Twenty-two voicemails.

That's how many Vickie Schaefer left during a five-day stretch, trying to get someone at Hennepin County to help her renew the financial assistance her 92-year-old mother relies on to pay rent at her assisted living facility.

Eventually, the Plymouth woman reached someone — on call 23 — but she worries that if others are not as persistent, they risk losing their housing, much like her mother.

"This needs to be fixed, and I don't feel like anyone is really paying a lot of attention to it," Schaefer said. "I'm advocating for all seniors now."

County officials acknowledge the system is stretched thin — and it's not alone. Short-staffed counties across Minnesota are struggling to meet the growing demand.

Thousands of seniors receive financial assistance through Minnesota's Medicaid program, called Medical Assistance, to offset costs of long-term care, including nursing homes and assisted living facilities. With 1 in 4 Minnesotans at age 65 or older by 2030, the demand for long-term care assistance is growing.

Staffing in Hennepin County, the state's largest by population, hasn't kept pace.

In 2022, the county created a team to work exclusively with people who receive disability waivers or live in long-term care facilities. Since then, the caseload has risen more than 1,000 each year — 24,000 in 2024 — despite the team having roughly the same number of employees, about three dozen. This year, the county is adding five staff members.

"Unfortunately, the system is often overwhelmed," said Cheryl Hennen, the state's ombudsman for long-term care. "And it's likely to only get worse."

Ann Noeker, a program manager in Hennepin County, said she couldn't comment about a specific case, but she acknowledged the system's complexity and challenges. Each month, Noeker said, the county completes about 2,000 renewals. It also is managing more than 600 pending cases.

"We know we need to do more," she said. "We need to do better."

Fear of losing assistance

Medical Assistance is funded by the state and federal government, and pays for half of all long-term services in Minnesota, according to the Department of Human Services. Recently, state leaders have sounded the alarm over proposed federal Medicaid cuts and a projected state deficit.

When someone applies for long-term care financial assistance, the case often involves not just the resident, but their representative, maybe a social worker, and facilities such as nursing homes. County workers must sift through the applicant's finances, including Social Security benefits, pensions, savings and disability payments, insurance and assets, to determine the "spend down" needed to qualify for waiver services, Noeker said.

In Schaefer's case, the county notified her that it hadn't received the necessary forms that she had mailed to renew her mother's financial assistance for long-term care. She called the county five times over two days, but no one got back to her.

A week later, she received a second letter from the county, informing her that her mother was being dropped from Medical Assistance. She would no longer receive $1,295 to help pay rent at her assisted living facility. Without it, her mother — who has begun showing early signs of dementia — would have to leave her home of four years.

"You're cutting my mom off, and I don't even know why," Schaefer said.

In a panic, Schaefer repeatedly called her mother's managed care unit the next two days and left voicemails. No one called her back.

"I was sobbing," Schaefer said. "I melted down."

Schaefer appealed the loss of her mother's assistance, and after several more calls, a worker guided her through the process. By early April, the aid was renewed.

Since then, Schaefer has made it her mission to push for improvements. While her conversations with county and state officials have garnered apologies and promises to do better, Schaefer said she's pushing to hear how they plan to improve coordination and communication.

"They've called me and said, 'Let us know if there's anything we can do for you,'" she said. "I want to know: How are you going to fix it? What are you working on?"

Looking to improve the process

Noeker said officials recognize the need to be better. Last year, the county worked with an outside consulting agency "to help us look at our processes and see how we could work more efficiently," she said.

"What we're hoping to do with that is that we are reaching out to them and answering their questions before they're even having to contact us," Noeker said.

But, she acknowledged there are cracks. Sometimes calls aren't quickly returned. Information may not be quickly or fully explained.

"We are here to serve residents," Noecker said. "I hate to hear when things go sideways and don't work out the way that they should."