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Reforming Mahnomen County

Published (3/9/2012)
By Sue Hegarty
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Counties have been the state’s vehicle for delivering health and human services for years, but the White Earth Nation in northern Minnesota is on track to become the first sovereign nation to take over those responsibilities for its own community.

“It’s just a really cool moment in time when we turn back something that (the White Earth Nation will) do well at. Seldom do we get to celebrate a moment like this. We mostly face challenges. We don’t get to celebrate successful moments,” said Rep. Jim Abeler (R-Anoka), chairman of the House Health and Human Services Finance Committee.

The White Earth Nation received legislative authority last year to provide human services to Mahnomen County residents. The county is entirely located within reservation boundaries, although about 55 percent of county residents are non-tribal.

Transferring authority for service delivery, such as child welfare, chemical dependency and employment, could save the state millions of dollars in Medical Assistance health care costs, say proponents because the federal government reimburses sovereign nations 100 percent for Medical Assistance costs, according to Monte Fox, White Earth health director.

“That’s where our savings is going to be for the state,” Fox said.

About 70 percent of Mahnomen County’s current case load is American Indian. The Department of Human Services estimates it may save up to $4 million by shifting MA services from the county to the White Earth Nation.

Rep. Kent Eken (DFL-Twin Valley) represents the county. He said counties, in general, are being asked to provide services with less funding and the potential savings to the state was the driving force. “Whenever something this precedent-setting is attempted, we have to be careful,” he said.

Others would argue that the cost to taxpayers is the same, regardless of whether it is state or federal funding.

“I guess when I think of savings, I think of costs going down, not changing where the money comes from. I would think you’d also be looking at some overall cost savings from how you would structure this as well,” said Rep. Mary Kiffmeyer (R-Big Lake).

Any financial gain to the state may be overshadowed by operating dual delivery systems.

“Mahnomen County is not going away,” said Karen Ahmann, county board chairwoman.

Abeler said he hopes that the White Earth Nation can deliver a more culturally sensitive approach to social services, resulting in stronger client recoveries and less need for ongoing care, which would result in total cost savings.

The White Earth Nation needed the administrative expertise to administer healthcare programs, such as determining eligibility. They currently have 42 nurses and 21 mental health professionals among the community. In addition, 29 members have experience working with some of the state information systems.

“The tribe got to the point where they can assume responsibility,” said Vern LaPlante, Department of Human Services’ tribal relations coordinator.

The complete transfer of services is projected by this fall or early next year.

There are still several details to work out, such as determining which residents would be served by the White Earth Nation and who would continue to receive county services. The White Earth Nation proposes to deliver health and human services to tribal members and their families, but who would qualify is still being determined.

“We don’t look at color. We don’t categorize our services by race,” Ahmann said. Also, the White Earth Nation health and human service location would be located in Becker County, rather than Mahnomen County. Ahmann is concerned that after the transfer, county staff may have to screen clients “at the door and that’s a very uncomfortable place to be.”

Despite the hurdles, Ahmann said, “We really do want to work with the tribe to make the quality of life better in the county.”

After the transfer of services is complete, the White Earth Nation may assume similar responsibilities in Becker and Clearwater counties, which also have high concentration of American Indian communities.

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