Restoring care where it has been abandoned — and building the infrastructure that turns recovery into a future.
Minnesota spends billions on health and human services. The problem is not the total spending — it is where the money ends up. Resources concentrate in the metro. Rural counties get what is left over, which is often nothing. Meanwhile the opioid crisis, the mental health crisis, and the collapse of rural hospital infrastructure have created a healthcare emergency in Greater Minnesota that the current administration is managing with press releases. This directive builds the infrastructure that should have existed twenty years ago — and funds the recovery model that actually works.
Each reform targets a specific gap in the current infrastructure. They are designed to reinforce each other — a resident in recovery enters the trade pipeline; a trade-certified worker stays in their rural community; a community with stable employment and provider access doesn't hemorrhage people to the metro. This is how you stop the cycle, not just interrupt it.
This directive was built for the people the current system treats as afterthoughts. They are not afterthoughts. They are the majority of this state by geography and they pay the same taxes as everyone else.
The Minnesota Department of Health's own data shows that residents in rural counties have shorter life expectancies, higher rates of chronic disease, and worse outcomes across nearly every measurable health indicator than residents in the Twin Cities metro. This is not because rural residents are less healthy by nature. It is because the infrastructure that catches problems early — primary care, mental health, substance use treatment — is either underfunded or simply absent.
The opioid and fentanyl crisis has hit rural communities disproportionately hard. The jobs that gave communities purpose have left. The recovery infrastructure has not arrived to replace them. You cannot treat addiction with judgment. You treat it with beds, with clinical support, and with a reason to stay clean. All three are missing in too many Minnesota counties.
And the federal Medicaid cuts moving through Congress will land hardest on rural Minnesota. Every rural hospital running on thin Medicaid margins is one bad legislative session away from closing. The best protection against that is a Governor running a clean, accountable system — one that can prove every dollar is going where it is supposed to go. That is why Directive 01 is the foundation and Directive 05 is the payoff.
Addiction is not a moral failing. It is a health condition. We have been treating it like a character flaw for thirty years and the overdose numbers have gone up every single year. The Restoration Model treats it like what it is — a medical emergency with a clinical solution and, when done right, a workforce outcome on the other side. That is not soft. That is the only approach that has ever actually worked.
The reforms in this directive are sequenced deliberately. Some are executable by executive action on day one. Some require a legislative appropriation that the Governor sends to the legislature immediately. None of them require waiting to see what is politically convenient.
These are not national averages dressed up as Minnesota facts. Every figure below comes from Minnesota-specific or directly applicable federal data. This is the documented baseline that makes Directive 05 necessary.
Every reform in this directive will face opposition. Some of it will be principled disagreement. Some of it will be people defending a system that has been working fine for them, even as it fails everyone else. Here is where I stand.
This directive does not ask for a tax increase. It does not cut existing programs that serve Minnesota residents. It redirects the money that was already supposed to be working for residents — and adds a new, documented revenue stream that the state has been leaving on the table.
The forensic audit recovery from Directive 01 is the first funding source. Minnesota's healthcare and human services agencies represent some of the largest expenditures in the state budget. A forensic-level review of vendor contracts, Medicaid billing, and grant disbursements in those agencies alone is expected to identify significant recoverable fraud. Recovered dollars fund the Resident Solution Fund. The Fund pays for rural health infrastructure.
The cannabis tax revenue from Directive 07 is the second source. A properly regulated, state-supervised cannabis market generates documented tax revenue. A portion of that revenue is designated for public health — including addiction recovery infrastructure and rural health access. That is the revenue-to-purpose connection that makes this sustainable without a general tax increase.
The Commissioner of Human Services is hereby directed to eliminate prior authorization requirements for residential substance use disorder treatment services for enrollees in state-administered Medical Assistance managed care contracts, pursuant to the Commissioner's rulemaking authority under MN Stat. §256B.0625. This directive applies to all managed care organizations operating under state contract. Implementation guidance shall be issued to all contracted managed care organizations within 30 days of signing. Any managed care organization that continues to impose prior authorization requirements for residential addiction treatment in violation of this directive shall be subject to contract remedies including financial penalties and contract termination.
