Key takeaways
- Minnesota’s first post-pandemic Medicaid disenrollments will come in July 2023
- Minnesota expanded Medicaid under the Affordable Care Act (ACA); enrollment has grown by 54% since 2013.
- Estate recovery in Minnesota is limited to long-term care costs.
- You can enroll in Medicaid in Minnesota online, or get help over the phone or in person.
- MinnesotaCare and Medicaid coverage is provided by managed care organizations and county-based purchasing plans.
How is Minnesota handling Medicaid renewals after the pandemic?
During the COVID pandemic, from March 2020 through March 2023, Medicaid disenrollments have been paused nationwide. Even if a person’s circumstances changed and they were no longer eligible for Medicaid, their coverage has continued unless they’ve requested a termination or moved out of state. But that rule ends March 31, 2023, and states can resume disenrollments as early as April 1, 2023.
Minnesota is waiting a little longer on that, and plans to have its first round of disenrollments in July 2023. Minnesota is going to keep enrollees’ existing renewal date, based on when people enrolled (renewals are normally conducted every 12 months, but that hasn’t been the case during the pandemic). People whose coverage is due to renew in July 2023 will get notifications in the mail in March and/or April, letting them know whether they need to do anything in order to keep their coverage (pre-renewal notices will be sent in March, and renewal packets in April). Here are FAQs about the return to normal eligibility redeterminations in Minnesota.
People with MinnesotaCare (the state’s Basic Health Program, discussed in more detail below) will get their renewal notices in October 2023. But renewals for Medical Assistance (Medicaid) will be spread out throughout the 12-month period that begins in the spring of 2023.
Legislation (HF2286 and SF2265) has been introduced in Minnesota in 2023 which would help to smooth the transition to normal eligibility redeterminations for Medicaid and MinnesotaCare. Among other things, the legislation would:
- Create state-funded cost-sharing reductions for people with income between 200% and 250% of the poverty level, bringing silver plan actuarial value up to 87% for this population (the most robust federal cost-sharing reductions aren’t used in Minnesota, since the state has a Basic Health Program that covers people with income up to 200% of the poverty level).
- Ensure that if a child under the age of 6 is determined eligible for Medicaid, their coverage will continue until they turn 6, without the need for periodic eligibility redeterminations. (HF914, also under consideration in Minnesota in 2023, would provide this same continuous coverage protection for children)
- Ensure that MinnesotaCare premiums will not be collected for months prior to a person’s renewal date (most people do not have to pay a premium for MinnesotaCare, but some do).
- For Medical Assistance (Medicaid) enrollees who are subject to asset tests, including those age 65 and older, assets would be disregarded during their first renewal after the pandemic-era continuous coverage period, and would not be taken into consideration until their second annual renewal.
People who are no longer eligible for Medicaid may find that they’re eligible for MinnesotaCare instead. And people who aren’t eligible for either program are likely to be eligible for either an employer’s health plan or a subsidized policy through MNsure, the state-run exchange.
ACA’s Medicaid eligibility expansion in Minnesota
In February 2013, then-Governor Mark Dayton signed HF9, a bill that expanded access to Medicaid Assistance (Minnesota’s Medicaid program) under the ACA.
HF9 eliminated the asset test for Medicaid eligibility (required under the ACA) and increased the upper income threshold for Medicaid eligibility for adults to 138% of the federal poverty level (133% plus a 5% income disregard, which is standard under the ACA).
As of early 2023, nearly 295,000 Minnesota residents were enrolled in expanded Medicaid. Total Medicaid/CHIP enrollment, including the expansion population, stood at more than 1.3 million at that point. That was an increase of 54% over 2013’s enrollment. That growth is due primarily to Medicaid expansion and the COVID pandemic, including the Families First Coronavirus Response Act that barred states from disenrolling anyone from Medicaid between March 2020 and March 2023. As discussed below, enrollment in Medicaid is expected to gradually decline in 2023 and early 2024, as states return to normal Medicaid eligibility redetermination processes.
