Clay County moves Special Needs Basic Care program to Public Health as UCare narrows coverage

The Clay County Board of Commissioners voted Oct. 21 to move the county's Special Needs Basic Care (SNBC) managed-care coordination fully into the public health department effective Jan. 1, 2026.

SNBC serves adults ages 18'64 who have both Medicare and Medicaid (medical assistance). Jessica (last name not provided), who presented the item, said UCare notified counties that it will stop offering its integrated SNBC product in most Minnesota counties, which will force affected members to enroll in non-integrated plans or revert to fee-for-service Medicaid. The change, she said, will likely reduce SNBC enrollment in Clay County by an estimated 15% to 30% and shift administrative burdens back to county staff.

Commissioners were told Clay County currently has about 277 SNBC enrollees under the integrated product. County staff explained how SNBC billing works: the county can bill UCare $25 per month for eligible members, or $185 per month for members for whom staff complete a Health Risk Assessment (HRA). Public health staff, the county said, have historically completed more HRAs and generated higher revenues per coordinator than social services.

Under the approved reorganization, all SNBC work will be housed in public health, reducing the number of SNBC-dedicated FTEs from five to four. Social services staff who currently perform SNBC work will be reassigned to other openings; the county said the two affected social services staff will have the opportunity to apply for two positions created or moved by prior board action (one Min Choices position remaining in public health and a disability case manager position in social services). Commissioners and staff emphasized they must follow applicable union posting and reassignment rules.

County finance presentations estimated that the net effect for social services in 2026 would be positive by roughly $45,312 after accounting for lost SNBC revenue and salary/benefit reductions. Public health's budget was projected to improve by about $192,604 under the consolidation, yielding an estimated overall levy savings of $237,916 in 2026. Staff cautioned these figures are estimates and depend on future member choices and enrollment retention.

Commissioners asked how the county would address the transportation disruption that could affect some SNBC members if they lose their integrated plan-provided rides. Staff said the county is exploring short-term contracts with registered DHS transportation providers to cover January-June 2026 and is evaluating whether existing county staff can absorb increased administrative workload for reimbursements; the state will take over mileage reimbursement administration on July 1, 2026.

Commissioner Ebinger moved to approve the SNBC transition; the board approved the motion by voice vote.

County staff urged affected SNBC members who received UCare notices to contact their Clay County care coordinator for help with options and directed Medicare questions to Aging Pathways (Senior LinkAge Line).