S.F. No. 32 establishes a defined contribution program for MinnesotaCare enrollees who are adults without children or families with children upon federal approval with family incomes equal to or greater than 133 percent of the federal poverty guidelines (FPG). The program would require the enrollee to use the defined contribution to purchase health coverage through the health plan offered in the private market or through the Minnesota Comprehensive Health Association (MCHA).
Section 1 (62E.14, subdivision 4f) specifies that a person who is eligible for the Healthy Minnesota Contribution Program may enroll in MCHA with a waiver of the preexisting condition limitation if the person has been denied coverage in the individual market.
Section 2 (256B.04, subdivision 18) requires the Commissioner of Human Services to modify the Minnesota health care programs application form to ask applicants if they are U.S. military veterans.
Section 3 ( 256L.031) establishes the Healthy Minnesota Contribution Program.
Subdivision 1, paragraph (a), requires the Commissioner of Human Services, beginning January 1, 2012, to provide MinnesotaCare enrollees who are adults without children with gross family income equal to or greater than 133 percent of FPG and families with children, upon federal approval, with gross family income equal to or greater than 133 percent of FPG with a monthly defined contribution in order to purchase health coverage through a health plan in the private individual market.
Paragraph (b) exempts these MinnesotaCare enrollees from MinnesotaCare premiums and the required enrollment in a managed care plan or a county-based purchasing plan.
Paragraph (c) states that the MinnesotaCare provisions related to covered services (Minnesota Statutes, section 256L.03), cost sharing (section 256L.03, subdivision 5), the effective date of coverage (section 256L.05, subdivision 3), and provider payments (section 256L.11) do not apply to these enrollees. This paragraph also states that the covered services, cost sharing, disenrollment for nonpayment of premiums, appeal rights and complaint procedures, and the effective date of coverage for enrollees are, instead, provided by the terms of the health plan purchased by the enrollee.
Paragraph (d) specifies that unless otherwise provided in this section, all MinnesotaCare requirements related to eligibility, income and asset methodology, income reporting, and program administration continue to apply.
Subdivision 2 allows enrollees to use up to the monthly defined contribution as determined under subdivision 3 to pay premiums for coverage under a health plan.
Subdivision 3, paragraph (a), requires the commissioner to determine the defined contribution amount using a sliding scale, under which the per person defined contribution is a function of age and income. This paragraph specifies that the monthly per person base contribution ranges from $122.79 for persons under the age of 21 to $357.19 for persons age 60 and over. The base contribution is multiplied by a percentage inversely related to income, ranging from 150 to 80 percent, to obtain the monthly per person defined contribution amount.
Paragraph (b) requires the defined contribution amount calculated under paragraph (a) to be increased by 20 percent for enrollees who are denied coverage in the private individual market and who purchase coverage through MCHA.
Paragraph (c) states that notwithstanding paragraphs (a) and (b), the monthly defined contribution shall not exceed 90 percent of the monthly premium for the health plan purchased by the enrollee, and shall be reduced by five percent if the health plan the enrollee chooses to purchase does not include coverage for mental health and chemical dependency treatment services.
Subdivision 4 requires the commissioner to administer the defined contributions by calculating and processing defined contributions for enrollees and paying the defined contribution to the health plan companies or MCHA, as applicable.
Subdivision 5 requires the Commissioner of Human Services, in consultation with the Commissioner of Commerce, to develop an efficient and cost-effective method to refer eligible enrollees to professional insurance agent associations.
Subdivision 6 states that beginning January 1, 2012, MinnesotaCare enrollees who are eligible under this section, and who are denied coverage in the individual market are eligible for coverage through MCHA and may enroll in MCHA in accordance with chapter 62E. This paragraph also states that any difference between the revenue and covered losses to MCHA related to the implementation of this section shall be paid to MCHA from the health care access fund.
Subdivision 7 requires the commissioner to seek all federal approvals and waivers necessary to implement coverage for enrollees eligible as families and children with gross family incomes equal to or greater than 133 percent of FPG in order to continue to receive federal funds.
Subdivision 8 states that this section will sunset upon the full implementation of the Patient Protection and Affordable Care Act (ACA). For purposes of this section, "full implementation" means premium credits and cost-sharing subsidies are available for health plans offered in Minnesota through a health insurance exchange as required under ACA.
Section 4 (256L.05, subdivision 6) States that the commissioner is required to ensure that all MinnesotaCare applicants with gross family incomes less than 133 percent of FPG who identify themselves as a veteran are referred to a county veteran’s service office for assistance in applying to the U.S. Department of Veterans Affairs for any VA benefits for which they are eligible.
Section 5 requires the Commissioner of Human Services to develop and present to the Legislature by December 15, 2011, a plan to redesign service delivery for MinnesotaCare enrollees who are adults without children or families with children with incomes less than 133 percent of FPG. This section also specifies the plan criteria and requires the commissioner to consider innovative methods of service delivery, including, but not limited to, increasing the use and choice of private health plan coverage and encouraging the use of community clinics as health care homes.
Section 6 requires the Commissioner of Human Services to apply for a federal waiver in order to include in the Healthy Minnesota Contribution Program families with children and, in the alternative, the parents of families with children who may be eligible.