WILLMAR — When the coronavirus took over in early spring 2020 and people began losing their jobs, the state and federal governments began to temporarily rewrite the rules for many public assistance programs to make sure help was available to those who needed it.
Now, almost exactly three years later, the time has come to rewind the clock and bring those programs back under their 2019 rules and regulations. The federal Public Health Emergency is set to expire on May 11 and, with it, many waivers to public assistance programs such as Medical Assistance, MinnesotaCare and the Supplemental Nutrition Assistance Program.
"It has been a long time in coming," said Jennie Lippert, Kandiyohi County Health and Human Services director. Lippert and two members of staff spoke Tuesday at the Kandiyohi County Board meeting to update commissioners on the beginning of the unwinding process.
"We are finding out that the Department of Human Services does not have exact time lines," Lippert said. "This is the information we have at this time."
The most sudden change will come from the Supplemental Nutrition Assistance Program — the federal program formerly known as food stamps that helps low-income households purchase food. Prior to the pandemic, SNAP benefits were based on household size and income. For the past three years, all those eligible received the maximum benefit for their household size, regardless of income. So a household of two was receiving $459 a month in SNAP benefits, even if under normal circumstances they were only eligible for a fraction of that.
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"These were always meant to be temporary benefits to help navigate the rising food costs and maintain healthy diets when people were being laid off, (facing) reduced employment hours and other obstacles," said Dana Wenisch, financial assistance supervisor with Kandiyohi County HHS.
Those emergency benefits have officially expired, with the last payouts now going out. Starting with the April distribution, benefits will again be based on income and household size. Program recipients will also have to resume meeting certain work requirements.
There are concerns coming from ending of the emergency benefits. Food, housing and transportation costs remain high, and some households are still suffering from decreased employment hours or people were unable to find work at the level they had prior to the pandemic. Not having the extra money for food might end up being a serious challenge for some households.
"A lot of clients have become dependent" on the emergency SNAP benefits, Wenisch said.
Changes are also coming to Medical Assistance and MinnesotaCare. Medical Assistance is Minnesota’s Medicaid program to provide health care coverage for people with low income. MinnesotaCare provides health care coverage for those who earn too much to qualify for Medicaid but whose incomes are below 200% of the federal poverty line.
Since March 2020, county case workers have been unable to make any negative changes to a client's eligibility for these medical programs, such as reducing benefits or removal from the program.
"Continuous coverage helped Minnesotans access care during the global pandemic and maintained high insurance rates in the state of Minnesota," Lippert said. It also made the state eligible for billions of dollars in assistance through the Family First Coronavirus Response Act, the first major pandemic stimulus package.
During the last nearly three years, the number of people in the state enrolled in those health care coverage programs jumped 330,000 people. In Kandiyohi County, one of every three residents is enrolled in a coverage program.
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Over the next several months, following direction from both the Minnesota Department of Human Services and the federal government, the county will restart the renewal process of clients' cases and will be able to make negative changes to those cases if clients are not meeting the eligibility requirements. This could lead to interruptions in treatment and care for enrollees, while health care providers may see delayed payments or increases in uncompensated care as the programs revert to their pre-COVID conditions.
"It has been 29 months since we last did renewals," said Deb Grunwald, financial assistance supervisor with county HHS. "At this point we're not really sure what to anticipate."
Clients who receive assistance for long-term care or skilled nursing facility placement will again have to follow asset limits. During the public health emergency, those limits were suspended, meaning there could be individuals facing displacement from their current residences if they are over the income or asset limits.
"This is very, very, very complicated. There are a lot of moving targets," Lippert said.
The process of unwinding the waivers from the public health emergency will also be a challenge for county staff. For about half of the case workers, they have only ever worked under the pandemic rules and have never been through a case review process. It will also mean additional work for staff as they review hundreds of cases to make sure they remain eligible for benefits.
While state lawmakers have introduced legislation that would provide extra dollars for the review process, Lippert believes that money would be better spent paying for the overtime of current staff than hiring new workers due to how long it takes to train new staff.
"We will try our best, try to stay on top of this," Lippert said.
Lippert also had a favor to ask of the commissioners when faced with angry constituents.
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"Don't try to unravel this yourself," Lippert said. "If you are getting upset folks, direct them to myself, so I can get them to the appropriate people."
The board is concerned about what is coming up, both for constituents who need the benefits and the staff who are now facing a challenging few months. While the state's hands might be tied by the orders coming from Washington, D.C., there are worries that the state Department of Human Services is moving forward without a plan.
"If I am a legislator down in St. Paul, I better be taking notice of this and figuring something out because this is not a tenable situation," said Commissioner Steve Gardner, who worries about the impact these changes might have on the most vulnerable. "DHS appears to be making it up as they go along."
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