A program that takes up about 25 percent of the Minnesota budget with costs that have increased by 40 percent during the last two years should be a cause for concern on the part of every Minnesota taxpayer.

The state’s share of the Medicaid program that provides health care for the poor surpassed for the first time $4 billion, according to a recent federal report.

The study shows 733,000 Minnesotans are now on the federal/state Medicaid program called Medical Assistance in Minnesota, an increase of about 20 percent over the last two years.

About 14 percent of Minnesotans are on the program, and while state officials say much of the increase in cost is more of a shift than new costs, the increases in participation and costs should not be taken lightly.

An option to expand Medicaid eligibility through the federal health care reform law added 80,000 to Minnesota’s Medicaid or Medical Assistance rolls. Officials suggest that’s not as much of a problem as it may seem as some of those enrollees were previously in a program completely paid for by the state. The Medicaid program is funded jointly by the state and federal governments.

The key to getting this program under control must come from all stakeholders. Already, Gov. Mark Dayton has attempted to rein in costs by negotiating with HMOs and providers on overall costs of their contracts. Some savings have been achieved.

And Minnesota is participating in some pilot programs that call for coordinated care as a way to improve care and lower the cost.

Given the recent expansion of the cost and the number of people eligible, it’s time to expand these efforts to every possible corner of health care.

The recent weakness in the job market could clearly put more pressure on these programs. The Legislature can’t stop the growth of the number of people eligible as new people qualify on a monthly basis.

And even if political leaders in Minnesota decided to cut back eligibility, they should know that two-thirds of those in nursing homes qualify for the program. That is a constituency political leaders of both parties are loath to harm.

The national report on Medicaid warns that states will have to keep a sharp eye on costs, and there are several wild cards that may increase costs, including the pending U.S. Supreme Court decision on the Affordable Health Care Act.

If the Medicaid portion of the law is upheld, eligibility will be expanded to cover those with incomes 133 percent of the poverty level, compared to 100 percent now. It’s estimated the number of Minnesotans eligible by 2014 will increase by 60,000 people.

Of course, the larger problem is the millions of Americans who continue to have no health insurance, posing even greater costs for those who are covered.

But the recent Medicaid cost report is troubling at best and threatens much other spending at the state level, including spending on education, higher education, roads and other critical needs.

It’s time state and federal leaders move to make sure Medicaid spending does not spiral out of control and create more costs, direct and indirect, for the taxpayers.

— Mankato Free Press, June 17