GOP bets on big savings in health care programs

At least once a year, a million Minnesotans who get coverage through subsidized health care programs must go through a renewal process.

That can be a form in the mail that they either sign off on or change. State and county officials also match up their information included in a federal data hub.

"If it all checks out, they continue their eligibility," said Department of Human Services Deputy Commissioner Chuck Johnson. "If there's something different, then we go back to the individual and say 'Hey, we're seeing something different here' and we work through it with them."

Republicans in the Minnesota Legislature say that's no longer good enough.

They want the government to weed out people who don't belong on public programs. They're aiming to save more than $140 million that way, on top of another $150 million by leaving inflation out of Medical Assistance expense estimates.

Johnson said he's skeptical all that money would materialize — unless the goal is to discourage people from staying in programs.

There would be fewer people on public programs at any given time, Johnson said, but not necessarily because they don't need the help.

"Some of it is just because you're creating so much hassle in the system it's just making it harder for people to keep their care on a regular basis," he said. "And that's when it starts lopping over to people not having the access to the medical care they need."

A report from Minnesota's Legislative Auditor last year rapped the Human Services Department for oversight lapses. It found trouble with eligibility verification, double payments, uncollected premiums or incorrect program placement — either because people were put in one that was too generous or too limited for their situation.

Auditors estimated that errors resulted in overpayment of health care benefits of at least $115 million and possibly as much as $271 million.

Officials say some fixes are already in progress.

But the problems exposed by the audit are why House Health and Human Services Finance Chairman Matt Dean, R-Dellwood, mocks the Dayton administration for suggesting Republicans won't be able to find the savings they're looking for.

"I don't think they could find a Dilly Bar at a DQ," Dean said.

Program administrators should do more to double check, Dean said. "We want them to go out and find Medicaid enrollees and just make contact with them."

A GOP-crafted budget bill puts the onus on health maintenance organizations to prove through signed documents that there's an eligible person tied to every account. Money would be withheld and people would lose coverage if their eligibility could not be verified.

"We're a great, big-hearted state, but we can't continue to write checks to HMOs for people who don't live here, who are dead or who don't qualify," Dean said.

So what if the savings don't materialize?

Extra costs from delivering care would eat into any future budget surplus or contribute to a budget deficit if the state's overall economic fortunes turn.

Democrats contend that's risky for both the state and people in the health care programs.

"What I disagree with is banking savings now in this budget before we know what the outcome of that eligibility check is," said Rep. Erin Murphy, DFL-St. Paul, a nurse who like Dean is running for governor next year.

Murphy says the population served by the programs can be transient, making it tough to reach by mail or other methods. She says removing coverage could cause interruptions in care or add administrative expenses to re-enroll people later.

"The idea of dis-enrolling because someone hasn't responded because they haven't received their mail is a short-term strategy with a long-term consequence for Minnesotans who are sick," Murphy said. "And I like the policy that we have in place now that we verify eligibility but we don't kick people off necessarily because they don't respond."