Human Services

Medical Assistance

http://www.dhs.state.mn.us/MA

Statewide Outcome(s):

Medical Assistance supports the following statewide outcome(s).

Minnesotans are healthy.

Strong and stable families and communities.

Context:

Medical Assistance (MA) is Minnesota’s Medicaid program that provides comprehensive coverage to the lowest-income families and individuals not able to afford coverage. Medical services covered by MA include preventive care, primary and specialty medical care, dental, mental health and chemical dependency services and long-term care coverage. The goal of this joint federal-state program is to avoid impoverishing low income elderly and disabled people due to high health care costs, and to provide basic health care coverage for very low income families and children. These services also help support older people and people with disabilities to function more independently in their homes and communities or in institutional settings. MA has lower income guidelines than MinnesotaCare, does not have premiums or insurance barriers, and pays for previously incurred medical bills. MA is funded with general fund appropriations and federal Medicaid funds. In fiscal year 2011, MA served a monthly average of 665,483 people and had total spending (federal, state and local) of $7.5 billion, of which $3 billion was the Minnesota state budget share.

Share of MA Total Enrollment and Payments by Population in FY2011

MA Population	Share of Total Enrollment¹	Share of Total Payments²
Families with children³	70%	30%
Elderly	8%	22%
Disabled	18%	47%
Adults without children⁴	4%	1%

Notes: ¹ Enrollment figures are based on a 12-month average.

²Payments include withhold payments to health plans in the year paid. Payments do not include an offset for pharmacy rebates.

³ Families with children payments include payments relating to Emergency MA, Family Planning Waiver, and Breast and Cervical Cancer coverage.

⁴ Adults with no children coverage began in March 2011.

The Minnesota Depertment of Human Services (DHS) partners with all 87 Minnesota counties to administer the MA program, and enrolls or contracts with most health care providers and health plans across the state to deliver care to MA enrollees. MA enrollees fall under one of five general categories:

1. MA Coverage of Basic Health Care for Elderly and Disabled

In FY2011, this segment of MA funds supported an average of 174,491 people per month (many of whom are also enrolled in Medicare as “dual eligibles”). The state budget share of this spending was $944.28 million. Recipients of these services are low-income elderly (65 years or older) and people who are blind or have a disability, who receive health care coverage or financial assistance to help them pay for their Medicare premiums and cost sharing/copayments (this approach is often cheaper than if the state provided their health coverage).

This segment of the MA program also includes employed persons with disabilities (a monthly average of over 7900 working people), who receive full MA coverage under the Medical Assistance for Employed Persons with Disabilities (MA-EPD) program. This program encourages people with disabilities to work and enjoy the benefits of being employed by allowing working people with disabilities to qualify for MA under higher income and asset limits than standard MA. More information on MA-EPD is available online at http://www.dhs.state.mn.us/id_004088

2. MA Coverage of Care through Long-Term Care Waivers & Home Care

In FY2011, this segment of MA funds supported an average of 54,780 people per month. The state budget share of spending was $888.78 million. Recipients of MA LTC waivers and home care services are low-income Minnesotans who are elderly or have disabilities. These long-term care services and health care-related supports enable them to live as independently as possible in their communities.

“LTC waivers” refer to home and community-based services (HCBS) available under a federal Medicaid waiver. These programs are called waivers because they allow states to "waive" the Medicaid rules that require individuals to be served in institutional settings. Waivers are available to people who qualify for MA and who have certain levels of need, within available funding. More information on the HCBS waiver programs is online at

http://www.dhs.state.mn.us/id_003726#.

3. MA Coverage of Care in Long-Term Care Facilities

In FY2011, this segment of MA funds supported an average of 19,308 people per month. The state budget share of spending was $377.44 million. Recipients of these services are elderly or have disabilities, reside in a nursing facility, and receive 24-hour care and supervision in an institutional-based setting, including nursing care, help with activities of daily living and other care needs, including housing, meals, and medication administration. More information on nursing facilities is online at

https://edocs.dhs.state.mn.us/lfserver/Public/DHS-5961-ENG

This segment of the MA program also includes services to persons with developmental disabilities who receive 24-hour care, active treatment in intermediate care facilities (ICFs/DD). ICF/DD residents may also receive day training and habilitation (DT&H) services. DT&H services help people with disabilities develop and maintain life skills, participate in the community, and engage in productive and satisfying activities.

