Transcript Public Health Programs in Minnesota * What*s Happening Now?

Public Health Care Programs
in Minnesota – Changes With
Health Reform
PRESENTED BY
PORTICO
HEALTHNET
Health Access Line
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 Portico Healthnet operates
the 489-CARE line
(866-489-4899)
 Callers throughout the state
can access information
about low-cost medical,
dental and mental health
resources.
 Uninsured callers are
transferred to Portico’s
Community Health Workers
for assistance in applying
for Minnesota Health Care
Programs or Portico
coverage
Outreach Program
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 Our Community Health
Workers (CHWs) screen for
potential eligibility for
Minnesota Health Care
Programs and MNSure plans
 CHWs assist with the
application and enrollment
process
 Our staff provide linguistically
and culturally appropriate
information and referrals for
the diverse groups we serve.
Portico Healthnet Coverage Program
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 Prevention-based
 Provides coverage for a comprehensive
continuum of services, including:
- Primary and preventive medical care
- Specialty and urgent clinic care
- Outpatient mental health services
- Prescription medications/DME
- Interpreter services for medical appointments
 Care management component helps participants
manage their health and navigate complicated
health care systems
Eligibility Guidelines for Portico Coverage
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 Resident of Dakota, Ramsey, Hennepin or
Washington county
 Uninsured
 Not eligible for Minnesota Health Care Programs
 Income at or below 275% FPL

($63,408 per year for family of 4)
Minnesota Health Care Programs
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 Medical Assistance
 For single adults, families, people over 65, people with disabilities
 You must meet income and asset limits to be eligible
 Applications are processed through the county where you live
 No cost
Minnesota Health Care Programs
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 MinnesotaCare
o For adults without children and
families
o You must meet income and asset
limits to be eligible
o There are rules about other health
insurance available to you
o Income limits higher than
Medical Assistance
o You must pay a monthly fee
to be enrolled
o Application processed by the state
MHCP and Immigration status
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 Minnesota Health Care Programs are not available to
everyone. Immigration status affects whether you can
qualify
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Citizens, refugees, and some permanent residents can qualify
People who are undocumented, people with visas, and people with
work authorizations usually don’t qualify.
In case of an emergency health need, people who don’t usually
qualify might be eligible for Emergency Medical Assistance to cover
a hospital stay or an ER visit.*
*Must meet all other Medical Assistance eligibility guidelines
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Over 60% of
uninsured
Minnesotans
are eligible for
a state-funded
health
coverage
program
Medical Assistance
Barriers to MHCP enrollment:
 Awareness of eligibility
 Complexity of the application
process
 Documentation required
MinnesotaCare
2011- 490,000
uninsured in MN
 Communication with case
workers
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Who will
enroll through
MNSure?
1.1 million
Minnesotans
300,000 previously
uninsured
October 1, 2013
Open Enrollment
began
January 1, 2014
Coverage began
MNSure: Minnesota’s Health
Insurance Exchange
 Online marketplace where people
can find health coverage
 Enroll in public health care
programs
 Compare and purchase private
insurance
 Tax credits for private insurance
 Small Employers
Applying for Coverage Through MNSure
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• Streamlined online

