Who is eligible
Children up to 1 year with household income up to 283% of FPL. Children ages 1-18 with household income up to 275% of FPL. Pregnant women with household income up to 278% of FPL. Adults with household income up to 138% of FPL; adults with income between 138% and 200% of FPL qualify for MNCare.
- healthinsurance.org contributor
- November 18, 2015
- Minnesota has expanded Medicaid under the ACA.
- Coverage is available for adults if household income does not exceed 133% of poverty (MNCare, with a small monthly premium, is available for those with income up to 200% of poverty), for infants with household income up to 283% of poverty, for children 1 – 18 with household incomes up to 275% of poverty, and for pregnant women with household incomes up to 278% of poverty.
- You can apply online at MNsure, you can print a paper application, you can get help enrolling by phone at 855-366-7873, or you can get in-person assistance at your County Human Services office.
Medicaid expansion in Minnesota
In February 2013, Governor Mark Dayton signed HF9, a bill that expanded access to Medicaid Assistance (Minnesota’s Medicaid program) under the ACA. The measure was expected to provide health coverage for 35,000 newly-eligible Minnesota residents.
HF9 eliminated the asset test for Medicaid eligibility (required under the ACA) and increased the upper income threshold for Medicaid eligibility for adults to 133 percent of poverty, plus a 5 percent income disregard (standard under the ACA).
Prior to 2014, Medical Assistance in Minnesota was available to parents with dependent children if their household income was up to 100 percent of poverty, and to adults without dependent children if their household income was up to 75 percent 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 states that haven’t expanded Medicaid under the ACA, there still isn’t.
The federal government is paying the full cost of covering the newly-eligible Medicaid population through 2016. After that, the state will gradually start to pay a portion of the cost, but the state’s share will never exceed 10 percent. A few weeks prior to passage, an amendment had been added to HF9 that would allow Medicaid expansion to expire if the federal government ever defaults on its promise to always pay at least 90 percent of the cost of covering the newly-eligible population. But that amendment was removed from the bill prior to passage.
Minnesota Care available up to 200% of poverty
In addition to Medical Assistance Medicaid, the state also provides Minnesota Care (MNCare) for residents with incomes above 138 percent of poverty, up to 200 percent of poverty. MNCare has existed in Minnesota since 1992, but it became a much more robust program in 2014. And 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 has now also established a BHP, effective January 2016.
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.
Unlike Medical Assistance, MNCare has a small monthly premium that ranges as high as $80, but calculated on a sliding scale and not applicable to some enrollees. The preferred enrollment method is through MNsure, but you can also print a paper application for MinnesotaCare. Like Medical Assistance, enrollment in MinnesotaCare is open year-round. By September 2015, average monthly enrollment in MinnesotaCare was roughly 100,000 to 117,000. A quarter of the insureds are new enrollees, while the rest were already on MinnesotaCare in 2014.
In the 2017 fiscal year, MinnesotaCare enrollment is projected to be 121,155 people, and the program’s cost is projected to be $824 million. Of that, $351 million will be federal funds and $438 million will be state funds. The remaining $34 million will come from enrollees’ premiums.
MinnesotaCare coverage is provided by eight managed care organizations and county-based purchasing plans in 2015,
Who is eligible for Minnesota Medicaid?
In addition to the aged, blind, and disabled populations, the following Minnesota residents are eligible for Medical Assistance:
- Adults with household incomes up to 138 percent of poverty (adults with incomes above 138 percent of poverty but not more than 200 percent of poverty are eligible for coverage under MNCare).
- Pregnant women with household incomes up to 278 percent of poverty.
- Infants during their first year, with household income up to 283 percent of poverty.
- Children 1 – 18 with household incomes up to 275 percent of poverty.
How do I enroll?
- You can enroll in Medicaid online at MNsure, the state-run health insurance exchange.
- You can print a paper application.
- 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).
How many people have enrolled?
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 had grown to 1,066,787 by August 2014, an increase of more than 22 percent over the enrollment total prior to October 2013. Many of these enrollees were already eligible prior to 2014, but were not aware of their eligibility.
By August 2015 however, total Medicaid/CHIP enrollment had declined slightly, to 1,019,309 (still 17 percent higher than it had been in 2013). The uninsured rate in Minnesota had fallen to just 4.6 percent by the first half of 2015, according to Gallup data. That was down more than 50 percent from the 9.5 percent uninsured rate in the state in 2013.
MNsure Navigator organizations have 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 are insured for the first time in 2014.
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, but has continued to be the mechanism by which Medicaid funds are dispersed to providers in Minnesota for three 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 percent of poverty for adults with dependent children, and up to 75 percent 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.