The Free Press, Mankato, MN

October 26, 2013

Obamacare change to aid stressed counties, poor

Thousands of area residents will qualify for Medicaid; counties will verify eligibility

By Dan Linehan
dlinehan@mankatofreepress.com

---- — The expansion of Medicaid in Minnesota means that about 152,000 people will become eligible for free health insurance from the federal government Jan. 1. That, combined with the requirement that almost everyone will have to get insurance, is causing counties to prepare for a wave of new eligibility applications.

Some area counties are creating new positions or preparing for overtime, while others believe they have the staff to handle the influx. Seven area counties say they will be hiring new positions, for a total of nine, to accommodate the new caseload.

The federal government is paying for 75 percent of the counties’ costs to determine eligibility, so there should be little or no rise in property taxes for this purpose.

The expansion in eligibility is part of the Affordable Care Act, also known as Obamacare. The Supreme Court ruled earlier this year that this expansion is optional for states, but Minnesota is one of the states that opted in.

Scott Leitz, assistant commissioner at the state’s Department of Human Services, said it was a good deal for the state.

The new enrollees are fully federally funded for three years, after which the state contribution rises to 10 percent. That’s compared to the 50-50 contributions under the old rule.

The biggest group of people affected by the expansion are those who make between 75 percent and 133 percent of the poverty guidelines. For a single person under the 2013 guidelines, that affects a person making between $8,618 and $15,282.

This group is currently covered by a state program called MinnesotaCare. The biggest difference between Medicaid, the federal program, and MinnesotaCare is that Medicaid requires no premium.

“We think it’s a better option for a lot of people,” Leitz said. What little changes patients can expect in what’s covered will be improvements, he said.

The health insurance exchanges created by the Affordable Care Act, including Minnesota’s MNsure, also have a role to play.

People can go online to MNsure to see if they’re eligible for Medicaid, which is called “Medical Assistance” in Minnesota. But they won’t be able to actually enroll for a plan — they need the counties' to help with that — for some time, perhaps six months or a year.

Counties get ready

Those counties have each received estimates from the state about how many people they can expect to come through their doors. Blue Earth County has been told to expect about 1,500 new cases and has hired three new employees.

“We really see that and presented that to our board as kind of a starting place because we’re not sure it’ll cover that or not,” Human Services Director Phil Claussen said.

Including benefits, the new employees will cost about $137,000 a year, of which the federal government is expected to reimburse about $100,000.

It’s hard to say when the newly eligible will decide to enroll, but Claussen hopes they come in early. While they can’t qualify under the new roles until Jan. 1, they can come in early and be prepared.

Nicollet and Brown counties, by contrast, did not add any new positions.

“We wanted a year to evaluate how the process would go,” Nicollet County Social Services Director Joan Tesdahl said. The department has budgeted $16,235 in overtime, though that may go higher.

Brown County Family Services Director Tom Henderson said his county is waiting, too.

“That’s because, while the state is saying there’s 550 people in Brown County who are qualified and could come our way, we are in a wait-and-see mode to see how many actually come,” he said.

The county’s eligibility caseloads are also lower than some counties, including Blue Earth.

“If we had been in that same position, we’d have hired,” he said.

Sibley and Le Sueur counties are planning to hire two new positions each. The collaborative that runs human services in Martin and Faribault counties plans to hire an employee for each county.

But the 75 percent federal match means that counties aren't too worried about the changes.

There's really no net cost to the county, Le Sueur County Administrator Darrell Pettis said.

Free Press staff writer Robb Murray contributed to this story.