Human Services

MinnesotaCare

Statewide Outcome(s):

MinnesotaCare supports the following statewide outcome(s).

Minnesotans are healthy.

Strong and stable families and communities.

Context:

Many working Minnesotans cannot afford – or do not have – health insurance coverage options available through their employer(s). The MinnesotaCare program provides health care coverage for low-income, working families and adults in Minnesota with higher income levels than the Medical Assistance program, who do not have access to affordable health insurance individually or through their employer. Populations covered under MinnesotaCare include pregnant women, children, parents/caretakers, and adults without children. In FY 2011, MinnesotaCare covered approximately 148,000 people in an average month.

MinnesotaCare covers preventive services and well-child visits, physician services, ambulance and emergency room services, laboratory and x-ray services, prescription drugs, chiropractic services, rehabilitative therapy, vision care, chemical dependency treatment and mental health services, inpatient and outpatient hospital care, immunizations, medical transportation, dental care, and services through rural health clinics, federally qualified health centers, and Indian health. All adults without children and parents at the upper income levels receive some lesser benefits than other populations on MinnesotaCare, most significant of which is a $10,000 limit to hospital services.

Families and individuals seeking coverage under MinnesotaCare can apply directly to the state (MinnesotaCare state operations) or through their county. DHS contracts with non-profit health plans to provide health care services through their provider networks to MinnesotaCare enrollees. Except for certain low-income children, applicants are not eligible if they have other health insurance (including Medicare), have access to coverage through their employer and the employer’s share of the premium is 50 percent or more, have had access to such coverage in the past 18 months, or have had other insurance within the past four months. There are no health condition barriers, but MinnesotaCare applicants must pay a premium, meet income guidelines and other requirements to qualify. Enrollees pay a premium based on income. The average enrollee premium for FY2011 was $22 per person per month. The premium for some low-income children was $4 per month until July 1, 2012, when the premium for those children went down to zero. The full list of MinnesotaCare populations, income and asset limits is online at https://edocs.dhs.state.mn.us/lfserver/Public/DHS-4346-ENG.

MinnesotaCare is funded with appropriations from the health care access fund, from federal Medicaid funds, and from enrollee premiums.

Approximately 50,000 adults without children on MinnesotaCare moved to the Medical Assistance (MA) program under the MA early expansion that became effective March 1, 2011. As of July 1, 2012, some MinnesotaCare adults without children at the upper end of the income range (above 200% of the Federal Poverty Guidelines) moved to the new Healthy Minnesota Contribution Program, which provides a subsidy for adults without children to purchase private health care coverage in the individual market.

Strategies:

DHS works with many stakeholders to determine how we can improve our health care programs. Here are some examples of how DHS is working toward program improvements:

Improving health outcomes of public health care program recipients while lowering costs for taxpayers

·         MinnesotaCare provides coverage of care coordination services for people with chronic illnesses through physician clinics that are certified Health Care Homes.

·         DHS, per legislative direction in 2011, is seeking federal approval to reform Minnesota’s public health care programs to achieve better outcomes for people with disabilities, seniors and other enrollees through the Reform 2020 initiative. More information is available online at http://www.dhs.state.mn.us/main/ dhs16_166654

·         DHS is submitting a grant application for a CMS Innovation Challenge for the “Strong Start for Mothers and Babies” initiative, to decrease disparities in birth outcomes for infants from communities of color.

·         DHS is partnering with the Minnesota Department of Health to help public health care program enrollees prevent diabetes and other chronic disease by participating in the YMCA’s Diabetes Prevention Program and receiving other incentives for healthy behavior.

Integrate primary care, behavioral health and long-term care

DHS is developing a grant project to integrate primary care and behavioral health care. This grant project includes the development of a methodology to identify children who are considered “socially complex” and would benefit from medical care coordination.

Institute payment reform in health care purchasing

DHS is negotiating with potential Health Care Delivery System (HCDS) sites to begin full operation by January 2013. HCDS demonstration projects will contract directly with providers in a new way that allows them to share in savings for improving quality of care and patient experience and reducing the total cost of care for public health care program enrollees. In this new model, MinnesotaCare enrollees will receive more coordinated care to improve their overall health, and health care providers will be paid based on the quality of care they provide to their patients and their ability to reduce the cost of care.

Results:

Performance Measures Notes:

1.         Measure is the percent of Minnesotans that do not have health insurance. Nearly three-fourths of the uninsured have some potential access to coverage but do not take advantage of it. Source: Minnesota Department of Health, Health Access Survey (measured semi-annually). Compares 2009 (Previous) to 2011 (Current).

2.         Measure is the percentage of children who receive six well child visits (e.g. age-specific preventive visits and screenings) by 15 months of age through their health care provider. Source DHS Data Warehouse (measured annually). Compares calendar year 2009 (Previous) and CY 2010 (Current).

3.         Measure is the number of physician clinics certified by the Minnesota Department of Health as health care homes that provide care coordination services for people with chronic illnesses. Source: Minnesota Department of Health (measured quarterly). Compares the beginning of CY 2011 (Previous) and CY 2011 fourth quarter (Current).