Improving verification and leave certification processes for paid family and medical leave in Minnesota
State of Minnesota Department of Employment and Economic Development
May 2024 - January 2025
Why This Matters For Families
Over the past 20 years, 13 states and D.C. have adopted paid family and medical leave (PFML) programs that provide income support to people who need time off work when a new child is added to the family, they need to care for a family member, or they suffer their own personal health issue. Paid leave is associated with higher labor force participation rates, higher earnings over time, better health, worker retention and productivity, and economic growth.
The New Practice Lab team is working directly with state administrators, as well as the individuals and families whom they serve, to streamline state paid leave program benefits. The team has also offered guidance to states working to pass paid family and medical leave laws, offering advice on language and processes that will aid benefit delivery to claimants and families. These programs can provide critical relief to U.S. families — but only if they reach the people who need them, when they need them.
Implementation Challenge
Last year Minnesota passed a paid family and medical leave law which will start disbursing benefits to Minnesotans on January 1, 2026. One of the major challenges that they face in running the program is verifying each claimant’s need for leave — which is a consistent source of delay across the existing PFML programs. The New Practice Lab partnered with Minnesota’s Paid Leave team to explore novel approaches to medical provider certification. The joint team tested these concepts, aiming to identify solutions that could one day be replicated across the paid leave ecosystem, without asking a resource limited state team on a strict timeline to take on the risk of implementing untested ideas.
As a subset of this leave certification exploration, the New Practice Lab also worked with the state on their trauma-informed and service design approach to their implementation of safety leave. Safety leave provides survivors of domestic violence and sexual assault paid time off to seek care, obtain legal counsel, and move themselves to a safer home. While safety leave represents a small portion of claims in existing programs, it’s by far the most challenging area to balance program integrity with claimant experience. Team members from the New Practice Lab and Minnesota have worked collaboratively to conduct trauma-informed research with survivors and advocates, and use insights from that research to inform policy and process questions.
Our Approach
We worked closely with Minnesota’s Paid Leave team to scope out several areas of inquiry related to our shared implementation challenge. This led to three workstreams: generative user research to better understand leave certification, technical explorations to expand the universe of possible software solutions for leave certification, and policy support to incorporate learnings from across the paid leave ecosystem into Minnesota’s program design.
ORIGINAL OBJECTIVE
Understand the wants, needs, and existing workflows of healthcare providers.
WHAT WE DID
Conducted user research with a cohort of healthcare providers, with an emphasis on those who serve marginalized communities like the uninsured and individuals living in rural communities.
ORIGINAL OBJECTIVE
Understand the needs and perspectives of advocates and survivors as it relates to the application and certification process for safety leave.
WHAT WE DID
Supported Minnesota in designing user research with advocates and survivors.
Co-founded a service design workstream to incorporate learnings from that research into policy and software.
ORIGINAL OBJECTIVE
Explore existing health software infrastructure and assess what options we can use to send and receive leave requests.
WHAT WE DID
Explored the possibility of using prescription data standards for communicating leave requests.
When prescription pathways proved infeasible, identified a federally supported data standard (FHIR) that is used widely across providers in Minnesota.
Worked with Minnesota staff to lay the foundation for prototyping partnerships with multiple medical groups
Developed working code proving out the feasibility of the concept
ORIGINAL OBJECTIVE
Incorporate our ongoing learnings into Minnesota’s policy and program.
WHAT WE DID
Provided Minnesota’s policy team with summary and analysis of approaches taken by other states, including performing desk research on specific topics as requested by the policy lead.
Helped Minnesota’s policy team learn about the design and software implications of different approaches to policy.
What We Learned
Paid leave teams should start by identifying multiple use cases and documenting complex leave scenarios, not just “golden paths” in which needs are straightforward. Research into safety leave scenarios, where we talked to domestic violence/sexual assault survivors, advocates, and counselors revealed a number of complexities that had significant policy and program design implications. Similar complexities come up when thinking through intermittent medical leave and caregiving scenarios, both of which are quite important to the paid leave program. Because Minnesota prioritized this work at the beginning of their program, learnings from this research can be used to inform legislative and technical decisions to serve these users gracefully.
Medical providers aren’t a monolith, and aren’t completely sure what their role in the paid leave process is. While providers generally understand their role with regards to filling out paperwork, they have different mental models of what position they should fill in the broader ecosystem. For example, some providers see themselves as advocates for patients’ wellbeing while others position themselves more as gatekeepers who prevent fraud and misuse. There is significant room for the state to provide both context and guidance to providers about what information the program needs and how it will be used.
“I think they are afraid that they’re going to be signing something and it’s going to turn into fraud, and then everyone’s going to be mad at them.”
“It’s a very imperfect assessment, I think, and I try to be on the more generous side because I don’t want them to not be able to use it if they need it.”
“There’s such a stigma around addiction treatment and just addiction in the first place. And so I think it’s very important to have that sort of privacy. If there was a system whereby, it wasn’t leave for addiction treatment, right? And it was just, like you said, safety leave or whatever, I think that would be very cool to sort of just lump it in with other sorts of types of leave.”
The CMS-backed FHIR data standard could be a major shortcut for medical providers to share leave recommendations with the state. The New Practice Lab’s technical team has demonstrated that the FHIR standard, which CMS requires all Medicaid and Medicare providers to support, could be used to quickly share selected records from an electronic health record system. If this approach is pursued, additional work is needed to build policies and systems to manage electronic certification.
If successfully implemented, the FHIR standard would allow medical providers to simply take notes about a patient’s need for leave in whatever electronic system their clinic uses. This note could then be securely transferred to the state and used as evidence of a claimant’s need for leave — no additional paperwork required.
In simpler terms, a task that can take doctors days or weeks to complete on a separate form could potentially be finished in minutes, using existing notetaking tools during the course of a normal exam.
We have an opportunity to set a durable standard for how leave information is shared between medical providers and states. Regardless of the path Minnesota follows, this work has led the New Practice Lab team to the conclusion that the longterm, optimal solution for certifying paid leave information is likely a specialized module in the electronic health record system that providers use. If successfully implemented, such an approach could dramatically speed up and standardize leave certification for paid leave programs across the country.
Next Steps
The project with Minnesota Paid Leave concluded in Fall 2024, with long tail support from a skeleton team through the end of December. The team is documenting lessons learned from the project to be shared with the New Practice Lab’s other PFML state partners. The team and Minnesota collaborators are in active conversation about how to best carry forward our joint work in 2025 and beyond, and have identified several areas for potential follow up work that will benefit the PFML community at large.
