Public Health Care Programs in Minnesota – Changes With H ealth Reform

1. Public Health Care Programs in Minnesota – Changes With Health Reform Presented by Portico Healthnet

2. Health Access Line • 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

3. Outreach Program 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.

4. Portico Healthnet Coverage Program • 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

5. Eligibility Guidelines for Portico Coverage • 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)

6. Minnesota Health Care Programs • 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

7. Minnesota Health Care Programs • MinnesotaCare • For adults without children and families • You must meet income and asset limits to be eligible • There are rules about other health insurance available to you • Income limits higher than Medical Assistance • You must pay a monthly fee to be enrolled • Application processed by the state

8. MHCP and Immigration status • Minnesota Health Care Programs are not available to everyone. Immigration status affects whether you can qualify • 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

9. Barriers to MHCP enrollment: • Awareness of eligibility • Complexity of the application process • Documentation required • Communication with case workers Over 60% of uninsured Minnesotans are eligible for a state-funded health coverage program Medical Assistance MinnesotaCare 2011- 490,000 uninsured in MN

10. 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 Who will enroll through MNSure? 1.1 million Minnesotans 300,000 previously uninsured October 1, 2013 Open Enrollment began January 1, 2014 Coverage began

11. Applying for Coverage Through MNSure • Streamlined online application • Streamlined verifications • Renewal improvements • No asset test • New method for counting income

12. MAGI 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

13. MA Expansion 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

14. MinnesotaCare Basic Health Plan • 2014 Income limit=200% FPL • 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 • Affordability- cost no more than 9.5% of income for self-only coverage • Plan must cover 60% of the Actuarial Value • Comply with premium guidelines • Lower premiums • Use MAGI methodology instead of gross income • No more sponsor income or asset deeming for LPR’s

15. Advance Premium Tax Credits • 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 • 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

16. Quality Benefits/Standards for MEC 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

17. Free Preventive Services Vaccinations and flu shots Blood pressure and diabetes screenings Cancer screenings: Mammograms and Colonoscopies

18. Out of pocket maximums • Everyone who buys coverage through MNsure will have a cap on their total out-of-pocket spending (includes deductibles, co-pays, co-insurance) 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

19. Options for Coverage in 2014 MNSure: Private Insurance With APTC’s Medical Assistance Minnesota Care Adults Private Insurance APTC’s Children 0-18 Children 0-18 Medical Assistance 0% 200% ~$1,915/mo for HH of 1 ~$3,255/mo for HH of 4 400% ~$3,330/mo for HH of 1 ~$7,850/mo for HH of 4 138% ~1,322/mo for HH of 1 ~2,611/mo for HH of 2 275% ~$3,468/mo HH of 2 ~$5,284/mo HH of 4 Children 0-18 will be eligible for MA up to 275%FPG This does not apply to non-MAGI populations

20. Plan Levels of Coverage

21. When can you enroll? Initial open enrollment runs October 1, 2013 through 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

22. Individual Mandate 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.

23. Navigator Role and In Person Assistor Roles 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.

24. Portico’s Navigators 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.

25. Eligibility Tool Simple tool to give people an idea of possible eligibility To determine actual eligibility a person should go to MNSure, a Navigator or Broker.

26. Portico Healthnet2610 University Ave W #550 Saint Paul, MN 55114651-489-CARE(2273) Portico Healthnet’s mission is to reduce the number of people without coverage for health care services. Rebecca Lozano Outreach Program Manager rlozano@porticohealthnet.org 651-603-5108 Sara Casey Outreach Program Supervisor 651-603-5107 scasey@porticohealthnet.org