Crow Wing County: making funding choices
A proposed Crow Wing County staffing move had commissioners questioning the savings.
Privatizing services, pots of government money and taxes were all intertwined at the Crow Wing County Board meeting Tuesday.
Community Services proposed contracting out the majority of the chemical dependency assessments, which help determine if a person has a problem with drugs or alcohol, to private providers. By cutting back on those chemical dependency assessments, two full-time employees would be available to fill staffing needs for the MnCHOICES assessments within the county’s healthy aging unit.
MnCHOICES is one of three state Department of Human Services initiatives “to improve the dignity, health and independence of people with disabilities and older Minnesotans.”
The state health department reported MnCHOICES assessment will replace current long-term care assessment processes and forms, including developmental disability screening, long-term care consultation assessment, personal care assistance assessment, private duty nursing assessment.
Ninety percent of the MnCHOICES work is reimbursed.
County staff members Tami Lueck, adult services supervisor, and Nathan Bertram, program coordinator, reported the move would save the county $74,000 in 2014 and in subsequent years from a budget of $144,000.
Administrator Tim Houle said unlike many counties that added staff to handle the increased workload with MnCHOICES, Crow Wing County staff is suggesting sending other services out to private providers and shifting those workers to fill the need in the healthy aging unit.
With the chemical dependency assessments, county staff reported they are duplicating efforts provided in the private sector. The county will continue to do the chemical dependency assessments on jail inmates.
Houle said the move means no net change in full-time staff members but a significant reduction in tax levy costs.
Commissioner Paul Thiede noted reports he heard that California along with other states doing their own health exchanges with the Affordable Care Act or Obamacare may be potentially bankrupt and there was no guarantee shortfalls won’t be there in future years.
Thiede said the county has been judicious in not rushing out to hire staff for MNsure, Minnesota’s health exchange, but said the limited options appeared to be putting the cost of a mandated program on the backs of taxpayers or using federal/state funding streams to pay for it. Thiede asked if he was wrong with his logic.
“That seems to me to be the story here,” Thiede said.
“Just want to clarify,” Lueck said. “This is not MNsure. This is MnCHOICES. This is that MnCHOICES assessment that we are required as a county to do.”
The county’s launch date is July 14. Lueck said in previous briefings to the board, the expectation was a need for four to five additional staff to carry out the program. One strategy was to move staff from other areas to handle the work load.
“I was not tying the two together ... ,” Thiede said. “They are different, yes they are, but I believe the driving force is the (health) exchange. That’s what got us to where we are and why we are doing this. ... I agree with staff. This is a way of handling that problem. ... I just wanted to make the point ... part of the creation of this problem comes from our entering into an exchange and I have significant concerns about that for the long term.”
Houle said: “The logic you have laid out is accurate logic, it’s just that it is not related to the Affordable Care Act. It’s related to a different federal mandate and that is to do the combined assessments for MnCHOICES.”
Houle said MnCHOICES is for home visiting, personal care assistance assessments and elderly waiver programs.
Thiede said people hearing MNsure and MnCHOICES have a very difficult time following it and the ramifications of the Affordable Care Act are yet unseen.
Commissioner Paul Koering said farming out the services and then deploying staff in other directions didn’t compute to him as a cost savings.
“That’s great. If we can privatize a lot more county services and we’re going to save money and we can get rid of some employees isn’t that kind of the direction that we should go down? Maybe we should contract with Anderson Brothers and have them plow the roads so we don’t have to have employees working in the highway department.”
Houle said it was a fair question. In this particular instance, staff proposed to save money not reduce employees. But in the broad question, Houle said a lot of services are privatized now. The county doesn’t build roads, Houle said, and many things are privatized already such as home health care services.
Houle said he was impressed with staff coming forward — knowing additional staff wouldn’t be an option — with this idea to using existing staff to meet a federally mandated program and reduce the tax levy.
“I think that’s what they’ve produced in this instance,” Houle said.
Houle said now two employees who were being paid for with tax levy dollars can be moved to fill a staffing need paid by federal dollars. Koering said “cheaper better way” is his middle name but privatizing some things and then redeploying staff didn’t make sense as a cost savings.
Houle said he understood Koering’s concern but this is a case of working both sides of the accounting ledger for an improvement in the property tax burden.
“I think it’s a creative thing we’ve done here and I think it’s a huge savings,” said Commissioner Doug Houge. Commissioner Rachel Reabe Nystrom agreed with Houge.
Koering said leveraging dollars from somewhere else was as though it was coming from the moon and he was paying state and federal taxes, so it was still coming out of his pockets.
Koering said saying the county would keep a zero percent tax levy and then take federal and state money was kind of like talking out of both sides of the mouth.
Just swapping pots of money didn’t make sense, Houle said. He asked commissioners to keep in mind the money from the federal and state government is being put on the table to pay a program they are requiring.
Houle said he’d love to have a discussion on whether the county should have to do the MnCHOICES assessments and then both the expense work and the revenue would go away. “But that’s not what we have in front of us,” Houle said. “We are required to do the assessment ... It’s reasonable for us to say we’d rather do something they are making us do with their money than with our money.”
The board unanimously approved the community service recommendation.