As Congress fights over health care, low-income Minnesotans have affordable insurance

BY T.W. BUDIG

ECM Capitol Reporter

The federal Patient Protection and Affordable Care Act, upheld June 28 by the U.S. Supreme Court, was passed by Congress in 2010 to make health insurance more available and affordable for all Americans. Its major provisions don’t take effect, however, until 2014.

But Minnesota already has a program for those who are unable to find affordable health insurance. It’s called MinnesotaCare, a state program providing health care coverage for lower income people.

First started in 1992, MinnesotaCare was envisioned as a stepping stone for people caught in the gap between being eligible for other state health care programs and affordable private sector health insurance.

"It’s helped a lot of people," said House Health and Human Services Finance Committee Chairman Jim Abeler, R-Anoka, who tempered his assessment with criticism of the program.

But MinnesotaCare was nation-leading, Abeler said.

Last year, about 148,000 Minnesotans per month enrolled in MinnesotaCare, which cost the state, the federal government and insurance consumers about $737 million, according to the Department of Human Services.

There are eligibility requirements. Besides needing to meet income requirements – adults without children in two-person households cannot make more than $2,522 per month, for instance – applicants cannot be otherwise insured, including through Medicare, and in general cannot have been covered by other insurance within the last four months.

Applicants must be state residents and U.S. citizens.

Premiums are determined on a sliding-fee scale, taking into account the size of family and incomes.

The average monthly premium paid last year by clients in MinnesotaCare was $23, with some children covered for just $4 per month, according to the human services department.

Costs vary among the various MinnesotaCare programs.

In MinnesotaCare Expanded – health care for pregnant women and children under 21 – there are no copays or deductibles under program guidelines.

In MinnesotaCare Basic Plus One – health care for adults without children – thereare prescription copays and certain program limitations.

Funding for MinnesotaCare has been controversial.

To a large extent, the program is funded through a tax on hospitals and health care providers – a so-called "sick tax" hotly debated at the Capitol.

Revenue from the provider tax is amassed in the Health Care Access Fund.

Other funding sources for MinnesotaCare include federal matching funds with a smaller funding source being client premiums.

Lawmakers last year set an ending date for the MinnesotaCare provider tax – the sunset date is in 2019.

In the meantime, the Minnesota Office of Management and Budget is to annually determine whether the tax rate can be lowered.

In an email, Human Services Commissioner Lucinda Jesson indicated that though changes to MinnesotaCare are anticipated, the results could be enrollees end up with even better health care coverage.

Some MinnesotaCare enrollees, for instance, will be eligible for Medicaid under the recent Medicaid expansion – this could mean better benefits at lower out-of-pocket costs, she noted.

The Governor’s Health Reform Task Force is currently studying how best to manage single adults making above the 138 percent poverty line currently eligible for MinnesotaCare.

Options include establishing a variation of MinnesotaCare utilizing additional federal funding, or ending MinnesotaCare and letting single adults obtain health care coverage, with federal subsides, through the insurance health care exchanges mandated by the federal law.

Other options are being considered.

The task force is expected to make recommendations to the governor before the start of the regular legislative session in January.

"In short, people on MinnesotaCare today will not be left without coverage," Jesson notes.

Indeed, health insurance coverage will broaden, in many cases offering better coverage than currently found in MinnesotaCare, explained Jesson.

MinnesotaCare is not the largest state-funded health care program.

Medical Assistance (MA), with a monthly enrollee average of 666,000 Minnesotans last year, is bigger.

According the human service department, the federal share of MA funding, last year at $4.5 billion, is the largest source of federal funding in the state budget.

The state’s share of MA was $2.9 billion.

It is now possible to apply online for most state health care assistance programs.

Prospective applicants can visit: applymn.dhs.mn.gov.

T.W. Budig is the Capitol Reporter for ECM Publishers.

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