WILLMAR — Kandiyohi County will ask Gov. Tim Walz to intervene in a dispute with the Minnesota Department of Human Services over the procurement process for publicly funded health programs.

County officials say the state's decision in July to go against the county's recommendation of PrimeWest Health as the sole health plan has left them disappointed, frustrated and angry.

It also introduces significant uncertainty for the county's entry into the PrimeWest Health county-based purchasing organization, set to take effect Jan. 1.

"We're trying to get the governor's attention and we're trying to get the legislative officials' attention," said Larry Kleindl, county administrator.

The issue is headed for mediation; a mediation session is scheduled for Sept. 23. County officials indicated Tuesday that if the ruling is unfavorable, the next step might be a lawsuit.

At stake is the management of health care for nearly 10,000 Kandiyohi County residents on Medical Assistance, MinnesotaCare, Minnesota Senior Health Options and other publicly funded health programs that cover low-income populations.

Care for these individuals has traditionally been covered through commercial health plans, typically through a procurement process with the Department of Human Services that helps determine which health plans will be offered in specific counties.

The landscape was set to shift next year as Kandiyohi County joins PrimeWest Health, a county-based purchasing organization that in essence allows the 24 participating counties to collectively function as a health plan, contract with providers and assume the financial risk.

County staff spent hours preparing their recommendation to DHS for PrimeWest as the sole health plan choice for eligible county residents, said Kathy Nelson, human services supervisor for Kandiyohi County Health and Human Services.

"We went through this process as a county," she said during discussion of the situation at a meeting Tuesday of the County Board.

But when DHS in July issued its decision on which health plans will be offered in the county, PrimeWest Health was one of two options for Medical Assistance enrollees and one of four choices for the publicly funded senior care plans.

It felt like a slap at Kandiyohi County's ability to make good local decisions, Nelson said. "We're appalled by the fact that DHS did not support us in this decision."

Two strongly worded letters, one from County Board Chairman Rollie Nissen and one from Nelson, are being sent to Gov. Tim Walz, asking him to intervene in support of Kandiyohi County.

The County Board was unanimous in its choice of PrimeWest as sole health plan for public health programs, Nissen said. The DHS decision against the county's recommendation was the equivalent of saying "we don't know what we're doing here, the state knows better," he said. "That's not partnership."

He and Nelson said one of the key reasons for joining PrimeWest Health is to put control into local hands over how health care is provided to a vulnerable population that often has multiple needs. Metro-based health plans frequently fall short when it comes to local needs such as transportation, language interpreters and provider shortages, and there have been ongoing challenges with fragmented communication and limited local input into how the plans operate in Kandiyohi County, Nelson said.

PrimeWest Health will enhance the county's ability to address local needs, become more cost-effective and provide better service to enrollees, she said. "It just makes so much sense for our citizens."

An even bigger issue is the future viability of PrimeWest Health and the investment that the participating counties have made in county-based purchasing.

The entire organization could be at risk, said Commissioner Roger Imdieke. "It's disappointing that they're going to pick winners and losers."

"I think there's a real trust issue here," said Commissioner Corky Berg.

He called the DHS decision "just crazy."

"It pulled the rug right out from under us," he said. "It's not just our county. It's our region."