Mary Scherling, Published July 01 2013
Letter: Legislature hangs Cass with unfunded mandateAmong the funding actions taken by the 2013 North Dakota Legislature was an expansion of the Medicaid program to cover individuals from ages 18 to 65 (including childless adults) with incomes below 138 percent of the federal poverty level. According to testimony provided by the North Dakota Department of Human Services, it is estimated that an increase of Medicaid enrollment anywhere between 20,500 to 32,000 more individuals throughout the state can be expected. As noted in the testimony, this is not an exact science and depends upon the methodology used to calculate estimates.
In 2012, Cass County Medicaid cases comprised 20.2 percent of the total for the state of North Dakota (18,268 individuals for FY 2012). Based on these estimates this could mean anywhere from 4800 to 7680 additional individuals in Cass County qualifying for Medicaid.
Although Medicaid program funding is provided federally through 2016 and thereafter a combination of federal and state funds, counties will be responsible for a large part of the administration of this program. The plan calls for individuals to make application online, telephone or via paper application. Cass County eligibility workers will be called upon to follow up and confirm reasons for discrepancies when self-reported and verified incomes are at odds. Monthly and annual changes in income will also need to be verified by the county. Any changes in eligibility will be reported to the county.
The county will be responsible to update third-party liability information, handle child support issues, investigate any fraudulent actions, handle out-of-state and out-of-county transfers, consider all appeals, be responsible for electronic narratives on new recipients, complete periodic reviews, and the list goes on and on.
The Legislature did not provide funds for counties to administer this program.
Based upon a caseload of 250 cases per eligibility worker (the state limit), we could be looking at a potential need for 19 or more workers to fulfill this mandate at an initial cost to the county of $1,166,942 for the first year. We have more questions than answers at this point.
In August 2013, there will be a two-day mandatory training for all eligibility staff in Bismarck at county expense. Cass County will have approximately 45 staff that will be required to attend at $250/person, which adds up to approximately $11,000 of added expense not budgeted for. The application process will begin in October and program implementation in January 2014. We go through our county budget process in August. With no funding in place from the state to carry out the program, it is up to the county to figure out where the money will come from. Do we cut services in other areas? Do we raise taxes? Neither option is appealing.
Unfunded mandates, and this one in particular, put a strain on county resources. We are committed to providing assistance to the poor and needy of Cass County. However, realize that decisions made at the state and federal level can have a direct impact on what we must do to provide that service at the county level.
Scherling is District 5 Cass County commissioner and chairwoman of the Social Services Board.