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
application
Streamlined verifications
Renewal improvements
No asset test
New method for
counting income
MAGI
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 Modified Adjusted Gross
Income
 MAGI methodology will be
used to determine
eligibility for certain
Medicaid groups and for
Advanced Premium Tax
Credits (APTC)
 Affects household
composition for certain
Medicaid groups
MA Expansion
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Effective January 1st, 2014
 Income limit for adults is 138% FPL* ($1,316/month for 1 person)
 Will continue to cover childless adults, parents and 19 and 20 year olds
 No asset limit
*Income limit is actually 133% FPL but there is a 5% income disregard which brings the limit to 138% FPL
 Previously no asset test for MA-Expansion group or 19 and 20 year olds. Parents
previously had $20,000 asset limit.
 Parents and 19&20 year olds previously have 100%FPL limit for MA
Income limit for children 0-18 is now 275% FPG
MinnesotaCare
Basic Health Plan
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o
o
o
o
o
o
o
o
2014 Income limit=200% FPL
o Income limit was previously 275% FPL for
parents so this is a step back for them
Remove $10,000 inpatient hospital cap
Remove 4 month and 18 month insurance
barriers
Remove asset limit
Will follow Minimum Essential Coverage
Guidelines
o Affordability- cost no more than 9.5% of
income for self-only coverage
o Plan must cover 60% of the Actuarial
Value
Comply with premium guidelines
o Lower premiums
Use MAGI methodology instead of gross
income
No more sponsor income or asset deeming for
LPR’s
Advance Premium Tax Credits
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 Individuals with household
incomes up to 400% FPG will
now be eligible to receive
Advance Premium Tax
Credits to help them purchase
private insurance through the
Health Exchange-MNSure
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
Household of 1: $45,000/year
Household of4:
$92,000/year
 If individual has access to
Minimum Essential Coverage
they are not eligible to receive
APTC’s
Quality Benefits/Standards for MEC
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 Hospitalizations
 Ambulatory Services
 Emergency Services
 Prescription Drugs
 Laboratory Services
 Maternity and Newborn Care (Pregnancy, childbirth
and breast-feeding support)
 Pediatric Dental and Vision services
 Mental and behavioral health
Free Preventive Services
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 Vaccinations and flu shots
 Blood pressure and diabetes screenings
 Cancer screenings: Mammograms and
Colonoscopies
Out of pocket maximums
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 Everyone who buys coverage through MNsure will have a cap on
their total out-of-pocket spending (includes deductibles, co-pays, coinsurance) for covered services offered by in-network providers

Maximum for individual is $6,350

Maximum for family is $12,700

Some plans offer lower out-of-pocket maximum costs
Options for Coverage in 2014
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MNSure:
Adults
Medical
Assistance
Children
Children0-18
0-18
0%
Private Insurance
With APTC’s
Minnesota
Care
Medical Assistance
138%
200%
~1,322/mo
for HH of 1
~2,611/mo
for HH of 2
~$1,915/mo
for HH of 1
~$3,255/mo
for HH of 4
Children 0-18 will be eligible for MA up to 275%FPG
This does not apply to non-MAGI populations
Private
Insurance
APTC’s
275%
~$3,468/m
o HH of 2
~$5,284/m
o HH of 4
400%
~$3,330/mo
for HH of 1
~$7,850/mo
for HH of 4
Plan Levels of Coverage
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Levels of Coverage
Plan Pays on Average
Enrollees Pay on
Average (in addition
to the monthly plan
premium)
Bronze
60%
40%
Silver
70%
30%
Gold
80%
20%
Platinum
90%
10%
When can you enroll?
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 Initial open enrollment runs October 1, 2013 through
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March 31, 2014
Annual open enrollment periods after that run October
through December
Special enrollment periods available in certain
circumstances throughout the year
Members of federally-recognized tribes may enroll or
change plan designations one time per month
Small employers can enroll/renew throughout the year at
one time of their choosing
Individuals may apply and be eligible for Medicaid
throughout the year
Individual Mandate
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 Must have Minimum
Essential Coverage or
may be subject to a
penalty*
 Some exemptions
granted for religion,
tribal membership, cost
of insurance, and some
other reasons.
Year
Penalty Amount
2014
$95 or 1% of
income
2015
$365 or 2% of
income
2016
$695 or 2.5% of
income
Navigator Role and In Person Assistor Roles
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 New service required by ACA, provided through the state Health Exchange.
Incorporates outreach and enrollment assistance roles
 Portico’s Community Health Workers and Care Management Coordinators are
certified Navigators and IPA’s
 MNSure’s website has a list of all certified Navigators, IPA’s and brokers in the
state.
 Navigators and IPA’s perform same duties, difference has to do with programs
they facilitate enrollment for, funding sources and per-enrollment
compensation.
Portico’s Navigators
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 We are on-site offering
application and
enrollment assistance at
over 10 community sites
 Computer bank events
 We accept new clients
from anywhere in the
state.
Eligibility Tool
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 Simple tool to give
people an idea of
possible eligibility
 To determine actual
eligibility a person
should go to MNSure, a
Navigator or Broker.
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Portico
Healthnet’s
mission is to
reduce the
number of
people without
coverage for
health care
services.
Rebecca Lozano
Outreach Program Manager
[email protected]
651-603-5108
Sara Casey
Outreach Program Supervisor
651-603-5107
[email protected]
Portico Healthnet
2610 University Ave W #550
Saint Paul, MN 55114
651-489-CARE(2273)