Rural counties urge Walz to intervene

If Governor Walz wants to mend fences with rural Minnesotans, he could start by cleaning house at the Minnesota Department of Human Services (DHS). Specifically, the mid-management bureaucracy blocking complete compliance with Minnesota laws empowering the highly-successful County Based Purchasing (CBP) model for delivering health care programs.

In the turbulent waters of contemporary health care delivery, the CBP model stands alone in providing county MA recipients dependable access to consistent, locally-administered, cost-effective care that streamlines local social services, public and behavioral health, medical care and wellness programs to meet the unique needs of each public health program participant.
While rural providers are often frustrated by late and low reimbursements from big HMO’s, CBP plans pay promptly and better. CBP plans reinvest any remaining revenues in the communities they serve to provide real benefits in the form of increased mental health access, dental clinics and other benefits to meet local needs.

In theory, counties work in close partnership with the state to deliver public programs at the local level. But under Governor Walz’s administration, the state DHS has consistently disregarded that partnership when it comes to CBP plans. Since 2019, DHS has undermined county authority under state law, insisting on inserting multiple health plans in every county for public health care programs, regardless of what those local counties feel is best for their residents. DHS claims that’s what the federal government requires, but cannot point to any such mandate. In fact, Minnesota has operated this single-source program successfully for 25 years, and there are at least three other states that have single plan, county-based models with the blessing of the federal government.

Counties spent considerable time, effort and revenues in good-faith negotiations with DHS over the last year-and-a-half, working to mutually determine what is best for each county. But earlier this year, DHS issued a Request of Proposal (RFP) that stated all counties would get multiple health plans, regardless of what the counties felt was best.
Counties called “foul,” wrote letters, asked DHS to rescind the RFP and raised new concerns about DHS’s commitment to genuine partnership.
DHS’s response: “Sue us.” So that’s what happened.

In February, the three CBP plans on behalf of their 22 member counties and the 92,000 people they serve – along with 11 other counties awaiting to serve residents as part of a CBP plan – filed a lawsuit arguing DHS has violated Minnesota law.

The case has been made and we expect a ruling at any time – perhaps even ahead of this publication.
At this point, a win for counties and their CBP plans is hollow at best as it means they’ve spent needless time, effort and critical revenues to get DHS to follow state law. If somehow the case goes against the counties, Governor Walz can still do the right thing and remove those in DHS who continue to block county authority and CBP plans.

That would be a good start toward building better relations in rural Minnesota.

Luke Johnson
MRC Chairman
Pipestone Co. Commissioner