Ousted DHS official says agency is ‘short-sighted,’ needs oversight

A former top official in the Minnesota Department of Human Services says leadership in the massive agency made “short-sighted” decisions about health care without seeking input from medical professionals.

In an open letter to Gov. Tim Walz and lawmakers this week, Dr. Jeff Schiff said the agency ignored the advice of physicians in several critical areas. He worked in the agency for 13 years and was medical director of Minnesota’s Medicaid program until last month, when he was told his position was eliminated.

“I feel like it was my duty to these recipients,” Schiff said in an interview with MPR News. “Even though they are not my patients that I treat directly, I feel like it’s my obligation as a physician to make sure people on the Medicaid program get the appropriate services that are evidence-based.”

The Department of Human Services is a massive, nearly $18 billion agency that serves 1.2 million of the most vulnerable Minnesotans. In his letter, Schiff said physicians were not involved in decisions including prior authorization of drugs to Medicaid recipients. And mothers on the program were denied access to long-term reproductive services that can prevent preterm births or unplanned pregnancies, he said, despite recommendations from physicians to do so. Schiff also ran a program that was working to change the way doctors prescribe opioids to patients before he was terminated.

“When I raised my concerns about these examples and other clinical issues to the Health Care Administration leadership, [leaders] were hostile and dismissive about the need for medical input to use of the best clinical evidence,” he wrote. “Dedicated physicians and other clinical providers from the community are persistently stymied in their ability to meaningfully give input into policy decisions.”

He also said the massive agency needs more oversight. He wants an independent board that reports directly to the Legislature to oversee the Medicaid program. In response, DHS Acting Commissioner Pamela Wheelock said there are already several independent boards advising the state’s Medicaid program and another entity would be of “questionable value for the taxpayer resources it would require.”

“Considering decisions through a clinical lens is important to the health and well-being of the people we serve,” Wheelock wrote in a statement. “The recent redesign of our medical director’s office will allow us to bring on specialized expertise to better address significant areas of opportunity related to health equity, health access and better integration of care across the state.”

The letter from Schiff comes after a month of turmoil at the agency, the largest employer in state government. Former DHS Commissioner Tony Lourey resigned earlier this month, along with his chief of staff. That was after news that two deputy commissioners, Chuck Johnson and Claire Wilson, had also planned to resign. But those deputies have since rescinded their resignations.

The administration has not explained what led to the resignations in the first place.