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Winona County staff recommends ending Blue Cross Blue Shield contract for some 65+ Medicaid casework to reduce waitlists; board signals support
Summary
County health-and-human-services staff told the board the department carries a growing waitlist for mandated assessments and recommended ending the Blue Cross Blue Shield contract so county staff can be reassigned to mandated 65+ assessments; annual losses on the BCBS contract have ranged from $88,000 to $230,000 in recent years, staff said.
Winona County health-and-human-services staff briefed the board on long waitlists and noncompliance for mandated assessments in the 65-and-over program and presented three options to fix the problem: (1) terminate the county’s contract with Blue Cross Blue Shield (BCBS) and reassign staff to meet mandated assessments (staff recommendation); (2) keep the BCBS contract and hire two to three additional staff to meet demand; or (3) take no action and accept continued noncompliance and budget losses.
Staff said the county’s wait lists exceed state response-time requirements, with more than 50 people waiting for the over-65 program and about 100 waiting for 65-related services in total; some have waited more than six months. Annual losses on BCBS work have ranged between about $88,000 and $230,000 over the last five years, staff said. Because BCBS referrals require fee-for-service administrative work and training, staff argued turnover and training lags make the contract loss-making for the county and divert limited resources from mandated work.
Under the staff recommendation, the county would give BCBS 130 days’ notice and support a planned transition in which BCBS identifies alternate vendors in the region to serve its members; staff said a staged transfer was possible and would avoid abrupt termination for individual beneficiaries. Commissioners asked about service continuity, whether private vendors would accept the workload, and whether rehiring or repositioning county staff would leave employees idle. Staff responded that other counties hire additional staff to keep BCBS workloads but that Winona’s staffing model and training timeline make rapid scale-up difficult and that the phased transition to outside vendors is feasible.
During the working session commissioners generally indicated support for the staff recommendation to end the BCBS contract and reassign staff to mandated assessments, subject to details about a careful transition and assurances that clients will not lose access during the changeover.
What’s next: Staff will prepare formal notice language, a transition plan, and a timeline (staff noted 130 days’ notice would apply) and return to the board for implementation decisions. The board emphasized the need for a planned transition to avoid gaps in service.