Prior to 2014, Medical Assistance in Minnesota was available to parents with dependent children if their household income was up to 100% of poverty, and to adults without dependent children if their household income was up to 75% of poverty. Minnesota was already very progressive in providing Medicaid access for most of the state’s low-income population — in many states there was no coverage at all for childless non-disabled adults prior to 2014, and in a dozen states that haven’t expanded Medicaid under the ACA, there still isn’t.
The federal government pays 90% of the cost of covering the newly eligible Medicaid population, while the state covers the other 10%.
Minnesota has accepted federal Medicaid expansion
- 1,395,209 – Number of Minnesotans covered by Medicaid/CHIP as of February 2023
- 522,169 – Increase in the number of Minnesotans covered by Medicaid/CHIP fall 2013 to February 2023
- 51% – Reduction in the uninsured rate from 2010 to 2021
- 60%– Increase in total Medicaid/CHIP enrollment in Minnesota since late 2013
Minnesota Medicaid estate recovery is now limited to cases in which long-term care was provided
Minnesota’s Medicaid program has utilized estate recovery (required under state and federal law) since 1967 as a means of recouping Medicaid costs after an enrollee dies. The estate recovery program applies to people who were 55 or older at the time they incurred Medicaid claims, and the program allowed the state to place liens against the enrollees’ estates, so that some or all of the money would be paid back to the state.
Prior to the ACA, the vast majority of adults 55 or older who were covered by Medicaid were elderly, low-income residents who needed long-term care (Medicare does not cover long-term care, but Medicaid does if the person’s income and assets are low enough). But starting in 2014, large numbers of residents — many of whom were 55 or older — became eligible for Medicaid, and many were caught off-guard when they found out that liens were being filed against their estates.
Lawmakers addressed the issue in 2016, amending the state’s existing protocol for Medicaid estate recovery. The state announced that pending federal approval, Medicaid estate recovery in Minnesota would be limited to cases in which long-term care was covered. The state intended to make that change retroactive to January 2014, but CMS did not grant approval for that. Instead, the new rules, which limit estate recovery to long-term care costs, apply to estate claims that were pending as of July 1, 2016, and to the estates of people who die after July 1, 2016.
Minnesota Care available up to 200% of poverty
In addition to Minnesota Medicaid, the state supports Minnesota Care (MNCare) for residents with incomes above 138% of poverty, up to 200% of poverty. MNCare has existed in Minnesota since 1992, but it became a much more robust program in 2014. As of January 2015, MinnesotaCare transitioned to a Basic Health Program under the ACA. BHPs are a provision of the ACA that any state can implement, but Minnesota was the only state to do so for 2015. New York established a BHP, effective January 2016, and Oregon is considering on that would be up and running by 2026.
Numerous improvements were made to MNCare effective January 1, 2014. The program no longer has a $1,000 copay for hospitalization, or a $10,000 cap on inpatient benefits. The asset test has been eliminated just as it was for Medicaid, and premiums have been significantly reduced. It used to be available only to applicants who had been uninsured for at least four months, but that provision was eliminated in 2014.
Legislation (SF49) is under consideration in Minnesota that would create a public option via a MinnesotaCare buy-in program. Similar legislation (HF11) was considered in 2022, but did not advance to a vote.
Unlike Minnesota’s Medicaid program, MNCare has a small monthly premium that ranges as high as $28 (this was as high as $80/month before the American Rescue Plan increased federal health insurance subsidies). The premium is calculated on a sliding scale and not applicable to most enrollees. The preferred enrollment method is through MNsure. Enrollment in Minnesota Medicaid and MinnesotaCare is open year-round. As of early 2023, there were 104,996 people enrolled in MinnesotaCare. As noted above, disenrollments for MinnesotaCare have been paused during the pandemic, just like disenrollments for Medicaid. But MinnesotaCare renewals (and disenrollments) will resume in October 2023.
