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Demand, software add to Medical Assistance cost

Growing demand for Medical Assistance and a failing software system have resulted in hundreds of thousands of dollars in additional cost to Olmsted County.

The county on Tuesday agreed to add five new full-time employees to its family support and assistance division, at a cost of $52,400 for the remainder of this year and $161,600 next year, after state and federal reimbursements.

Olmsted County Board of Commissioners member Ken Brown said he was "outraged" by the unexpected costs passed down to counties by inefficiencies in the state and federal governments.

"The public should be absolutely outraged, calling their legislators on a daily basis for this," Brown said. "It is an appalling waste of resources and stuffed down to the local level once again, with no thought, no appreciation, no funding, nothing to help us out. And they simply continue to reinvent the damn thing and get nowhere."

Medical Assistance in Olmsted


Medical Assistance provides health insurance to individuals and families who qualify, based primarily on their income. The program is federally funded through Medicaid. The state of Minnesota sets policy rules for the program and counties are required to do the work of determining eligibility of participants and handling their casework.

In Olmsted County, nearly 25,000 adults and children receive health insurance Medical Assistance — about 17 percent of the population, according to Heidi Welsch, director of Olmsted County's family support and assistance division .

Enrollment in Medical Assistance has grown by 40 percent from 2013 to 2016. The Patient Protection and Affordable Care Act passed down new mandates for individuals to hold health insurance, and the act also expanded eligibility to Medicaid and Medical Assistance.

Minnesota in 2013 rolled out new software to assist counties in managing Medical Assistance eligibility cases . The new system is called METS (Minnesota Eligibility Technology System). It has been phased in over several years to replace an aging system called MAXIS.

Olmsted County this year processed a little less than half its cases using the new software. Next year, the eligibility casework will transfer primarily to the new system.

'Not what we were promised'

When the state introduced METS in 2013, counties were told as much as 80 percent of cases would move through the software without interaction from an eligibility worker or case aide.

"It hasn't worked out this way," Welsch said. "This system is not what we were promised."


According to Welsch's most recent analysis, the METS software only moves 11 percent of cases without worker interaction — meaning 89 percent of cases require hands-on work from a county employee.

Another complication to the county's work system is on the way in September: the Minnesota Legislature in 2015 passed a new requirement for METS work, called periodic data match (PDM). The data match requires review of every Medical Assistance eligibility case, each year.

The added requirement is projected to increase the county's workload by another 33 percent, Welsch said.

Staffing need

To cope with the inefficiencies of the METS software and take on new requirements in the Medical Assistance program, Welsch and the family services division requested four full-time eligibility workers and one full-time case aide to begin in the last quarter of this year and continue in 2017.

The actual cost of the added positions is $162,904 this year and $378,765 next year. Reimbursements from the sate and federal governments bring the net costs to the county to $52,417 this year and $161,598 next year.

Olmsted is not alone in dealing with the inefficiencies of the METS system. In the state's nine largest counties, 249 full-time employees have been hired or are requested by county governments to work with the system.

The Olmsted County Board begrudgingly approved the staffing request.


"The state should be absolutely ashamed of themselves for this, and the public should look at this and realize just how detrimental this is," Brown said.

Board member Sheila Kiscaden said the issue should be a top legislative priority for the county next session, particularly the periodic data matching requirements.

"A lot of this boggles my mind, but this PDM just seems like a superfluous, bureaucratic, make-work, no-benefit requirement," she said.

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