Want less waste, fraud and abuse? Simplify. Modernize
The Minnesota Legislature has focused on reducing waste, fraud and abuse in health and human services programs for the past several weeks. We were initially enthused by this, given the lengthy history Minnesota’s counties have in delivering innovative, high-quality services, often within severe resource limitations.
We’ve long supported reductions in waste, fraud and abuse, motivated by our care for our residents and commitment to good government. In a recent Pioneer Press article (“Audit: Welfare programs have lax eligibility checks,” March 25) the commissioner of the Minnesota Department of Human Services reiterated the state’s commitment to improving program integrity, especially through training support for the county workers who enroll Minnesotans in these programs. At the Legislature, the House Health and Human Services budget would institute “periodic data matching” to review cases more often to ensure those receiving benefits are eligible.
While we all share the same goal of a highly functioning system, we believe these solutions reflect limited viewpoints. Minnesota’s counties would like to propose a different solution, one that builds on past successes of all of us: the Legislature, the Department of Human Services and counties.
The root cause of this problem is that Minnesota’s public programs are far too complicated and county workers are using outdated technology systems to determine eligibility. Investments in simplifying the program rules, standardizing eligibility criteria and building a functional technology system will reduce waste, fraud and abuse — but they require investments from the Legislature, not more budget cuts.
Let me paint a picture for you: At the county level, financial workers are tasked with enrolling Minnesotans in a multitude of public programs. A family walks in the door of a county human services department, and a worker meets with them to determine what they need, and what they might be eligible to receive. The family is eligible for help from three programs: income, food support and health care coverage for a disabled child. But each program has different — detailed — rules, which the worker needs to look up and make sure he/she is applying correctly to that family’s circumstances.
Financial-worker positions were once considered entry-level professional positions, but in many counties, that is no longer the case. That is because the training for new financial workers takes hundreds of hours. In fact, a county invests between 12 and 24 months of training in a financial worker before he or she can independently enroll clients in human services programs. Why? Because there are hundreds of decision points that a financial worker must sort through to determine which programs fit each person’s situation, and the eligibility criteria (income levels, assets and such) vary between programs. The reference manuals include literally thousands of subsections covering more than 40 programs and eligibility types. In most Minnesota counties, a single financial worker is responsible for hundreds of cases, each of them complex.
Adding to the complexity, a financial worker must navigate four separate state computer systems to determine eligibility and complete enrollment. Individual clients may have to have data duplicated across these four systems, and families are split between these systems. And three of the four systems use DOS computer language, a technology that has been obsolete for more than two decades. The fourth system uses the same technology platform as MNsure, the problems of which have been well documented.
Furthermore, once financial workers are fully trained and on the job, the Legislature continues to revise the eligibility for these programs every year, adding more complexity. So, the rules change, and suddenly new people are eligible or not eligible for programs, or must submit different information. And the DOS systems can’t be updated to easily accommodate these revisions, so financial workers must rely on manual processes.
Working in this environment, is it any wonder that mistakes are made?
The solution to the problem of waste, fraud and abuse isn’t simply more training, as suggested by DHS, or more data checking, as suggested by the Legislature. The solution lies in streamlining and simplifying these programs, keeping the eligibility rules consistent from year to year and updating the technology. This will take more investment, not less, from the Minnesota Legislature.
Gary Hendrickx is a Swift County commissioner and 2017 president of the Association of Minnesota Counties.