Minnesota human services officials are pushing for a sweeping overhaul of Medicaid programs amid heightened fraud investigation.
The move would shift the state away from privately managed care organizations toward a single state-run administrative system.
Deputy Commissioner and state Medicaid Director John Connolly says this ongoing transformation aims to eliminate administrative fragmentation that's created significant backlogs for one in five residents relying on these services.
"We thought that was a good idea and we implemented that," says Connolly. 'And we've actually now incorporated that in a new quarterly process such that if a provider hasn't billed in a year we will disenroll them."
Meanwhile, the Department of Human Services is currently defending its oversight in court, seeking the release of $243 million after implementing new protocols to dis-enroll inactive businesses and track ownership across multiple companies.
"Minnesota is one of the small minority of states to do it this way, and by centralizing that work under DHS, we can ease administrative burdens for the counties and for our tribal nations in the state and create a more seamless enrollee experience," Connolly adds.
As the department races to meet a critical May 30 deadline for provider re-enrollment, the focus now turns to whether the legislature will support these centralized reforms.
