When the pandemic hit last year, the state had to change the way it did a lot of business, and fast.
The Department of Human Services made some 115 temporary changes to its rules and regulations for health care, economic assistance and program licensing, from waiving training to incorporating telemedicine into the safety net.
The changes made it easier for people who needed it to get help, without the usual burdensome bureaucratic rules.
Just like private sector companies that have discovered the benefits of flexibility, DHS wants to keep some of the waivers, streamlining and simplification — which is the subject of negotiations as the Legislature prepares to reconvene Monday.
Taking a page from President Joe Biden’s “Build Back Better” plan, Gov. Tim Walz’s administration dubs his DHS proposal “Back to Better.” It would cost $14 million over the next two years, largely to help counties restart work and catch up on background checks.
Among the innovations the pandemic forced on the agency: Application interviews for the Minnesota Family Investment Program — a cash assistance program for poor families with children — were once done in person, but were switched to phone. And people no longer have to go to a county office to update information from their employer and bank.
During the pandemic, the state began reimbursing providers in the Medical Assistance program for conducting telemedicine; stopped limiting people to three such video or phone appointments per week; and began allowing more behavioral specialties to use the treatment method.
Now, DHS wants to expand telemedicine access even more.
DHS Deputy Commissioner Chuck Johnson said one of the biggest changes was the waiver of in-person interviews for Medical Assistance, which is Minnesota’s version of the federal Medicaid program, and the Supplemental Nutrition Assistance Program, formerly known as food stamps.
Minnesotans on medical assistance and the public insurance program for the working poor — called MinnesotaCare — got waivers to get continuous coverage; paperwork requirements were temporarily reduced for cash assistance programs such as housing support; and work and meeting requirements were waived for MFIP.
“We have a proposal that has both legal flexibility around timelines and funding to help support the work we need to do,” Johnson said. “So we’re hopeful the Legislature will adopt that when they get around to finishing it.”
Under current law, DHS can keep the waivers for up to 60 days after the state and federal peacetime emergencies end. Ending those waivers that fast would be a heavy lift, DHS officials say.
For example, to get hired for jobs in mental health treatment, foster care, children’s residential facilities, nursing homes and hospitals, employers must do a background check that includes fingerprints. But when the pandemic hit, nobody was doing fingerprints, so DHS waived that requirement and relied upon criminal histories.
When the emergency rules end, the state will have to redo almost 200,000 background checks within two months, in addition to the nearly 300,000 DHS does annually. The governor and House Democrats want a year to do the work; Senate Republicans prefer 180 days.
Rep. Tina Liebling, DFL-Rochester, chair of the House Health Committee, said the “slow off-ramping” in Walz’s proposal is needed.
“You can’t just flip a switch,” she said.
In the long term, DHS also wants counties and tribes to be able to waive interviews for economic assistance programs if they have enough documentation, and some periodic eligibility checks for health care programs to be suspended for six months.
Johnson said work was deferred with the idea that the state could catch up when the pandemic ends, but nobody knew how long it would go on.
Sen. Jim Abeler, R-Anoka, chairman of the Human Services Reform Finance and Policy Committee, predicted some or all of Walz’s proposal will go forward, with the only controversy coming over whether 15 more people need to be hired. He said hopefully fraud won’t increase as the regulatory burden is lessened.
“All parties should keep an eye out as the changes are made,” he said.
Johnson said the department hasn’t found evidence of fraud so far, and will carefully review documentation and claims through retroactive auditing of services and billing from Medical Assistance providers.