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County bracing for rise in Medical Assistance cases

As fast as some aspects of the Affordable Care Act are moving, others are staying put for now.

Washington County Community Services officials are already planning for major changes though, including a significant increase in cases by 2014.

But whether or not that will result in additional staff is still a mystery, since some aspects of the law require a more streamlined system that may cut down on workload.

One of the most pertinent changes will be how the county determines eligibility for the Medicaid program, also known as Medical Assistance.

And with Gov. Mark Dayton signing a bill last week to expand the program to 35,000 additional Minnesotans, Washington County expects a 5,200 jump in cases.

"That has already resulted in a significant increase of new cases and on top of it there is continued expansion as it will unfold in 2014," said Dan Papin, director of Community Services for Washington County. "Between the two, we're looking at several thousand new cases that will be eligible for Medicaid."

In addition to determining eligibility, the county's 40 staff members in that department will have to maintain and monitor changes in income, family dynamics and employment to make sure they're still eligible for public assistance.

Papin and other Community Services staff members met with Washington County Board members at a workshop Tuesday, Feb. 19. But they did not make an official request for any changes in the program or budget.

Papin said the reason for the meeting was "to make sure the board knows there is still unanswered questions here."

"As fast as its moving on one level, there is still issues unresolved," he said.

The latest number of Medical Assistance cases in Washington County totals 15,908, according to Papin. Most of them include more than one person, for example a mother and a child or two.

"An average case is probably a little over two people," he said.

The number of families and individuals seeking assistance was already on the rise when the economy tanked in 2008.

"The caseload rose dramatically at the start of the recession and it went from just under 14,000 to almost 16,000," Papin said.

Specifically in Woodbury, 5.5 percent of the total population was on Medicaid between 2009 and 2011, according to the latest available data from the U.S. Census Bureau.

Additionally, 5.9 percent of Cottage Grove's total population was also enrolled in the same program during that time, according to the data.

"I anticipate, at least on a temporary basis, we will be requesting staff in the future," Papin said. "But, and this is a big but, we are hoping for some serious administrative simplification."

The serious simplification he's referring to involves streamlining all of those different qualification tests each case has to go through in order to be enrolled in the program.

Even if county staff members are confident that an applicant will be denied coverage, they're still required by law to process the paperwork.

"The detail and complexity of the program requires an awful lot of staff time," Papin said, adding that 60 percent of the cases that apply are not eligible for reasons such as too much income or assets.

A new aspect of the Affordable Care Act takes out the "asset test" too, which will also contribute to an increase in the caseload.

"Without an asset test for health care programs, you do have some issues that could surface," Papin said.

Riham Feshir
Riham Feshir is a reporter and photographer for the Woodbury Bulletin. Her coverage includes Woodbury City Hall, Washington County Board of Commissioners and business news.  Follow Riham on Twitter @RihamFeshir for the latest updates.