Wadena County could be paying off hospital stays for three Wadena County residents for the next 53 years.

Wadena County is on the hook for paying a bill of $192,294 to the Minnesota Department of Human Services for the hospital stay costs incurred by those three residents, who were receiving inpatient hospital level care at some point between April 2017 to August 2019.

Recently hired Wadena County Human Services director Jennifer Westrum brought the topic to the full board for the first time Tuesday, May 19, seeking input on a resolution. She explained that the situation recently came to her attention. The reason Wadena County must pay the bill is due to statutory county cost shift between DHS and counties that occurred four years ago. Ever since the cost shift, when a patient no longer meets hospital level of care, but does not have a discharge placement, they are labeled Does Not Meet Criteria (DNMC). When that occurs, the patient’s resident county must start paying for the care or find another option for care.

In this case, Wadena County Human Services did not find another placement and so they were assessed the costs.

Wadena County Commissioners were full of questions about how this could happen.

The county has been paying a minimal amount of $100 a month for each of the three patients, totaling $300 a month. So far the county has paid off $4,834 of the bill since 2017. Seeing this as a liability for Wadena County, Westrum presented four options including 1) paying the bill in full from the Wadena County Human Services reserves. 2) Continue to pay $300 a month until the sunset in 2073. 3) Increase monthly payments to a rate determined by the board. 4) Continue with the current payment and review the item in November in light of potential budget shortfalls related to COVID-19.

Westrum explained that the county has to pay at least a minimum amount on these charges or DHS can hold certain payments going forward. She added that there is no interest charged on the amounts.

Board chairman Chuck Horsager spoke first in favor of continuing to pay the $300 monthly. The rest of the board agreed and recommended continuing that action “with a stipulation that human services and the budget committee totally review this issue in the budgeting process.”

Commissioner Bill Stearns made reference to Stearns County, which found themselves in a worse situation having a bill of $2 million for two patients. Commissioners hoped Human Services staff would put heightened focus on finding resolution for these patients before the county would have to incur extensive costs.

“It’s unfortunate that there wasn’t an adequate discharge plan for these people,” Stearns said.

Kangas said he didn’t want to point fingers, but he questioned if someone dropped the ball.

He pushed further asking where these costs were showing up and shouldn’t the county see these outstanding bills. Commissioner Chuck Horsager and Jim Hofer who served on the budget committee in the last two years were unaware of the charges.

“We should indeed show the liability out there on a financial statement, somehow we should be made aware of that so we can best deal with it,” Horsager said.

Westrum said the county receives a letter within 24-36 hours that a patient becomes DNMC, in some cases the county is notified before it happens. In either case, Westrum said the day someone is placed in a CBHH the county should be looking for a placement for them.

“Did these three cases languish because there was no bed available or because we didn’t react,” Monson asked Westrum.

“Unfortunately we can’t determine that because no one who was employed and involved with these cases is employed with Human Services at this time,” Westrum said.

Monson further asked about mitigation efforts to keep this from happening. Westrum said that process started last week because they currently have one patient in one of the six behavioral health hospitals.

Patient bills

Here’s a closer look at the nearly $200,000 in patient bills.

  • One of the three patients had charges of $124,116 for 83 days in the Community Behavioral Health Hospital (CBHH)- Rochester from May 29 - August 19. That patient stayed there at a cost of $1,452 a day for 33 days and then $1,524 a day for 50 days following a price increase with a new fiscal year. The patient was also in the CBHH-Annandale for 12 days at a cost of $17,424 in April 2019.
  • Another patient, also at CBHH-Rochester, had charges of $33,588 over 18 days.
  • A third patient had charges of $22,000 over a 16-day period beginning in April 2017. Charges were payable to Anoka-Metro Regional Treatment Center, the state’s largest psychiatric hospital.

Other actions

The county board also gave approval on a recommendation to enter into a special needs basic care contract with Medica. Prior to 2020, residents were offered special needs basic care through South Country Health Alliance but after the county exited from that provider they had to find a new provider. The county is entering into a contract with both Ucare and Medica so residents have access to two health plans in order to access more options.

Collections

The board was apprised of impressive collection efforts by Human Services. During 2019, they collected $367,162. That includes $257,068 in probate fees. Collections are comprised of such things as detox, county burials, rule 25, fraud and parental fees associated with social services or correction placements.