Minnesota Department of Human Services needs emergency powers

This is an unprecedented moment for our state and our country with the spread of the potentially fatal coronavirus in our communities. To minimize the impact, we need swift and decisive action by our health care institutions, including the Minnesota Department of Human Services (DHS), which serves more than 1 million Minnesotans across all 87 counties and 11 tribes. Legislative action is needed to provide DHS the regulatory flexibility needed to protect the health and well-being of all Minnesotans and should be adopted immediately.

A key provision related to coverage of telemedicine for Medicaid enrollees was already passed and included in the $200 million coronavirus emergency bill signed by Gov. Tim Walz. Telemedicine allows for medical consultation for the most vulnerable, allowing those with chronic conditions to receive needed consultation in the safety of their homes. We applaud this swift action. But additional provisions need to be adopted to increase the opportunities for social distancing for DHS enrollees, which will help slow the virus transmission across Minnesota. For example, current regulations may require people with chronic conditions to make repeated trips to pharmacies every 30 days to refill their prescriptions. Language is needed to give Medicaid and MinnesotaCare authority to allow people to fill 90-day prescriptions, instead of needing to return to the pharmacy regularly for 30-day refills. Additional language could give DHS temporary authority to relax requirements for prior authorization from a physician in order for a medication refill to be approved.

These provisions are essential for those with the greatest need for medical visits and prescriptions, including the elderly and those with disabilities. DHS programs serve the most vulnerable among us, who are at greatest risk of severe health outcomes should they contract COVID-19. These steps are also critical to our front-line health care workers, to relieve burdens from clinicians at a time when they will be stretched thin. They also protect all Minnesotans by containing the spread of the coronavirus.

In order to flatten the curve, we need to make sure people who are showing symptoms seek out medical care and not wait until a crisis requires an emergency room visit. Health insurance coverage is key. Giving DHS emergency flexible authority for Medical Assistance and MinnesotaCare eligibility decisions will make it easier for more people to gain and keep health insurance coverage that will encourage them to seek out care when symptoms arise.

Coronavirus transmission does not distinguish between the old or the young, the rich or poor, or who has health insurance coverage or not. Some 250,000 Minnesotans do not have either public or private health insurance coverage, including 50,000 children, creating the potential for further spread of this horrible virus. It's imperative that the state use every tool available to ensure access to health care at this moment in time. DHS needs the flexibility in this time of great emergency to come up with innovative solutions in order to adequately serve the millions of Minnesotans who depend on it for services.

We urge the Legislature to grant DHS the ability to temporarily relax regulations in a range of areas including program eligibility, prior authorization and prescription coverage. This is not an abandonment of oversight but a swift and needed response to a crisis. The new authority is explicitly temporary and would expire 60 days after the conclusion of the governor's declaration of a peacetime emergency. And, DHS would still be subject to compliance and reporting requirements under this temporarily expanded authority.

Minnesota has so far distinguished itself with its timely and careful responses to the coronavirus crisis. In the coming months, DHS will be the agency at the front lines of ensuring access to health care and other critical services for over a million Minnesotans. We need to ensure that the department has the ability to act quickly and decisively to slow the virus and minimize its effects. The Legislature should consider passing language to grant DHS the emergency flexibility it needs to combat the coronavirus.

Ezra Golberstein and Lynn A. Blewett are professors of health policy and management at the University of Minnesota School of Public Health.