4. MA Coverage of Basic Health Care for Families with Children

In FY 2011, this segment of MA funds supported an average of 463,151 people per month. The state budget share of spending was $791.21 million. Recipients of this health care coverage are often the poorest Minnesotans, and include low income pregnant women, children, and parents/caretakers.

This segment of the MA program also includes funding for the Minnesota Family Planning Program (MFPP), which provides coverage of family planning and related health care services for people not currently enrolled in MA or MinnesotaCare.

5. MA Coverage for Adults without Children

In the four-month period from March–June 2011, this segment of the MA program served an average of 82,800 people per month. The state budget share of spending was $50.78 million. Recipients of this health care coverage are single adults with income at or below 75 percent of the federal poverty guidelines ($8,388 per year). Federal law allows all states to expand MA eligibility to cover adults with no children effective January 2014, and allowed some states to expand coverage to low income adults without children earlier. Minnesota expanded its MA program to this population beginning March 1, 2011.

The full list of Medical Assistance populations, income and asset limits is online at

http://edocs.dhs.state.mn.us/lfserver/Public/DHS-4346-ENG. For more information on expenditures and enrollment, go to http://www.dhs.state.mn.us/main/id_016358, scroll down to “Background Data Tables for the Expenditure Forecast,” and click on “Background data tables for February 2012.”

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 improvements in MA:

Improve health outcomes of Medicaid recipients while lowering costs for taxpayers

MA 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 MA 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 working with many partners to launch the Money Follows the Person Rebalancing Demonstration Program, aimed at increasing the number of Minnesotans with disabilities served in their homes and communities rather than in institutions. (See http://www.dhs.state.mn.us/main/dhs16_162194).
DHS is partnering with the MN Department of Health to help MA 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

Minnesota will see large growth in cost and utilization of long-term care services as Minnesota’s population ages. We can control cost growth, reduce duplication of services and improve the health of our recipients if we better integrate our health care services. Some examples include:

As part of Reform 2020, DHS is building on current state initiatives to improve performance of primary care and care coordination models for dual Medicare-Medicaid eligibles. Part of this focus is on primary care payment reform. More information about this component of the overall reform is available online at http://www.dhs.state.mn.us/dhs16_163573
DHS launched the “Own Your Future” public awareness campaign to encourage Minnesotans to plan for aging care needs and increase the number of Minnesotans who take action to address and provide for their future long-term care.
DHS is developing a grant project to integrate primary care and behavioral health care.
DHS submitted the Long-Term Care Realignment waiver proposal to CMS in February of 2012 to request federal authority to implement the new nursing facility level of care criteria.
DHS is partnering with Hennepin County on an innovative pilot project to test new strategies to better deliver human services to high-needs populations by integrating medical, behavioral health and county human services for up to 10,000 low-income Minnesotans.

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 Medicaid enrollees. In this new model, MA 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	Previous	Current	Trend
1. Percent of Minnesotans lacking health insurance	9%	9.1%	Stable
2. Percent of children receiving well-child visits	40.3%	42.1%	Improving
3. Number of clinics certified as health care homes	0	155	Improving
4. Percent of seniors served by home and community-based services	54%	62.4%	Improving
5. Percent of people with disabilities served by home and community-based services	92%	94.5%	Improving

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 percent 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) data

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. Previous measure represents the beginning of CY 2011; current measure is CY 2011 forth quarter.

4. Measure is the percent of older adults receiving publicly funded long-term care services who receive home and community-based services (HCBS) through the Elderly Waiver or Alternative Care program instead of services in nursing homes. Source: DHS Data Warehouse. Compares FY 2007 (Previous) and FY 2011 (Current) data.

5. Measure is the percent of people with disabilities receiving publicly funded long-term care services who receive HCBS services through disability waiver or home care programs instead of services in nursing homes or Intermediate Care Facilities. Source: DHS Data Warehouse. Compares FY 2007 (Previous) and FY 2011 (Current) data.

More information is available on the DHS Dashboard: http://dashboard.dhs.state.mn.us.