By Derrick Knutson
Among county government officials, the phrase “unfunded mandate” often elicits a less-than-positive reaction.
Needless to say, when the Chisago County Board of Commissioners heard those two words pass the lips of Nancy Dahlin, the director of Chisago County Health and Human Services, Aug. 1, the discontent was palpable.
She explained to the board that due to a decision by the State Legislature this past session, Chisago County could now be on the hook for assessing residents on Medicaid waivers.
On the surface, that might not sound like an overwhelming responsibility, but Dahlin estimated the county would need 8.7 additional full-time county employees to complete the assessments.
Essentially, an assessment means someone with medical expertise needs to come to the places of care for those on Medicaid waivers on a bi-yearly basis and assess the level of care they’re receiving.
Before the change by the Legislature, the previous county of residence was in charge of completing assessments.
“With folks in such (places) like group homes and assisted living, it had been when you moved into these sites from say, Ramsey County, the Ramsey County staff continued to give you your assessment on a twice-a-year basis,” Dahlin said during the board meeting. “The (statute) language change has changed that, now the county of residence is responsible for that assessment.”
She noted the amount of people residing in group homes and assisted living within the County has increased exponentially over the past 4 to 6 years.
“We’ve gotten the data from our State Department and what that translates to for Chisago County is about a 94-percent increase in that requirement, that activity head count,” she said.
Dahlin added that in addition to the 8.7 full-time employees needed to complete the assessments, other employees, such as clerical, billing and supervisory, might need to be hired to support the Medicaid waiver assessors.
She said her office has received notice from the State Department that the cost of completing the assessments with county staff would be covered, but she stressed that’s “kind of an ambiguous statement” because a funding source for covering that cost has not yet been identified.
Board Chairman George McMahon asked Dahlin what would happen if Chisago County refused to follow the mandate.
She responded to his query by noting the state has the power to withhold grants, which the county relies upon for its budget.
“Until that funding source is here, there’s no way we can provide (the assessments),” McMahon said. “There’s no way we can hire x number of people.”
County Administrator Bruce Messelt echoed Dahlin’s skepticism about the state providing all the necessary funding for the mandate.
“My experience is very, very, very few state programs will actually pay the full cost of providing the service and that’s the direct cost, let alone the other costs,” he said.
“As this evolves we want to keep you ahead of it and aware of it.”
Commissioner Lora Walker was taken aback by the mandate.
“I don’t know what to say,” she said. “Nine staff to complement this activity is absurd. We can’t sustain, let alone grow in this environment. In any way, shape or form we have to tell them we can’t do it. Sometimes the best answer is no.”