Testing new medical certification pathways in Minnesota
State of Minnesota Department of Employment and Economic Development
February 2025 - December 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 families when new children arrive, a family member needs care, or a family breadwinner suffers their own personal health issue. Yet the nature of state-by-state policies means that tens of millions of workers are left behind. Paid leave is associated with higher labor force participation rates, higher earnings over time, better health, worker retention and productivity, and economic growth. To extend those benefits to more Americans, it is essential to pass more state policies and, ideally, a national policy — and ensure those policies are designed and implemented to serve the workers and families who are most in need.
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
In 2023, 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. Existing programs often struggle to reliably establish the provenance of submitted certification materials, or to ask questions about those submitted materials, because form-filling is often quite complex within medical practices. Certification paperwork is often completed or transmitted by administrative staff — and even then, the average doctor spends 8.7 hours per week (16.6% of working hours) on administration. Paperwork burdens and distributed paperwork responsibilities make it challenging for practitioners, claimants, and the state to coordinate and clarify claim information.
“When the patient had a surgery and their surgeon is supposed to fill out the forms, but they don’t do that kind of stuff. And so then it falls to us. A good surgeon fills them out, or their staff does, but sometimes, a lot of times that stuff falls on Family Medicine.”
Throughout 2025, the New Practice Lab continued its work from 2024 to partner with Minnesota’s PFML team to explore novel approaches to medical provider certification, and to help close communication gaps between medical providers, claimants, and the program. The joint team tested these conceptual approaches, 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.
Our Approach
As a result of NPL’s initial explorations last year, in 2025, Minnesota was able to dedicate a product manager and a technical team to further explore these ideas with our team. In particular, we laid groundwork for Minnesota’s paid leave program to become the first such program in the U.S. to pursue creating a state-maintained leave certification portal that will embed directly inside providers’ electronic health records (EHR) software — the systems that providers “live in” during their day-to-day work. That EHR-embedded portal will make use of Fast Healthcare Interoperability Resources (FHIR), an industry standard for storing and structuring medical information, to securely and verifiably transmit claim certification information to the state.
Together, we scoped our areas of inquiry into 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.
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 in rural communities.
OBJECTIVE
Explore existing health software infrastructure and assess what options we can use to send and receive leave requests.
WHAT WE DID
Explored how to use providers’ own EHR systems (and the FHIR data standard) to share data directly between the state and health care providers.
Worked with Minnesota staff to lay the foundation for prototyping partnerships with multiple medical groups.
Developed working code to validate feasibility of the EHR-embedded portal concept.
OBJECTIVE
Support Minnesota team with tools and knowledge from discovery assist in continued solution development and implementation with their vendor.
WHAT WE DID
Documented our findings and recommendations for a future development team.
Provided limited hands-on assistance with prototyping, design, and feature development to ease the transition.
OBJECTIVE
Scale what we’ve learned across the paid leave ecosystem.
WHAT WE DID
Worked with Minnesota to document our joint findings; currently in process sharing those findings across the state administrators ecosystem.
What We Learned
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. Minnesota now has a certifier toolkit online, and is working to further improve and provide additional resources for certifiers.
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. Together, the Minnesota and New Practice Lab technical teams were able to identify multiple ways to use the FHIR data standard to transmit information, such as electronic fax and EHR-embedded forms – all of which could allow providers to complete medical certifications inside of their normal EHR workflows. Other states do not need to fully replicate Minnesota’s certification approach, nor the rote technical specifics of Minnesota’s certification portal project, to benefit from using FHIR data and EHR-rooted processes in their program to make medical certification easier and improve provider verification.
Next Steps
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, and have identified several areas for potential follow up work that will benefit the PFML community at large.
If the use of Minnesota’s FHIR-based,EHR-embedded certification portal ultimately is successful in the next round of live environment pilots, a task that can take doctors days or weeks to complete on a separate form could potentially be finished in minutes, using existing tools during the course of a normal exam. This presents an opportunity to set a durable standard for how leave information is shared between medical providers and states.
