Todd County reviews health and human services budgets, grant timelines and staffing; directors plan a reorganization for board consideration

Todd County commissioners and health and human services staff used an April 10 work session to review combined health and human services fund balances, grant timelines and staffing needs, and to discuss a proposed reorganization the department plans to present to the full board.

Staff said their review of combined county funding for public health and social services from 2018 through 2024 shows relatively flat county-dollar support and cautious budgeting. Public health staff reported the public-health fund balance currently exceeds a five-month target and that most public-health revenues come from ongoing grants; the presenter said the department manages 15 grants and that only two are slated to end within two years. "WIC is one of our largest federal grants," a public-health leader said, adding that several grants are state-funded or are federal funds filtered through the state.

County public-health staff told commissioners that some pandemic-era (COVID) grant dollars inflated past-year revenues and that those federal funds have been wound down; staff said they spent their share of COVID-related funding and returned certain late-arriving vaccine dollars they could not spend. Staff warned that proposed state reductions at the Minnesota Department of Health could reduce state pass-throughs and that the county may need to seek additional grants if state funding declines: "I think we'll have to increase our grants if the state starts decreasing our funds. Right? We'll have to go after other grants," the public-health director said.

Children's services and other social services were a primary focus. Staff said children's services costs are largely driven by mandated child-protection activities, court-ordered services and out-of-home placement. "When we came before the board, we've talked about out of placement costs... we're struggling a lot with a lot of high needs kids," a children's services supervisor said, noting that specialized placements sometimes require out-of-state facilities. "I've had kids placed in Missouri, Indiana, Ohio," the supervisor said, describing a shortage of in-state specialized placements for certain high-needs cases.

Staff also reviewed program-specific trends: the county's fee-for-service revenues (for example, some clinics or home-care billing) have fallen as the county reduced clinic work and discontinued its home-care program in 2023. The county noted that changes in utilization and program structure affect both revenue and expenses.

Staff flagged several operational constraints. They said the statewide Social Services Information System (SSIS) cannot support upcoming statutory changes and that the state has invested limited funds in upgrades: "The state has invested $10,000,000 to upgrade the software. That's a drop in the bucket. We need a new system, which is gonna take probably about 200,000,000," the HHS director said. Staff urged caution about implementing new statutory requirements before the software and systems modernization can support them.

On staffing and internal structure, county managers proposed a reorganization they will ask the board to consider at its next meeting. The proposal would:

- Move the front-desk positions and case aids that support eligibility functions under the financial services unit (to improve coordination with eligibility work). - Create an accounting supervisor role to oversee accounting staff and centralize financial oversight. - Add two "lead eligibility" positions intended to provide dedicated, program-specific training and day-to-day coaching for eligibility workers so new staff become proficient faster. - Reclassify an administrative-services manager role to a supervisor-level position and reassign some duties accordingly. - Create a resource navigator / interpreter job description to formalize bilingual interpretation and navigation work that is now performed informally by some staff.

Staff said funding for the two lead eligibility positions could be absorbed by other adjustments and that eliminating an open care-coordinator vacancy would offset some of the added salary costs; staff provided a budget figure for the care-coordinator position at about $91,881. The presenters said they had identified additional cost-savings opportunities (roughly $71,000) and planned to present a Board Action Form and job descriptions to the board on Tuesday, pending a job-grading review by Gallagher. "Our request is to... bring this to board on Tuesday," the HHS director said.

Commissioners and staff discussed operational details: staff reported the county provides a rep-payee money-management service for vulnerable clients and currently serves about 38 people without charging a fee; commissioners asked whether the county might charge for that service in the future. Staff also described the county's care-coordination arrangement with private health plans, noting one plan recently reclaimed inactive members and that the county expects savings by redistributing caseloads.

Staff emphasized demographic pressures: county projections show a large and persistent population of residents aged 65 and older through 2055, and presenters warned that long-term care needs and program complexity tied to an aging population could increase demand for eligibility and long-term-care processing. Commissioners asked questions about turnover among eligibility workers and whether adding leads would simply shift workload or meaningfully improve training and retention; staff said the leads would provide hands-on training and casework coverage, accelerating proficiency and reducing supervisory load.

No formal board action was taken during the work session. Staff said they will present the proposed organizational changes, job descriptions and budget implications to the Board of Commissioners for a decision; some job descriptions must be graded before final budget figures can be included. Commissioners signaled general support for moving the matter to the board agenda and discussed timing and next steps.