The Commissioner of Human Services, in coordination with the Commissioner of Employment and Economic Development and the Chancellor of the Minnesota State Colleges and Universities system, shall establish the Recovery-to-Trade Pipeline program pursuant to MN Stat. §254B and MN Stat. §116L. The program shall:
The Commissioner of Human Services, in coordination with the Office of Inspector General, shall conduct a full accountability audit of all opioid litigation settlement funds received by the State of Minnesota. The audit shall verify that settlement funds are reaching frontline treatment providers and direct services, document the percentage absorbed by administrative costs at state and county levels, and identify any settlement funds held in reserve or redirected from their designated addiction treatment purpose. The audit report shall be submitted to the Governor's Office and published publicly within 120 days of signing. All findings of misapplication of settlement funds shall be referred to the Attorney General.
The Commissioner of Health is directed to activate and expand the rural health incentive programs authorized under MN Stat. §144.1481 through the Office of Rural Health and Primary Care. The Commissioner shall immediately designate eligible Health Professional Shortage Area counties for the Protector Term program, establish the three-year service commitment structure, and begin accepting applications from qualifying healthcare professionals including physicians, nurses, nurse practitioners, physician assistants, and licensed mental health providers. Simultaneously, the Governor's Office shall submit a legislative appropriations request for the full student loan forgiveness and housing stipend funding structure on the first day of the 2027 legislative session. Providers who begin Protector Term service prior to appropriation shall have their loan forgiveness commitments honored retroactively upon appropriation.
The Commissioner of Commerce, pursuant to the enforcement authority under MN Stat. §62A.673, shall conduct a full audit of telehealth reimbursement compliance by all state-regulated health plan companies within 90 days and issue binding guidance establishing that telehealth reimbursement rates must achieve genuine parity with in-person rates for equivalent services. The Commissioner of Human Services shall implement full telehealth reimbursement parity for all state employee health plans and Medical Assistance managed care contracts effective upon signing of this order. Audit findings identifying non-compliant health plans shall be referred for regulatory enforcement.
The Commissioner of Health shall establish the Minnesota Rural Mobile Health Unit Program pursuant to the general public health authority under MN Stat. §144.05. The Commissioner shall:
The Commissioner of Health shall direct the maternal and child health programs under MN Stat. §145.881 to identify Minnesota counties with the worst documented maternal health outcomes — including maternal mortality, severe maternal morbidity, and obstetric access gaps — and deploy targeted resources to those counties as a priority. The initiative shall include expanded access to midwifery services, telehealth prenatal care, mobile obstetric support, and transport coordination assistance for pregnant women in counties without proximate labor and delivery services. The Commissioner shall report to the Governor's Office within 90 days on the counties identified, the resources deployed, and a three-year outcome improvement target for each designated county.
The Commissioner of Human Services is directed to reorient Home and Community-Based Services waiver spending priorities under MN Stat. §256B.49 to maximize the proportion of waiver funding directed toward in-home and community-based care settings, with particular priority on rural counties where institutional care requires displacement from a resident's home community. The Commissioner shall establish the Resident-to-Resident Community Care Stipend program, providing state-authorized stipends for family members and documented community caregivers providing qualifying in-home elder care to Medicaid-eligible seniors. The program structure, eligibility requirements, and stipend amounts shall be published for public comment within 90 days and implemented within 180 days of signing. Home care provider licensing and quality standards under MN Stat. §144A apply to all program participants.
The Commissioners of Health, Human Services, Employment and Economic Development, and Commerce are each directed to submit implementation plans to the Governor's Office within 30 days of signing. All agencies shall cooperate fully with the recovery hub site selection process, the mobile unit deployment coordination, the opioid settlement audit, and the telehealth compliance review. Commissioners shall provide quarterly progress reports to the Governor's Office on all programs established by this order, with public versions published within 30 days of each quarterly report.
This Executive Order is effective immediately upon signing and shall remain in effect for the duration of this administration, or until superseded by statute establishing equivalent or greater healthcare access protections for rural Minnesota residents. Nothing in this order shall be construed to diminish any existing statutory protections or service obligations for Minnesota residents.
There is a resident in Greater Minnesota who has been waiting months for a mental health appointment that no one can give them. There is a family driving sixty miles to deliver a baby because the hospital stopped doing it. There is someone in recovery who got clean and then had nowhere to go. This directive is for all three of them. It starts on day one.
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