Affordable Care Act financially impacts county

Implementation of the federal Affordable Care Act later this year will have a financial impact on Anoka County.

There is expected to be a significant increase in the number of applicants for health care coverage starting Oct. 1 and those that apply for coverage and are eligible for Medicaid will be managed by the counties, according to Jerry Vitzthum, the county’s economic assistance department director.

To deal with the additional workload and to have the new staff trained and in place by Oct. 1, Vitzthum recommended and the Anoka County Board unanimously approved the hiring of 14 limited term financial assistance specialists for the economic assistance department.

“Funding is available in the department’s budget in temporary salary dollars and increased federal participation,” Vitzthum said in a memo to the county board.

The salary range for the financial assistance specialist position is $3,245 to $3,980 per month with federal dollars picking up 45 percent of the cost, according to figures presented to the county board.

The county’s cost of the new hires is anticipated to be $196,500 this year and $102,000 in 2014, Vitzthum said.

The biggest spike in applications is expected to occur from Oct. 1 through April 2014, according to Vitzthum.

But the department is anticipating an additional workload anywhere from 25 to 50 percent through the end of 2015, Vitzthum wrote in his report to the county board.

In his presentation to the board, Vitzthum said that the case load is expected to increase by at least 7,000 from its current level of 25,500.

And all existing cases will have to be converted using the new eligibility rules and management information system, he said.

In addition, between 25 and 40 percent of the 7,000 new cases are expected to enroll in the SNAP (Supplemental Nutrition Assistance Program) food program, Vitzthum said.

The county’s SNAP case load is projected to increase between 6 and 10 percent, he said.

Adding to the equation is the fact that the department has a steady turnover rate and the case load, even before the implementation of the Affordable Care Act, has been increasing at a steady rate, 1,907 more cases in 2012, while classroom training takes more than three months followed by hands-on case load training, he wrote.

“It will be critical to have staff trained that will be able to work with the increased volume,” Vitzthum told the county board.

These positions will be considered hire aheads and move into regular vacancies as they occur, according to Vitzthum.

When they do so, they are not expected to be replaced, Vitzthum said.

“Without these positions, the workload will be unmanageable, extremely stressful and more errors will occur causing non-compliance for processing application timelines,” he said.

However, from the county’s perspective the uncertainty of funding complicates its implementation of the Affordable Care Act mandates, Vitzthum said.

Vitzthum plans to come back to the county board in early summer with recommendations on future needs, he said.

In his presentation to the county board, Vitzthum said that a preliminary analysis shows the potential for additional staff and overtime in unfunded costs between $1.2 million and $1.4 million over the three-year period.

According to County Commissioner Robyn West, who chairs the county board’s Management Committee, which recommended the new hires, they are needed to deal with the increased workload that the Affordable Care Act will bring and there is not too much time to process them and have them trained.

“We need to bring these people on board up front,” said County Commissioner Jim Kordiak.

County Commissioner Matt Look voted for the new hires because of the federal mandates, but he said it was a “fiscally unsustainable program.

“But I’m not sure how to fix it,” Look said.

Anoka County Board Chairperson Rhonda Sivarajah said paying for the extra case load mandated by the Affordable Care Act will mean an extra cost for county taxpayers.

Peter Bodley is at peter.bodley@ecm-inc.com

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