Editorial: Dayton's smart call on Medicaid opt-in

Star Tribune

Gov.-elect Mark Dayton has made a sensible, jobs-friendly decision that will give Minnesota the rare opportunity to benefit from its pioneering health programs for the poor.

By taking advantage of a federal health reform measure allowing early Medicaid enrollment for about 95,000 low-income adults -- something that Gov. Tim Pawlenty opposed -- Dayton will strengthen Minnesota's fraying health care safety net and bolster the bottom lines of its medical providers, some of the region's largest employers.

Dayton's timely decision also means that state taxpayers will no longer bear the sole burden of paying for the care of these often seriously disabled or mentally ill adults.

Most currently get coverage in two expensive state programs -- General Assistance Medical Care (GAMC) or MinnesotaCare -- that provide barely adequate coverage at best and inadequate care for far too many. As imperfect as these programs are, they're still ahead of the curve nationally.

It's because of this forward thinking that Minnesota was one of a handful of states offered the opportunity to enroll low-income adults in the Medicaid program for the poor before expanded nationwide eligibility in 2014.

Under the joint state-federal Medicaid program, the federal government will match the state's contribution -- something that could steer as much as an additional $1.4 billion to Minnesota health care providers over the next three years.

It's not "free" money, of course, but it does mean that some of the billions Minnesotans pay in federal taxes will deliver benefits closer to home. The result?

Better coverage for the state's sickest adults, care that's closer to home for many and better reimbursement for the state's world-class medical community, allowing it to hire and invest again.

The shift of this low-income population could create or save up to 25,000 jobs, according to some estimates -- a key reason health providers across the state are applauding the shift as business-friendly.

With Minnesota's economy still sputtering back to life, the sooner this enrollment transition can happen, the better. But last week, state human services officials announced to great surprise that it could take up to 10 months to complete.

About 50,000 records may have to be entered by hand, an almost unbelievable situation in this digital age. While Dayton and legislators are pressing for greater speed, updating incompatible and aging computer systems is going to take time.

Those frustrated by the situation also ought to be asking hard questions about the state's human services information infrastructure. This has been a relatively painless area to cut. Is it now time to invest so that the state can deliver services more efficiently, something that would pay dividends far into the future?

It's also difficult not to look at this delay with cynicism.

Minnesota could have begun shifting this needy population to Medicaid last summer. Pawlenty opposed it, citing concerns about the cost of footing the state's half of the Medicaid bill.

Administration officials have said it will cost $431 million more over the next three years. But this week, George Hoffman, a respected Department of Human Services official known for his conservative cost estimates, said the state would incur no additional cost from shifting low-income Minnesota adults to Medicaid.

Delving into the cost dispute is an adventure in politically motivated math. Taxpayers deserve a straighter, clearer answer than they've gotten.

To be fair, Pawlenty is right that cost remains an issue, though it's more accurate to term the issue "cost control." The Medicaid early opt-in improves coverage, and getting people regular preventive care will help hold down the state's and nation's soaring health tabs.

Much more needs to be done. Fortunately, Minnesota is pioneering reforms that begin rewarding providers for quality and efficiency, not volume.

The state must continue to lead the way on this. Dayton should put a high priority on continuing that work.