Ramsey County’s Medicaid backlog is so big it is hiring 80 people to tackle it

Ramsey County is so behind on performing the assessments residents need before they can receive in-home Medicaid funded services that it’s hiring 80 new workers over the next year to catch up.

Residents now wait up to eight months for initial assessments for the MnCHOICES program, which determines the types of in-home and community services someone can receive. These backlogs have been worsening for years across Minnesota with many counties struggling with delays.

State law says a resident who needs an initial assessment should get one within 20 business days of requesting it. Annual reassessments are required to maintain services, and some people receiving help, like in-home care, physical therapy or transportation, risk losing it if the review is not completed in time.

“Today, there are significant backlogs, which you are aware of, because you get those communications regularly,” Sophia Thompson, director of social services, told the Ramsey County Board. “If left unaddressed, these backlogs are expected to escalate.”

The County Board unanimously approved the new hires Tuesday.

The 80 new social services staffers will cost the county about $5 million a year with another $1 million in initial hiring and training costs. County officials plan to use state funding from the Social Service Time Study program, which reimburses administrative costs by sending workers emails at random moments to track their tasks.

In 2023, that program paid Ramsey County more than $26 million for administering Medicaid assessments and other related services. Those payments grew in 2024, but final numbers were not yet available.

Despite that funding, the county has struggled to keep up with the growing demand for assessments. State rule changes have made the assessments more time consuming and other budget constraints have left the county without enough staff.

The 80 new hires will join a team of about 140 staffers and should help the county complete another 1,000 assessments per year.

“This is long overdue,” Commissioner Rena Moran said of the hiring plans.

The demand for services that require a MnCHOICES assessment has soared in recent years. Ramsey County saw a 40% jump in residents who need Medicaid assessments since 2017 and a growing number are people with disabilities who are under 65.

There are now nearly 2,000 Ramsey County residents waiting for their initial MnCHOICES assessment and roughly 6,800 residents need to be reassessed annually.

Initial assessments can take up to 20 hours to complete. The person needs to be reassessed every year, but those evaluations don’t take as much time.

Ramsey County is not alone in the need to add staff. Anoka, Hennepin and Dakota have all boosted staff in recent years to handle the growing demand for assessments.

County leaders across the state are nervously watching lawmakers in St. Paul and Washington, D.C., to see what changes they might make to Medicaid funding.

The Trump administration’s efforts to reduce government spending could impact how much states receive for Medicaid. Republicans, who control Congress, have not detailed what any Medicaid cuts would look like.

Democratic Gov. Tim Walz has included a change in his long-term budget proposal that the Association of Minnesota Counties says will cost local governments $82 million in 2027.

That’s part of Walz’s plan to slow the growth of state spending on Medicaid, which many lawmakers say is climbing at an unsustainable rate. But a bipartisan solution to slow it down has not yet emerged.

Matt Hilgart, of the county association, says shifting the costs to counties shouldn’t be part of the answer. Local officials are already struggling with rising costs.

“It’s really scaring them, because they know local property owners are not ready for double-digit property tax increases,” Hilgart said.