Column: 'Cost shares' become 'cost shifts'


Nina Arneson is director of Goodhue County Health and Human Services.

Goodhue County Health and Human Services' mission is to "Promote, Strengthen, and Protect the Health of Individuals, Families, and Communities." Our vision is working for a safer and healthier Goodhue County as a trusted, skilled and innovative health and human services agency.

We do this in partnership with Goodhue County residents, local service providers, regional, state and federal partners. Our services include educating people through public health efforts, providing safety and protection to the most vulnerable children, families, and adults, providing care for addictions and mental health, and enabling people in Goodhue County to live independently.

It is truly an honor, privilege and awesome responsibility to carry out these services in the most fiscally responsible manner and produce the best possible outcomes for Goodhue County residents. As public servants, we take this responsibility very seriously especially during times when service demands are increasing, cost shifts have taken place resulting in increased costs to county property taxpayers.

This column will highlight some of the statewide human services system issues and the fiscal impact of just one cost shift among many cost shifts at the local level.

Minnesota has a state-supervised, county-administered human services delivery system. It is essential that the policy, which governs both, is established with integrity and transparency, and in the end, produces measurable and positive outcomes. The public policy surrounding Minnesota's human services cost shares has evolved to be referenced more informally as "cost shifts," due to the amount of unforeseen local tax burden that has been realized by counties across the state.

Two past reports from the Minnesota Office of the Legislative Auditor issued key findings that also support the need for a more sophisticated approach, highlighting areas of concern around transparency, equity, and sustainability.

• The January 2007 report on Human Services Administration found that "Minnesota's approach to funding human services contributes to inconsistencies in local tax burdens and services."

• A February 2012 report on Fiscal Notes found that while notes in general "appeared to be based on plausible assumptions ... many did not adequately explain their assumptions or calculations," and concluded that "fiscal notes provide limited information on local impacts."

Cost shift example

Since the efforts of the late 1990s to serve mentally ill individuals in community-based settings instead of large institutions, counties have been responsible for a share of costs associated with state-operated hospitals such as Anoka Metro Regional Treatment Center or AMRTC.

A sufficient community-based system has struggled to be funded and built, which puts additional pressures on the few remaining state care facilities after Minnesota closed eight state hospitals.

In general, this cost share commences when an individual no longer needs a hospital level of care, but may need to remain in the hospital until a community-based service option is made available which is extremely difficult and in some cases impossible when no community based options are available.

This dilemma is often referred to as being "stuck" in Anoka. This is also at the same time when there are many other people needing this level of care, but there is not a bed available because the people who do not need this level of care are "stuck" in Anoka and have no other place to go.

This system failure causes counties to be penalized for a system that has not been funded or built.

In contrast, community behavioral health hospitals were designed to leverage third-party insurances, thus a county cost share was never instituted since their opening in 2005. The 2016 Legislature passed a bill that now requires counties to pay 100 percent of the cost of care in these facilities for days when a person no longer meets hospital level of care.

Essentially, this cost shift went from a daily rate of zero to $1,866.

Below, please find what this costs shift looks here at the local level in Goodhue County, which mirrors the experiences across the state.

In general, Goodhue County's customer count has been stable for these types of needed services and the main two cost drivers for the 2,376 percent increase from 2014 to 2016 have been a result of the legislative changes and state's insufficient community-based mental health system that has not been funded or built.


This is just one example of the state-to-county cost shifts for these critical and much needed services.

Stop shifting costs

If this column's left you asking how can we improve this for all, especially for some of our most vulnerable county residents that need this critical service? A good starting point would be for the state to place a moratorium on additional state-to-county cost shares or shifts to local property taxpayers. This needs to be in place until a new, sustainable, modern and available service model can be established.

At GCHHS, we will continue to do our best with the current systems, state mandates and with our desire to serve the public and carry on the mission to "Promote, Strengthen, and Protect the Health of Individuals, Families, and Communities."

Thank you for the opportunity to serve Goodhue County and Goodhue County residents.