County government officials voiced frustrations Wednesday over their struggles to use MNsure for people who need help from government social service programs.
Counties use the health exchange IT system to enroll low-income Minnesotans in the Medicaid health insurance program, and officials have repeatedly complained over the past year that the system has made it difficult to efficiently connect many with coverage.
During comments to the MNsure board Wednesday, county officials said the MNsure problems also can prevent county workers from getting people connected to other needed services such as alternatives to nursing home care.
"A year after implementation, MNsure remains woefully inadequate for managing public health care programs, and counties really are reaching a tipping point," said Linda Bixby, economic supports division manager with Washington County.
During Wednesday's board meeting in St. Paul, MNsure officials described plans for spending an expected $85 million in new state and federal money for IT fixes this year.
Many of those fixes should help address problems faced by county workers, said Chuck Johnson, deputy commissioner of the state Department of Human Services.
"It's been a struggle for the counties," said Johnson, who attended the board meeting in place of Human Services Commissioner Lucinda Jesson. "One of the priorities … is to get the case management side of this working better, so counties can do their job more effectively."
In comments to the Star Tribune on Tuesday, Jesson outlined the expected $85 million in IT funds, including $21 million in grant money that's already been awarded to MNsure by the federal government.
The grant award, which was announced earlier this month, triggers another $58.5 million in federal IT funding through the Medicaid program. The state is expected to provide $6.5 million as a match for Medicaid funding.
Gov. Mark Dayton included the $6.5 million in his budget proposal released Tuesday, but Republicans who control the state House sounded cool about the idea.
On Wednesday, those House leaders sent to DFL Sen. Tony Lourey a letter asking for a prompt meeting of a MNsure oversight committee in the legislature to better understand the request.
"The [committee] has a responsibility to understand where this need is coming from and why Minnesota taxpayers need to pay more instead of MNsure's vendors and management bearing the cost of completing a system that has already cost over $180 million in taxpayer dollars," the Republicans wrote. "Despite cosmetic improvements to the website, MNsure's technology remains deeply flawed."
In comments to the MNsure board, Marti Fischbach of Dakota County said her workers can't perform many tasks in MNsure such as closing an applicant's case in the IT system.
That's important because as long as an applicant's case is open in MNsure, county workers can't help the person in a different computer system for ordering certain in-home services, said Fischbach, director of employment and economic assistance with Dakota County Community Services. "In a very extreme example of how this is impacting clients, they might have to leave their home and go to a nursing home," Fischbach said, because the services can't be ordered.
State officials can close such cases on behalf of counties in an emergency, she said, so people can get the services. But the state is overwhelmed with such requests to intervene.
"The volume of high priority cases is so vast," Fischbach said. "It's becoming more and more unmanageable to try and work on these cases."
It wasn't immediately clear Wednesday how often such problems occur.
Minnesota launched the MNsure exchange to implement the federal Affordable Care Act, which called for exchange marketplaces that cover all 50 states. People can use it to buy coverage from private insurers.
In launching MNsure, Minnesota opted to also use the new system for eligibility and enrollment in Medicaid and the MinnesotaCare public health insurance program.
The old computer system for public programs is still being used alongside MNsure, but it's clunky, obsolete and ultimately will be replaced by the new MNsure system, said Johnson of DHS. Bixby of Washington County offered a similar assessment of the old system, but said county officials prefer it in many ways to MNsure.
Where it took 10 minutes with the old system to add a baby to a new mom's coverage in Medicaid, "it now takes 45 minutes in MNsure, if it works at all," Bixby said.
On IT fixes that would be funded by the new $85 million, MNsure officials have developed a list of 18 priority items, said Chief Operating Officer Katie Burns. In picking those items, Burns told board members: "We did consider the workload of state and county staff more heavily."
The 18 priority items are a subset of 30 priorities identified last summer by Deloitte, an outside consultant that MNsure hired to guide improvements to the IT system.
Only one of the 30 items has been completely fixed, MNsure officials said. Of the remaining items, MNsure spokesman Joe Campbell wrote in an e-mail: "There are 29 priority items that still require varying levels of work, but tremendous work has been done on many of them already."