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MnSure to flood county with case work; no hiring yet (09/11/2013)
By Chris Rogers
Winona County Community Services is about to get a lot busier. The state healthcare reform program MnSure is expected to increase the case load of Community Services, potentially by 40 to 75 percent.

Expanded eligibility for medical assistance programs means that more people will qualify for state assistance through the county probably 1,600 to 1,700 new people, according to county staff. Additionally, new penalties for individuals without insurance are expected to bring in an unknown number of people who are currently uninsured but who would qualify for state help. Perhaps the county will see a total of 3,000 new participants, County Administrator Duane Hebert told the County Board at a recent meeting. Currently, around 19 staff members in the department serve 4,000 cases total, across all programs.

Numbers of cases and numbers of individuals are not always the same, since several individuals in a family may be grouped into a single case. Still, the projected increase is considerable. It got my attention, said Community Services Director Beth Wilms.

Other counties have been hiring en masse to prepare for the flush of new cases, but not Winona County.

"I hear that counties across the state are hiring more people. We've been assured we don't need to, but, seriously, how many more people do we feel that Winona is going to deal with because of that change in federal policy?" asked county commissioner Marcia Ward at a board meeting last month.

Hebert said the county expects it will have to hire some additional staff eventually, but he and Wilms said they need to wait before they can make hiring decisions. "There is such a lack of information," Hebert said. "Until we have more of those answers, we're just not prepared to come to the board and say we need additional staff," he added. How the state will provide training for county employees, who will serve as "navigators" charged with shepherding the public through MnSure applications, and when online applications will be available are all still unanswered questions.

'How many more people?'

Perhaps the biggest questions for the county, however, are how many people many people will apply for MnSure plans and benefits, period, and exactly how many new medical assistance and Minnesota Care clients will join the county's case load. When asked, Hebert said that this, too, is part of the reason for the county's wait-and-see approach to hiring to prepare for MnSure.

When asked if the he was concerned that the county might be overwhelmed with work when MnSure opens in October and county staff find out how many people will be signing up, Hebert said, "We have many other mechanisms to deal with case loads and workloads" other than hiring. He suggested that increased efficiencies, overtime, and temporary help might be able to handle the expected increase. By next year, the county will have a better idea of how the whole program is working and what their staffing needs are, he said.

"We worry about that, too," Wilms said, referring to an overload. The learning curve for new case workers is long, she added. Old and new staff will have things to learn about MnSure, on top of the added medical cases. Still, "we don't want to overact," Wilms explained.

"Some counties have jumped the gun" in hiring people, Hebert told the County Board. "They feel like they have enough information, but our managers have said we need a little more information before we come to the board and say we need to have some more staff."

MnSure 101

Minnesota's version of federal health care reform, MnSure will be a marketplace for comparing and buying insurance plans that meet government standards. Participants will also be able to use the program to find out whether they qualify for expanded state and federal tax breaks and help with medical expenses. On October 1, people can enroll in plans and benefits that take effect January 1, 2014. Eventually, Minnesotans will be able to sign up online. The county plans to add two public use computers in kiosks in the county office building to allow citizens without computers to sign up, and, as Hebert noted, those citizens could use library computers, as well.

State lawmakers have required that helpers be provided at such kiosks to shepherd applicants through the program; however, who those helpers will be remains unclear, according to county staff.

Minnesotans will not be able to sign up for MnSure plans and benefits online until January at the earliest, according to county staff. Online application may not be up and running until March or April, they admit. In the meantime, people will apply on paper.



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