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Simplicity, flexibility needed for family services to succeed

WILLMAR -- When county family service administrators have the chance to bend the ears of legislators, they will ask for flexibility and simplicity in the state regulations and mandates that govern how counties provide services.

The Minnesota Association of County Social Service Administrators has developed its legislative platform for 2011 and the overriding theme is flexibility and simplicity, said Jay Kieft, Kandiyohi County Family Services Director.

During a recent presentation to the Kandiyohi County Board of Commissioners, Kieft said if the state gave counties more flexibility with how to spend state money and simplified complicated regulations, counties could provide better outcomes with the limited amount of available state money.

Citing examples that ranged from Medicaid waivers for disabled individuals to child protection services, Kieft said counties could deliver services more effectively if the state allowed flexibility in how counties could spend money.

An increase in state bureaucracy in chemical dependency treatment, said Kieft, is one example of how programs have become less effective by following a stringent case-by-case program. Pilot programs that provide flexible block grants have had better outcomes, he said.

Waiver programs that are commonly used to obtain federal Medicaid funds for individuals, including those with disabilities or traumatic brain injury, have become more complex and difficult to use. Kieft said the social service administrators would like the Department of Human Services to "universalize the process" and create a simple standard for how to administer waivers.

Another issue the association intends to pursue with legislators is the designation of permanent state funding for child and vulnerable adult protection services to allow counties to provide basic safety nets for the state's most vulnerable citizens.

Kieft said more flexibility for counties would allow expanded use of a medical care coordination pilot project that has worked well in another county. Under that program, people who frequently end up in expensive emergency rooms would have contact with an individual in the hospital who would connect them with programs that would reduce the need for emergency care.

Kieft said the pilot program, which allowed the county to receive Medicaid reimbursements, reduced ER visits by 60 percent in two years for that group of individuals and saved $900,000.

He said the state should "fund these things that make sense" and give counties flexibility in how to administer them.

"We have to adapt to the changing landscape," said Commissioner Harlan Madsen, who supports a state redesign of services.

With more complicated rules being written, Madsen said the state has "lost sight of what the original intent" was for many programs that counties are now required to provide.

Carolyn Lange

A reporter for 35 years, Carolyn Lange covers regional news with the West Central Tribune.

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