Highlight on Minnesota: Funding and coverage for many in jeopardy

Minnesota has a large backlog of renewals for Medical Assistance and MinnesotaCare, and 60,000 people stand to lose subsidized coverage if they do not submit more information. According to the state Department of Human Services (DHS), those who have received notices need to respond in 30 days. Assistant Commissioner Chuck Johnson stated that although the department wants to preserve coverage for those who are eligible, it needs to ensure that only the eligible non-responders are receiving coverage. An additional 120,000 people are in various stages of the process for renewing coverage.

MNsure, or unsure?

This large backlog is attributed to problems with MNsure, the state’s health insurance exchange, which handles renewals for Medicaid and MinnesotaCare. The technical problems were first announced in May, and 55,000 renewals were reportedly delayed. Specifically, MNsure had issues exchanging income information with a federal data hub. The hub checks both financial and immigration data. Due to these issues, the state has had a hard time collecting MinnesotaCare premiums and ensuring that citizens are meeting the proper qualifications for coverage. The exchange was created using $189 million in federal dollars, and the state received about $50 million in both state and federal Medicaid funding to improve the system. According to DHS, there were problems with both MNsure and the federal hub, and the problems with the hub have been resolved. Although the state has failed to send bills for premiums for 2015 coverage to 55,000 Minnesotans, DHS encourages enrollees to continue paying premiums.  The state hopes to handle all renewals by August 31, 2015.

These issues have prompted state Republican legislators to call for the establishment of a legislative oversight committee. Some have even discussed dumping MNsure and using the federal exchange instead. State Senator Tony Lourey believes that this wouldn’t solve the Medicaid and MinnesotatCare issues. Lourey also said that it is time for a meeting of an oversight committee, but that suggestions for fundamental changes should come from a task force already established for the job.

Mental health funding

Also on the line is coverage for mental health services for children. CMS had previously questioned Minnesota’s regulatory compliance for psychiatric residential treatment facilities (PRTFs). This statement expressed the possibility of cutting off federal financial participation (FFP) immediately. The state responded and asked CMS to allow DHS to maintain its current practices regarding mental health care, retroactive to 2001. The letter to CMS, signed by several state legislators, pointed out that Minnesota’s “services have been developed over many years to effectively meet the individual and unique needs of children, adolescents and their families in the state.” The efforts to protect the nearly $5 million in federal funding are led by Senator Al Franken (D) and Representative Erik Paulsen (R).

Federal Medicaid funding was originally excluded for institutions for mental diseases, which are facilities with over 16 beds. A later exception was established for enrollees under 21 years in larger settings, including PRTFs. HHS determines what settings qualify for the exception to the exclusion. With CMS input, Minnesota developed its rehabilitation model in 2001, which “allows for any medical service that has been recommended by a physician or other licensed practitioner for maximum reduction of a disability to be provided in a residential treatment center.”

The program in question is known as the Children’s Residential Bed program, which has 830 beds across the state. For federal funding purposes, a facility that has more than 50 percent of residents admitted for mental health reasons is considered a mental health institution, which cannot accept federal funds. Last year, providers raised concerns about participating facilities’ qualifications for federal funds, which prompted evaluation and inspection of the Children’s Residential Beds facilities that is currently ongoing. The state is urging CMS to stick by the state plan it originally approved and continue providing funding.