As a nurse focusing on geriatric care, I see patients with a wide range of health conditions and medical issues. Sometimes the most difficult conditions are also the cheapest and easiest to treat; but because patients are ashamed to admit they have a problem, they can spiral out of control.

Michelle Reynolds
Michelle Reynolds
Incontinence is one of those health issues. More than 25 million Americans suffer from incontinence, and almost every American knows someone who is impacted. Many patients are afraid to leave their houses because of the risk of embarrassment. High-quality incontinence products - meaning adult diapers - can give patients their lives back for just a few dollars a day. But for some low-income adults, particularly those dependent on Social Security, incontinence products are more than they can afford.

Because the alternatives to incontinence products, including lost jobs and nursing-home admissions, cost so much, Medicaid gives low-income patients access to these products. This incontinence program has been highly successful. It is critical to the health and dignity of more than 40,000 Minnesotans, including several of my patients.

For reasons I cannot understand, however, the Minnesota Department of Human Services won't leave this program alone. Two years ago the department proposed awarding a single company a monopoly to distribute incontinence products to Medicaid providers in the state. Department leaders told legislators this change would be merely technical, and that nobody would notice or care.

But, of course, those of us in health care immediately understood the potential risk. The change would force patients into low-quality products that would seriously impact their lives and lead to costly health problems down the road.

Health care and disability advocates worked tirelessly last year to end the monopoly program, eventually convincing both parties in the Legislature and Gov. Mark Dayton to include repeal of the monopoly distributor law in a larger spending bill. The Department of Human Services, rather than acknowledging its mistake, dug in its heels.

Then everything went haywire. Gov. Dayton vetoed the spending bill for unrelated reasons. And Human Services, rather than following the wishes of the Legislature, governor, and advocate community, saw an opening and tipped off political and legal maneuvering. The medical-supply industry sued, and a judge took the unusual step of stopping the monopoly program, pointing to several legal issues with its implementation.

Incredibly, Human Services still didn't give up. It attempted to have the lawsuit dismissed on technical grounds. Eventually, an agreement was reached to stay the court case until this year, to give the Legislature time to end the monopoly distributor program once and for all.

That brings us to today. Unfortunately, the Minnesota Department of Human Services seems not to have gotten the message. Not only does the department still oppose repeal of the monopoly distributor incontinence program, it actually suggested further drastic cuts to a wide range of other medical supplies and equipment. These cuts would be especially acute in rural Minnesota, despite Gov. Tim Walz's interest in protecting rural communities. This stubbornness is particularly frustrating, given that Human Services Director Tony Lourey was instrumental in getting the incontinence program repeal language passed last year when he was a legislator.

Thankfully, there seems to be significant momentum for repealing the monopoly program: Leaders from both parties in both the House and Senate authored bills to repeal the program. Sens. Jim Abeler, R-Anoka, and Michelle Benson, R-Ham Lake, have been particularly strong in their support and even included money in their budget proposal to fix the program.

Duluth's DFL Rep. Jennifer Schultz also co-authored the bill repealing the monopoly program. She did so as a member of the House Health and Human Services Finance Committee. As this year's legislative session draws to a close, I hope she can use her position to help end this terrible program and protect Minnesota's most vulnerable patients once and for all.


Michelle Reynolds is director of nursing at Keystone Bluffs Assisted Living in Duluth.