County braces for budget hit with Medicaid assessments

In a time when local government budgets are very tight, Chisago County might have to find an extra $350,000 to $500,000 in its coffers to address a state mandate that will require the county to perform more Medicaid assessments.

At the Jan. 23 Chisago County Board of Commissioners meeting, Chisago County Administrator Bruce Messelt relayed to the board the impact of a recent decision by the state Legislature about the Medicaid assessments.

Before this year, the previous county of residence was responsible for performing the assessments.

By Aug. 1, the state is recommending the current county of residence be responsible for conducting 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.

The amount of assessments Chisago County is now required to perform equates to the workload of about nine more full-time employees.

“Not only are the assessments required, but the time involved is expected to go from about an hour and a half per assessment to about six hours per assessment,” Messelt said. “That means (the county) could anticipate about a 300-percent increase in the workload.”

Messelt mentioned just to get the employees hired and trained, it would cost anywhere from $350,000 to $500,000.

“We should note that $300,000 to $500,000 was not budgeted in Health and Human Services this year,” commissioner Rick Greene said.

Whether or not the county will have to simply eat the cost associated with the mandate has not yet been determined.

“The state has not indicated how they will reimburse us, when they will reimburse us or at what level,” Messelt said. “We do know this much: we will have to hire employees six months before they can begin working, just to get trained. Those six months are not covered or reimbursable.”

Messelt said he plans to talk to representatives at the Capitol about the assessments to see if there might be a way to lessen the financial impact on Chisago County.

Logic behind the decision

Messelt said the Legislature made the decision to have the Medicaid assessments moved from the county of fiscal responsibility to the county of location because it deemed having professionals in the county of residence provide the assessments would be more efficient.

As an example, he noted someone could be living at Ecumen in Chisago County, and their county of residence might still be Ramsey, meaning, under the old system, Ramsey would be responsible for performing the assessments for the people on Medicaid living in Chisago County with legal residences in Ramsey.

“The state is trying to make sure that people who are on state and federal assistance are eligible for it and matched with the programs and the money they’re getting,” Messelt said during a phone interview last week.

Messelt mentioned not every county in the state would be adversely affected by the Legislature’s decision.

He said three to six counties like Chisago, that have a high number of residents on Medicaid who have their legal residences in another county, are impacted.

He added that if the state had told the counties affected by this change about the decision early on in their budgeting processes, the counties could have more adequately prepared for costs associated with the assessments.

“This was not very well thought through,” he said. “We weren’t told last September to budget for it. It’s been a pretty tough pill to swallow in terms of how we’re going to get this ready by Aug. 1.”

He added, “If you were going to write a textbook about an unfunded mandate this would be it.”

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