Over the past six months Minnesotans have witnessed a steady stream of troubling disclosures from the state Department of Human Services (DHS). The most recent assert that county taxpayers will need to pay nearly $9 million, chiefly for amounts DHS over-collected from the federal government related to chemical dependency treatment services.
The recent spate of mistakes has been met with calls to restructure DHS. But what's also required is a more comprehensive review of Minnesota's human services delivery model — the need to unwind complex financing and administrative requirements that shift state costs onto counties.
These mind-numbingly complex requirements distract from a focus on outcomes and contribute to a DHS culture that views county staff as a regulated industry rather than as professional partners.
The essential role of counties in delivering state programs results from the way the Minnesota service delivery model differs from most states'. Minnesota is one of only a handful of states where state human service programs are state-supervised, but county-administered.
In Minnesota, if you need temporary financial assistance, mental health or chemical dependency treatment services, you go to a county office. In most other states, clients directly contact a state agency office to access such services.
Minnesota counties spend about $2 billion annually and employ thousands of staff to deliver these services, in addition to state staff and spending.
In the recent chemical dependency over-collection error, the domino effect, whereby DHS errors result in counties having to repay funds, stems from a choice made by the state to mandate that counties fund a portion of these service costs. There are dozens more examples where state law requires counties to maintain certain spending levels or pay a portion of state human service program costs with no consistent rate or policy rationale being applied across programs.
Additionally, it is not uncommon for counties to have to pay hundreds of thousands of dollars — for a single patient — who is eligible to be served by a state mental health treatment facility but cannot be because there are not enough treatment beds in state facilities.
Yet another provision specifies that the county that physically detains a person needing detoxification services is responsible for 100% of the costs — a bit of an odd incentive structure.
In May, policymakers wisely agreed to eliminate one such mandate that required counties to pay 30% of the state's costs for state-determined chemical dependency treatment services. Unfortunately, an incorrect date in the legislation left counties to absorb an additional $9.3 million in costs even as the same legislation imposed a new requirement that counties pay 25% of state costs for state-determined sex offender treatment services for individuals being provisionally released into the community.
These are all state programs. So why are a portion of the costs shifted onto county taxpayers? All too often the answer is simply to help balance the state budget.
Why does this matter? In short, it wastes the time and energy of expert county and state staff. It contributes to inequities across the state. And it redirects county expertise into administrative processes rather than into collaborative county-state efforts to find better ways to help vulnerable Minnesotans.
So it is important to get this right, not only to ensure every dollar is being well spent, but to ensure that Minnesotans who need these programs get the services they need, when they need them. As we sort out a better path forward, county experts must be genuinely included in designing the solutions. They are our "on-the-ground" experts.
State health and human service programs provide essential assistance for Minnesotans. They make it possible for aging Minnesotans to remain in their homes longer, and for people with disabilities to lead self-directed and fulfilling lives. They also support our economy by providing subsidized child-care, health care and housing services.
We need these services. We need them to work well for Minnesotans. And while a rearranging of the DHS organization chart to improve such programs would itself be no small undertaking, it would only be part of the solution.
What is needed is a delivery system and a culture that routinely and genuinely integrates county expertise into a statewide human services team that fosters innovation, and that discontinues the shifting of state costs onto county budgets.
Matt Massman is executive director of the Minnesota Inter-County Association and previously served as the state commissioner of administration.
