The notice arrived in my mailbox even though it should not have. I am an enrolled member of the Red Lake Nation and a person living with a medical disability. For health coverage, I am dual-eligible: Medicare covers my primary care, while Medicaid helps with deductibles and copays (aka Medi-gap).

By state and federal standards, my circumstances should exempt me from the most aggressive new reporting rules. Under Minnesota’s automated renewal process, the state is supposed to check existing data, including Social Security and income information, before sending paper forms. That process should reduce work for local caseworkers and protect eligible residents from unnecessary paperwork.

Instead, I received a premature 25-page manual renewal packet, before adding the physical proofs required to complete it. My formal renewal was not due until spring 2027. If someone who serves on state boards overseeing these programs can be tripped up by the process, what chance does the average enrollee have?

The broader crisis

My mailbox is one example of a larger problem unfolding in Minnesota’s county and tribal human services departments.

The federal One Big Beautiful Bill Act, HR 1, has changed Medicaid administration by adding shorter reporting cycles, new verification requirements and potential financial penalties. In practice, those changes fall on local offices already managing workforce shortages, aging systems and high caseloads.

Minnesota healthcare leaders estimate the new requirements could drive roughly $165 million a year in added administrative costs across state, county and tribal governments. Because the Legislature adjourned without a dedicated funding mechanism, that burden becomes an unfunded mandate for local systems.

More money alone would not solve the problem. Counties already struggle to hire and retain human services workers. Even funded positions can sit vacant, leaving existing caseworkers to absorb more paperwork, tighter deadlines and greater risk of error.

The 25-page Medicaid maze

Minnesota knows how to do better. Federal rules require states to attempt ex parte renewals before sending paper forms, using existing case information and reliable electronic sources to confirm eligibility whenever possible. That approach protects eligible residents and saves caseworker time.

Yet manual packets still reach residents who should be verified through existing data. A standard Medical Assistance renewal form for people who are aged, blind or disabled can run 25 pages before supporting proofs are added. The process is also fragmented, with different forms for individuals, families, guardians and children.

That design creates confusion for enrollees and more sorting, tracking and auditing for county workers. For rural residents without a printer, reliable transportation or easy mail access, each proof requirement becomes a real barrier. A missing document or delayed envelope can mean a procedural termination, even when the person remains eligible.

The error-rate trap

The new federal rules also raise the stakes for accuracy. If processing errors exceed a 3% threshold, the state can face financial clawbacks, including risks to federal matching funds. That puts county and tribal workers in a difficult position: process more documents, meet tighter timelines and make fewer mistakes, even as the system gives them longer forms and fewer tools.

Poor form design makes that harder. Dense language and scattered questions increase the chance that applicants will submit incomplete or inconsistent information. That creates follow-up work and makes it harder to distinguish honest mistakes from intentional misrepresentation. A confusing form does not protect taxpayers; it penalizes people who are trying to comply.

A clearer path

The state already has a simpler model under the Minnesota Health Care Programs umbrella. The Ryan White Part B Program HH renewal uses a short form that can be submitted online and includes a release of information, allowing the agency to obtain income and insurance proofs securely. That kind of design supports program integrity while reducing unnecessary work.

Minnesota should use automated renewals wherever legally available, expand secure releases of information, simplify forms and invest in county and tribal technology and staffing. These steps would help eligible people stay covered, reduce avoidable workload and improve accuracy.

Health coverage should not depend on who can survive a paper chase. We need a renewal system that verifies eligibility with modern tools, protects local workers and keeps eligible Minnesotans connected to care.

Aaron Wittnebel, SME, represents rural and tribal communities across Minnesota’s 76 counties on state boards overseeing Human Services, Medicaid, and MinnesotaCare. He is a public health advocate, a former mayor, and a former Minnesota House legislative aide. He is a member of the Red Lake Nation and resides in rural Becker County.

This story was originally published by MinnPost.

Aaron Wittnebel

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Medicaid renewal bureaucracy is overwhelming Minnesota counties

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