Working with a MNsure IT system that’s still cumbersome, county officials across Minnesota say they must hire more people or shift existing staff to handle the growing workload in the state’s public health insurance programs.
Last month, Hennepin County proposed hiring 92 more workers as the state starts moving more cases into the MNsure system this year and requires county workers to perform more eligibility checks on those getting coverage.
Other counties don’t have Hennepin’s large caseload, but are confronting the workload crunch, too.
“It’s still not a great case management system,” said Heidi Welsch, associate director of community services in Olmsted County, where officials are reviewing staffing needs. “There are still all kinds of tasks, all kinds of case management functions that take much longer than they should.”
Ramsey County transferred nine workers last month into its unit for MNsure work, and could be looking at hiring between eight and 15 new workers down the road. St. Louis County plans to permanently assign to MNsure-related duties 11 people who previously were doing the work on a temporary basis. There’s talk of staffing changes in Anoka, Isanti and Sherburne counties, as well.
When Hennepin County voiced concerns last month, the state Department of Human Services (DHS) issued a statement acknowledging that the MNsure system still requires both manual workarounds and ongoing training for county workers.
In a statement last week, DHS pointed out that some people with health coverage in public programs currently are seeing their cases renew automatically through MNsure. That’s an improvement on the old system, DHS says, which required county workers to be involved in all such cases.
Even so, the state says it initially hoped for better than today’s automatic renewal rate of 11 percent. Counties say they were told a few years ago that a large majority of cases would renew automatically.
“We know each county’s ability to maintain cases has varied, with some struggling to keep up while others are generally up to date,” DHS said Friday in a statement. “Each county must manage resources as it deems best and understand that in some cases, expansion of staffing levels may be the best approach.”
MNsure is the state’s health insurance exchange, which Minnesota launched in 2013 to implement the federal Affordable Care Act.
Government-run exchanges are an option for individuals to buy private coverage in all states; in Minnesota, the exchange IT system also handles public health insurance programs.
State officials now call this portion of MNsure the Minnesota Eligibility Technology System (METS), which state and county workers use to handle enrollment and eligibility for Medical Assistance and MinnesotaCare. Those are the state’s health programs for lower-income residents.
Since MNsure’s launch, the state and counties have been moving cases from an old computer system into the new one. The job was supposed to be done in 2014, but has been delayed with technical problems. Currently, there are 600,000 people with cases in the new system, DHS says.
Beginning Oct. 1, the state wants to move the final batch of 230,000 cases into MNsure/METS over a 12-month period. The shift means work for counties — the job requires more than 50 new workers in Hennepin County, officials say.
“Data matching” required
Last year, after audits that showed many in public programs had coverage but didn’t qualify, lawmakers called for “periodic data matching” to catch cases where people are wrongly covered.
Republicans say the data matching is essential given past problems, while DFLers suggest it’s an additional burden at the wrong time.
Either way, the new requirements aren’t the only reason Hennepin needs more help, said Rex Holzemer, the assistant county administrator, when he described the situation to the County Board in May.
“What we’re finding is that, consistently, the amount of time it takes to navigate and manage those cases in that new system is four to six times, by individual function, what it takes to do that same work in [the old system],” Holzemer said.
The 92 new workers the county says it needs would cost about $4.7 million per year, with costs split among the county, state and federal governments.
“We were hopeful the new system would give us some efficiencies,” Holzemer said. “I think you’re all well aware that it hasn’t done that — it’s actually gone in the opposite direction.”
Other counties offer a similar commentary, although some aren’t as far along in projecting how many workers they might need.
Ramsey County could hire new workers depending on how much work is involved with the new eligibility checks, said Tina Curry, the county’s director of financial assistance services.
“It’s not working so well,” Curry said of the MNsure/METS system. “There are still a lot of manual workarounds that we have to do.”
St. Louis County will be performing an ongoing assessment of whether more workers are needed, said Dave Lee, the director of public health and human services.
“Across the state, we’re seeing an increased need for workers because of the complexities of the system, and the additional work,” Lee said.
Sherburne County, which is considering new hires and staffing shifts, sent a letter to DHS in March that voiced frustration and described impacts for clients.
“Clients contact the county stating they were refused service by their provider, could not get prescriptions filled, are getting billed directly by their provider, not getting medical transportation, etc.,” the county wrote. “It requires county staff researching the case and contacting the state for assistance in resolving the issue.”
The letter concluded: “The counties have been told many times that improvements are on the way, but we have seen few.”