services. What was your first reaction to the governor's plan?

JOSH BERG: Yeah, no. I share Julie's excitement, and I also share in the comments related to the details matter. I mean, this is a bold move. And kudos to Governor Walz and the administration for thinking broadly and boldly. And now it's we got to get to work.

We got to see what this looks like. Because as we've seen over the last nine months, decisions made in a vacuum can have really harmful impacts to the people that receive supports and services across Minnesota, to the organizations that provide those supports and services. So, I mean, at this point, it's a beautiful thing to have something to respond, to have conversations about, and then see where there's a there there and how we can get into the weeds on some of these proposals.

So much of what is outlined in this proposal are concerns and issues that many stakeholders have been raising for years. So it's fantastic to now be able to come to the table to have these conversations, get into the weeds. And that's where collaborative, productive, transparent discussions and debates are going to have to happen in order for this to roll out well.

NINA MOINI: Can you say a little bit more about when you're talking about decisions being made in a vacuum, what you're talking about? Because you're also saying these are complaints that people have had time after time, year after year that the governor appears to be responding to with these proposed changes. What part of it is it that you want a better seat at the table or a seat at the table?

JOSH BERG: Yeah, no. And it's not just one particular stakeholder group that I'm speaking to. I wear a provider hat. I wear an advocacy hat. I wear an individual that supports loved ones that receive services and things like that. So I think we need to take the full context into picture.

And I think it's the decisions that have been made over the last nine months here in Minnesota have been directly a result of some of the issues that have been brought up at the federal level. And those pressures are forcing our administration to act quickly, to act what they feel is appropriately. But sometimes, that then prevents those stakeholder engagement opportunities to really make sure that the decisions don't have ripple effects or collateral impacts on the people all across the continuum.

Because as Julie mentioned, I mean, this is incredibly complex. And we need to make change. And this is an opportunity to do that. But we need to do it thoughtfully and transparently and collaboratively. And I just-- I urge everybody to be a part of this process, to be willing to get uncomfortable, to have conversations that are going to be tough.

But this is an opportunity to really transform the system in a positive way. So I'm incredibly grateful for Governor Walz for proposing something like this. And now we actually have to see the details of it and start talking about them and seeing which direction we start to go first.

NINA MOINI: What would be, Josh, if you could pick, the greatest change or the biggest change that you would like to see to make the system work better for Minnesotans? And are you feeling like that is being addressed in the governor's proposal?

JOSH BERG: I mean, I think the one that is probably starting to get more traction and more attention, but it's an underpinning and a foundational one in all of that, and it's that technology, that infrastructure of the system. We can talk about policies. We can talk about different programs and oversight things.

But if we don't fix the guts of the system that we have in place, all of those are Band-Aids on a system that is being held together by antiquated infrastructure and technology that doesn't talk with one another. So I think there's going to be a lot of support in doing something like that. But I also think it's going to be an expensive fix to do something like that.

So we'll see. We'll see. Can the state put forward the money and the resources to actually pull it off? Because without doing that, so many things become less meaningful if we don't fix the core of what has been a problem for decades now.

NINA MOINI: I see some common themes, definitely, between you and Julie and your perspectives. Thank you so much for your time again, Josh.

JOSH BERG: Thanks so much for having us.

NINA MOINI: Josh Berg is a Board Member with the Association of Residential Resources in Minnesota.