After months of turmoil at the state Department of Human Services (DHS), Minnesotans now have some answers about what’s gone wrong. The next challenge is to move from decrying the problems to enacting both short- and long-term solutions to enable this agency to efficiently deliver the vital services it provides to the poor, the disabled and the elderly.
DHS has garnered headlines for months after leadership departures and revelations that it had made $29 million in overpayments for substance-abuse treatment to two of Minnesota’s tribal nations. On Tuesday, the venerable Office of the Legislative Auditor delivered its findings after investigating the overpayments.
The report was grim. The agency has an $18 billion annual budget but lacked “internal controls” to track decisionmaking and ensure compliance with the complex web of state and federal regulations for spending medical assistance dollars.
Who made the original decision that led to the overpayment? We don’t know. How long has this been going on? We’re not really sure. Why wasn’t it caught before now? The unsatisfactory answer: institutional autopilot. An editorial writer reading the report wondered if the state expects better accounting from charitable pulltab booths at local bars than it does from DHS.
The auditor’s report did put a valuable spotlight on a systemic problem that allowed this problem to occur, then fester. The division responsible for the payments apparently was allowed to operate with too much autonomy. The auditor’s crew had a damning interview with a DHS employee who said that administrators were viewed as “intrusive” if they asked questions and that there’s a “culture” in certain divisions of keeping administrators at bay.
The new DHS commissioner, Jodi Harpstead, spoke before two legislative hearings triggered by the report’s release. She merits praise for acknowledging the problems instead of being defensive. She also has sensibly put in place quality-improvement processes used in both the private and public sectors. This is unglamorous but vital work.
Legislators also have work to do, as the auditor’s report made clear. It may be necessary to codify accountability mechanisms at the agency to ensure that they endure beyond the current leadership team. Lawmakers also need to address two more complex issues:
• Restructuring the agency. There have been calls for years to break up DHS because it’s so big. Doing so wouldn’t be a cure-all, but it could reduce management layers, allowing leadership to more rapidly spot problems. Lawmakers should commission a report from outside experts outlining the advantages and drawbacks of that idea.
• Repayment by tribal nations. It doesn’t appear that state regulations allow DHS to hold the two tribal nations harmless for the overpayments. The Legislature should change state law. It’s not an ideal solution, but it would avoid a protracted legal battle with the tribes, whose leaders followed the agency’s guidance. It also would help repair the relationship between DHS and the tribes. That’s critical because both play a vital role in stemming substance abuse in American Indian communities. The tribes could help the process by providing reassurance that the money was spent appropriately.
Some perspective is also needed as DHS’s troubles continue to garner headlines. Former state Rep. Matt Dean, a Republican, provided that in a recent tweet: “I’d like to see as many people concerned about addiction in Leech Lake [and] White Earth tribes as are concerned about overpaying for it. It’s beyond a crisis. The numbers are unbelievable and heartbreaking.”
Dean is right. Substance abuse, educational disparities and poverty have long plagued tribal communities here and elsewhere. Legislators, these problems merit your time and attention, too.