MARSHALL — A Minnesota Department of Human Services mediation process next month might determine the limits to which a 24-county health insurance alliance can serve human services clients.

Then again it might not. Counties could respond to mediation results by taking their concerns to litigation, which would leave the matter in the hands of Minnesota’s court system.

PrimeWest Health, an Alexandria-based health insurance provider, is scheduled for DHS mediation during the Sept. 19-24 mediation period. It is currently the single source insurer of choice in 24 counties, which means that all human services client insurance needs are handled through PrimeWest.

All 24 counties have pledged to support continued single sourcing, even if that means contributing shares for up to $100,000 that might be needed for legal representation.

The Lockridge, Grindal and Nauen law firm is prepared to represent the PrimeWest counties. They comprise most of the 33 counties in Greater Minnesota that single source. Similar client insurance is used with another eight-county alliance and by Itasca County.

Current DHS action scheduled to take effect at the start of 2020 would require that clients have a choice of three health insurance plans. Human services staff would not have the authority to recommend one plan over others, even if their professional knowledge clearly indicates that one of the choices would be best for a particular client situation.

“Clients would have to go through the information themselves,” said Carol Biren, Public Health Division Director for Southwest Health and Human Services. “We’ve been satisfied with the service they’ve received from PrimeWest. The response time when clients have questions has been excellent.”

PrimeWest’s operations include having direct county-based representation on its board. It also returns as many funds as possible to local communities in the form of Community Reinvestment Grants.

A total of $13,482,548 has been paid out in grants since 2007. Among the grants awarded since 2014 were $300,000 for Big Stone County, $165,205 for Renville County Hospital and Clinics, and $75,000 for the city of Browns Valley.

“Even though PrimeWest could still be selected by clients as one of the choices, not being able to single source would change how it operates,” Biren said. “They would have to make adjustments since there would not be any guarantee as far as volume.”

She said PrimeWest has thus far not had to make any funding requests, referred to as a “cash call,” to cover budget shortfalls. It’s structured the amount of reinvestment grants awarded each year according to how much extra funds are on hand.

Similarly the Minnesota Counties Insurance Trust, which operates in conjunction with the Association of Minnesota Counties, has awarded cash dividends when extra money can be refunded back to the county level.

Pipestone County, one of six that are part of SHHS, has been part of PrimeWest since it began in the 1990s. Three of the five others; Lincoln, Lyon and Redwood counties, started to participate more recently.

Murray County will go through a different mediation procedure since it wishes to have the number of provider choices for some of its programs reduced from three to two, with the goal of simplifying the decision-making process for clients.

Rock County is the only SHHS county that currently plans to work with the three-provider choice standard put forth by state DHS officials.

Biren and SHHS Director Beth Wilms said a final mediation decision from the current DHS commissioner will be due Sept. 30. Counties would then have until Dec. 31 to have new insurance contracts in place.

Decisions to have single source client health insurance were made by individual county boards following information provided by local and regional human services administrators.

“It wasn’t done lightly,” Wilms said. “We presented information to each of the county boards and they looked into their options. Everybody weighed the pros and cons.”

The Sept. 30 decision will take into account recommendations from the three-member mediation panel. It will be composed of one DHS representative, another from AMC, and a third from the Minnesota Hospitals Association.

“We’re hoping it can be settled through the mediation process,” said Yellow Medicine County Family Services Director Rae Ann Keeler Aus, whose county is planning to join PrimeWest. “We’d like to know how to proceed with insurance coverage. Hopefully it will be a direction that’s simplest and best for both the taxpayers and our clients.”

The $100,000 price tag is the highest commitment from the 24 counties thus far for any potential court action. Spread out equally among the participants, each of them would be responsible for about $4,000 in legal fees or less based on county-level decisions prior to the September mediation process.

“The legal services agreement states that costs can be incurred up to $100,000,” said Lincoln County Attorney Glen Petersen. “If it looks like it could go past that point to continue the process, the legal counsel would have to come back to each of the county boards to ask for more money.”