Federal funding for MinnesotaCare (and New York’s BHP, The Essential Plan) was reduced when the Trump administration cut off funding for cost-sharing reductions. The two states sued, and in August 2018 the federal government agreed to restore most of the federal funding for 2018.
Who is eligible for Medicaid in Minnesota?
In addition to the aged, blind, and disabled populations, residents who meet the below requirements are eligible for Medicaid in Minnesota:
- Adults with household incomes up to 138% of poverty (adults with incomes above 138% of poverty but not more than 200% of poverty are eligible for coverage under MNCare).
- Pregnant women with household incomes up to 278% of poverty (coverage for the mother continues for 12 months after the baby is born)
- Children 0-2 in households with income up to 283% of poverty.
- Children from 2-18 in households with income up to 275% of poverty.
How does Medicaid provide assistance to Medicare beneficiaries in Minnesota?
Many Medicare beneficiaries receive assistance through Medicaid with the cost of Medicare premiums, co-pays, deductibles, and services not covered by Medicare — such as long-term care.
Our guide to financial assistance for Medicare beneficiaries in Minnesota explains these benefits, including Medicare Savings Programs, Extra Help, long-term care coverage, and income guidelines for assistance.
How do I enroll for Medicaid in Minnesota?
If you’re under 65 and not on Medicare:
- You can enroll in Medicaid online at MNsure, the state-run health insurance exchange.
- You can call 855-366-7873 for help enrolling or to locate a navigator in your area who can assist you with the enrollment process in person.
- You can enroll in person at your County Human Services office (includes Tribal Health Care offices).
If you are 65 or older or have Medicare, visit one of these websites (seniors and people with disabilities) for help applying for Medicaid.
Minnesota Medicaid enrollment
In the fall of 2013, prior to the launch of the ACA’s exchanges, Minnesota’s total Medicaid/CHIP enrollment stood at 873,040.
There were 144,481 new Medicaid enrollments through MNsure, the state-run exchange, from October 2013 through April 2014, and total enrollment in Minnesota’s Medicaid program increased by more than 22% from 2013 to 2014. Many of these new enrollees were already eligible prior to 2014, but were not aware of their eligibility.
MNsure Navigator organizations made a concerted effort to reach out to populations that have historically been underserved by the health insurance market, helping them to enroll through MNsure. Many of the enrollees helped by the navigator organizations are eligible for Medicaid and were uninsured prior to 2014.
As of late 2022, there were a total of 1,344,631 people enrolled in Medicaid/CHIP in Minnesota. Most of these enrollees (1,318,400) were enrolled in managed care programs as of early 2023. Eight managed care plans support Minnesota’s Medicaid and MinnesotaCare programs: Blue Plus, Health Partners, Hennepin Health, Itasca Medical Care, Medica, PrimeWest Health, South Country Health Alliance, and UCare.
Minnesota Medicaid history
Minnesota was one of the six states that enacted Medicaid as soon as the program became available, in January 1966.
In the 1980s, in an effort to control costs, Minnesota began implementing PMAP, or pre-paid medical assistance programs. PMAPs provide blocks of Medicaid funding to non-profit HMOs and a variety of rural health programs across the state. The program was instituted as a demonstration project in 1983 and continued to be the mechanism by which Medicaid funds are dispersed to providers in Minnesota for decades.
The Minnesota Department of Human Services was tasked with setting rates for the payments that HMOs receive in the Medicaid PMAP. Over the years, there have been improvements made to ensure that the various participating HMOs are using uniform reporting methods for their administrative expenses.
Minnesota had some of the country’s most generous eligibility guidelines for Medicaid prior to expansion under the ACA (up to 100% of poverty for adults with dependent children, and up to 75% of poverty for those without dependent children). And the state also became the first in the nation to establish a Basic Health Program under the ACA.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.