Not long ago it seemed a sure bet, but the multi-county health care proposal appears to have hit a huge federal pothole.
Whether that is enough to knock the Essential Health Plan, also called county-based purchasing, off the road is yet to be answered. But it was enough to veer the counties away from an anticipated March start date and may be enough to force them to reconsider the proposal altogether.
Crow Wing County Board Chairman Terry Sluss said Tuesday the main obstacle is a federal insistence for competitive bidding. Sluss said the federal health authority did not believe there was not a lot of competition in the region. The end result leaves the Essential Health Plan proposal in doubt.
Essential Health is a plan to provide more local options for health care for Medical Assistance and general assistance clients.
The program involves contracts with area medical providers from pharmacists to major hospitals. The goal was to provide more services more efficiently than the state alternative.
The plan was approved by the state Department of Health, but a federal waiver was needed to move the plan into fact.
Cass, Crow Wing, Todd, Morrison and Wadena counties are all involved with the plan. Each of the counties contributed $105,000 as a start-up fund. The multi-county group sent representatives to meet with the Federal Health Care Finance Authority in October. Minnesota was one of the first states to seek a local alternative to state and federal programs.
Sluss said in answer to the federal feedback the county has two options. One is to fight a political battle for two or three years. The second option is to go to a competitive bid award and put the federal finance authority out of the picture.
The second option includes working with the state and responding to a request for proposal that the state Department of Human Services issued this week.
The counties have six weeks to respond and then the state will decide whether the proposed Essential Health Plan or an alternative health management option is best suited to the county. Individuals who may be part of the health plan may number at a minimum of 9,000.
"I think there is a strong belief that we have the best to offer," Sluss said.
But there are additional questions to be worked out with the state. One question remains whether Essential Health will be awarded a Rural Health grant of more than $200,000 to help with program development costs.
The counties may have to set a drop dead date when pulling out of the program will mean facing the smallest financial risk.
Welfare Director Sue Beck said one of the benefits of the proposal was the good relationships forged between the five counties and health care providers.
"I would hate to see that go by the wayside and have the whole project turned over to an HMO," Beck said.
Commissioner Ed Larsen said one of the frustrations is that the right thing is not the one the county can do. "I hope we can move more toward doing what is right," Larsen said, instead of doing what is political. "I'd like to see us pursue this."
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