Health care overhaul has Minnesota counties scrambling

If you want to know how much work it takes to implement the new federal health care law in Minnesota, ask Linda Bixby, economics support division manager for Washington County Community Services.

"I've worked in human services for over 20 years and I've never encountered anything quite like this," she said. "It's kind of like the perfect storm, [with] so many things converging at one time."

By "perfect storm," Bixby means the state's expansion of Medicaid — also known in Minnesota as Medical Assistance — to more than 151,000 newly eligible state residents and the launch of MNsure, the state's new online insurance marketplace.

"I've worked in human services for over 20 years and I've never encountered anything quite like this."

Both of those sea changes are set against the backdrop of a multi-year overhaul for the decades-old information technology system the state uses to determine clients' eligibility for government assistance.

The result is a lot more work for Minnesota's counties, long on the front lines of assisting low-income Minnesotans. The work includes helping enroll new Medical Assistance applicants, and transferring existing data on current enrollees to the state's new eligibility IT system. To handle the extra responsibilities, most counties are in the midst of a hiring frenzy, competing with each other for a small pool of qualified workers.

To some degree, MNsure is intended to lighten the counties' work load because Medical Assistance applicants can enroll in the program through the website without extra help.

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But county officials doubt many applicants will use the site in the early days after MNsure goes live in October. Until MNsure has all its kinks worked out, counties expect they'll have more work in the coming year — not less.


In the state's most populous county, it's the little details that are weighing on Deborah Huskins' mind.

As area director for the Hennepin County Human Services and Public Health Department, Huskins is worried that current identification numbers for Medical Assistance participants won't be compatible with the state's new IT system. She's also mulling how the county will handle clients who are also eligible for other forms of government assistance, such as food stamps.

But what she's really wondering is how many of the roughly 38,600 people in Hennepin County who will become newly eligible for the Medical Assistance program in 2014 will come to her staff to enroll rather than using MNsure's online system. The more people who come asking for help, the more her staff's workload will increase.

"In October when we go live with the new system, there will be a dramatic improvement for people in terms of the time-lag."

"The ideal that the state is pushing and that we want to support is that people can be as self-sufficient with their own applications and their own cases as possible," she said. "But we do expect that there will be a lot of people who maybe start out trying the web portal but have some difficulty or have some questions and need some human help whether that's by phone or in person."

Stephanie Radtke, deputy director of community services in Dakota County, shares Huskins' concerns.

"We expect there's going to be a significant percentage of cases," county staff will have to handle, she said. "We have no way of knowing what those variables will be until we get some experience with [MNsure]. How many applicants will not have everything on hand and will not be able to get through that application process on their own?"

Minnesota Department of Human Services assistant commissioner Scott Leitz said state officials expect MNsure's systems won't be a problem when the online marketplace goes live in October. In particular, they said the technology will be able to determine Medical Assistance eligibility of families and single people from the start.

That confidence is based partly on the results of a key test. The system has successfully tapped into a federal data hub that includes various bits of information needed to determine whether someone is eligible for government help, he said. And Leitz said MNsure will get people enrolled faster.

"We do a lot of stuff by paper still. And there's a lot of time lag when a person applies," Leitz said. "In October when we go live with the new system, there will be a dramatic improvement for people in terms of the time-lag... They'll get an instantaneous, real-time determination of their eligibility."

For the time being, however, MNsure won't have the capacity to handle applications for people who are disabled or elderly, Leitz said. Because the website's content will initially be only in English, he said, people who speak other languages will either have to fill out a paper application, or get help from a county worker or organizations that have received grant money to help people with MNsure.

Despite the state's reassurance about MNsure, Ramsey County Community Human Services director Monty Martin fears even people with relatively uncomplicated cases may have trouble navigating the new website, and may lack the documentation they need for the process to work the first time. It's likely to be a problem particularly for people who are eligible for Medical Assistance for the first time because that population is more prone to mental health problems, Martin said.

"How well [our clients] are going to be able to navigate that site and understand what they're signing up for and have the information available that they will need is in question," Martin said.


Another big unknown for counties is whether their staffs will have to hand-enter data about current Medical Assistance participants into the state's massive new eligibility system. The system will serve as the backbone of MNsure, and will eventually determine eligibility for food and cash assistance, too.

State and county officials hope the upgrade will reduce the time and effort required for people to re-enroll in Medical Assistance or other government health insurance programs.

This massive data project is one reason counties across the state are hiring. Hennepin County, for instance, is adding 75 new workers. Ramsey County plans to hire 26 people.

"You have to have social skills ... you have to have an extremely high aptitude for numbers, and efficiency in working with numbers and computers."

The federal government will help pay the bill, covering 75 percent of the cost of the new workers. Without federal funding, bringing in 21 new employees in Anoka County would have been an "incredible burden," said Jerry Vitzthum, the county's director of economic assistance and its job training center.

But finding money to hire new employees may be the easiest part, Vitzthum added. The county has had trouble filling the spots because surrounding areas and the state are competing for a limited pool of skilled workers willing to take on a high-stress job with relatively low pay.

"You have to have social skills ... you have to have an extremely high aptitude for numbers, and efficiency in working with numbers and computers," he said. "And the case loads are extremely high."

The Human Services Department's Leitz said the state is working with the federal Centers for Medicare and Medicaid Services on a plan to let clients do much of the work of entering their personal information into the new system as part of the Medical Assistance renewal process.


Despite the deluge of work county executives expect in the next year or so, they also see a payoff. The officials MPR News contacted stressed that in a few years enrolling in Medical Assistance, as well as other programs like food assistance, will be easier and more efficient.

That's partly because the federal health care law eliminated the need for county workers to verify an MA applicant's assets such as cars and homes. That will save county workers time. The new law also extends the amount of time participants can be in the program before having to re-enroll.

But it's the state's modernization of its ancient eligibility system that is the most welcome development at the county level, said Martin, of Ramsey County.

"The long run is a good one to look forward to," Martin said. "All of us in counties want to see our systems modernized. We want to see things more efficient. It's just going to take us a while to get there."

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