Board gets health care law overview

WashCo_logoThe Washington County Board of Commissioners waded into the 1,000-page federal Affordable Health Care Act Tuesday on the same day Gov. Mark Dayton signed legislation expanding health coverage for 35,000 state residents.

Staff from the Community Services and Public Health and Environment departments provided commissioners with an overview of the federal law and its affects on county health services.

“Our goal is to identify key issues with the Affordable Health Care Act,” said DCS Director Dan Papin.

Papin touched on some of the major features of the law, which expands health care coverage to 32 million people phased in over four years. Those features include requiring most U.S. Citizens and legal residents to have coverage; creates state-based health care exchanges; expands Medicaid to all persons under age 65 with incomes up to 133 percent of federal poverty guidelines; increased rates of federal financial participation to cover expansion; requires a single set of rules for eligibility and claims, and places new emphasis on reduced costs and improving health outcomes through prevention and early detection.

“It would try to reduce costs and improve outcomes by making an impact on the front end (of health care),” Johnson said. “Part of this is teaching people how to navigate the system.”

One goal of the new law is preventive health care, Johnson said. That’s important since the county’s population is aging, he added.

“Medicare will pay more for wellness visits,” he said. “We want to have healthy aging in the community.”

The law also expands DPHE’s home visit program, Johnson said. DPHE recently received $610,000 over two years for the program out of $12.5 million the state received from the Centers for Disease Control.

Johnson also said his department is working with the county’s hospitals on a community health needs assessment that identifies where community health dollars are spent.

Papin said one part of the law that would affect the county is Medicaid expansion.

“The county does not have the cost of Medicaid. The county does have a cost in the staff that determines (Medicaid) eligibility.”

DCS staffer Linda Bixby said states will get enhanced federal money as part of Medicaid expansion. The county currently has two percent of Minnesota’s Medicaid population, but is experiencing a increasing caseload, she added.
Bixby also said she expects the county will see an increase child support cases since anyone getting medical assistance and is involved in a child support case must cooperate in that case.

Papin and Bixby said with the expected increase in Medicaid clients will come a streamlined eligibility and enrollment system through “The Exchange” provision of the act. Papin said The Exchange is a one-stop shop for public-private health insurance that begins offering coverage Jan. 1, 2014.
However, Papin said he does not know how the exchange would affect his department’s Medicaid case workers and their clients.

“How will the exchange change the way we work,” he said. “A lot of these folks we’re working with are not stable. They’re working in jobs where one month they’re employed and then they’re laid off the next month.”
Papin also said it’s important that the state have the same system for regarding Medicaid expansion for all counties.
“Part of simplification is getting commonality. Let’s not have Minnesota doing its own thing,” Papin said. “It would be nice to have a common platform.”

Bixby said streamlined Medicaid administration is coming, but it’s impact on county caseworkers remains unknown.

“I do know we’ll have administrative simplification. I think it’s possible our workers could handle more cases. I don’t know what the number would be,” she said.