AP NEWS

Can the state fix its medical eligibility system?

March 5, 2019

Chris Johnson has seen calls increase.

As an Olmsted County senior eligibility worker, he fields calls from local residents who received automated notices about their Medical Assistance or MNsure eligibility.

He said many of those notices are wrong.

“We know that a notice going out is going to be the wrong information, but I can’t stop it, so I have to create another notice with the correct information, so the client will get two notices in the mail,” he said.

Other times, phone calls are the first time eligibility workers discover a problem exists.

It’s not a new problem for the county’s 16 eligibility workers who handle 8,800 Medical Assistance cases reviewed by the Minnesota Eligibility Technology System.

Also known as METS, the software system was implemented in 2013 to determine who is eligible for the state’s Medical Assistance program, as well as serving as the backbone for eligibility work related to MNsure, which adds more local cases to the system that the county doesn’t specifically track.

Olmsted County officials and employees say the state’s mission is failing and continues to put added pressure on the county.

“We’ve had to hire additional staff because of their technology,” Deputy County Administrator Paul Fleissner said. “Most good technology means you need fewer staff, not more.”

The county added five employees in 2016 to deal with the increased burden.

When the system was introduced, counties were told that as much as 80 percent of the cases would move through the state system without interaction from an eligibility worker or case aide.

That hasn’t been the case.

CONCERNS CONTINUE

While Johnson said more than half the cases are entered online by individuals or MNsure navigators, all it takes is some improper punctuation to kick out an automated rejection, which typically requires an eligibility worker to fix.

“If you put in a person’s address and add punctuation where it’s not supposed to be, or a space, it will cause the person not to get the desired outcome, and you don’t find out until the person who applied goes to the doctor or the pharmacy and is told their coverage has ended,” he said, noting being turned away at the doctor’s office or pharmacy could have detrimental effects.

At that point, an eligibility worker might be able to fix the file, but Johnson said about half the cases require starting over by closing the case and re-entering all needed information from scratch.

While MNsure clients could opt to re-enter the information, Johnson said county workers typically take on the task.

“The case closed and it wasn’t their fault, so it’s on us to get it to work again,” he said.

Ruth Olson, the county’s Family Support and Assistance supervisor, said the result is a system that has plagued county staff for five years.

“Because all these little glitches happen, no eligibility worker can feel like they can really trust the system,” she said.

In addition to needing to recheck the system, Olson said METS also requires more work to make changes in a fail. As an example, the previous system required nine keystrokes to make an address change, and it’s a 19-step process in the new system.

“It ends up being a lot of time, a lot of staffing with taxpayer dollars,” she said, noting other challenging changes include adding a new child to a family’s insurance.

CLIENT FRUSTRATION

The impact goes beyond staff.

Aaron Wager, lead pastor of Bear Creek Christian Church, said he appreciated it when MNsure lowered his family’s monthly insurance costs from $1,500 to $50, but said METS notices have been troublesome.

“You get all this paper trail constantly,” he said.

Knowing Johnson through the church, Wager said he’s able to get answers and assurances quickly but noted others likely face lingering worries.

“It kind of freaks you out,” he said of receiving automated notices his insurance was rejected.

While each rejection has been followed with a correction, he said the process could be improved.

STATE AWARE

Minnesota’s Department of Human Services is aware of the concerns and has indicated it is working to address them.

“DHS is frustrated by the lack of progress to address the ongoing challenges with the METS system,” the department stated in an email response to questions about the system’s status. “While DHS works with counties to identify issues and make system fixes to improve them, under the new administration, DHS plans to work with counties and fully evaluate the current shortfalls and determine the best solutions for counties and their workers.”

While no one from the state department was made available to speak about the issue, the official response indicated plans to invest available technology funds to make changes.

Additionally, Gov. Tim Walz released a budget proposal on Feb. 19 that seeks $11.2 million over two years to address existing compliance issues, noting the majority of needed fixes are related to METS.

Rep. Tina Liebling, who is leading the House’s Health and Human Services Finance Division this year, said the request doesn’t mean the funding will be available.

“We’ll be hearing the proposal, but we haven’t talked about it yet,” the Rochester DFLer said, noting the funds requested are part of a proposed $20 million budget increase.

BROADER DISCUSSION

At the same time, she said the governor’s proposal likely will spur needed discussion on how human services are delivered in the state.

“It looks to me like it’s both putting some more resources into the current system to continue to make it more user-friendly ... and the rest of it looks to be to sort of start a redesign of the whole system,” she said. “I’m kind of heartened by that.”

In his budget proposal, Walz said he wants to provide a “more integrated, person-centered user experience for all Minnesotans served by the system.”

For Johnson, who has been working with METS since 2014, any efforts will be welcomed by him and the clients he serves.

“We don’t want them to have a MNLARS experience with METS,” he said, referring to the multimillion-dollar Minnesota Licensing and Registration System that has caused delays in obtaining licenses and registering vehicles.