Key Policy Decisions in Minnesota’s Basic Health Program

This month, Minnesota will be the first state to submit its blueprint for a Basic Health Program to the federal government for approval. This is the second blog in our series encouraging states to consider Basic Health as a strategy for providing health coverage to low-income residents. Other blogs in this series: 

1.   Why Minnesota and New York Are Pursuing Basic Health Programs
3.   Advocacy Tips for Basic Health Progams

As the first state preparing to implement Basic Health, Minnesota’s decisions about how it designed its program may help guide other states. This list of key policy decisions is drawn from the Blueprint for Basic Health that Minnesota will be submitting to HHS for approval.

1. Charge a premium and establish a cost-sharing scale that are more affordable for consumers than marketplace coverage, with cost-sharing that is similar to Medicaid.

   Why: Low-income residents have tight budgets. Higher premiums deter people from getting coverage, and high out-of-pocket costs deter them from getting care. They are more likely to get, keep, and use coverage if it is affordable. The people served by Basic Health are just beginning to move up the income ladder from poverty to middle class. It is important to protect them from medical debt as they work to do so. Moreover, before the Affordable Care Act, Minnesota already provided affordable public coverage to low-income residents through its MinnesotaCare program. In its Basic Health program blueprint—which will also be called MinnesotaCare—the state chose to continue MinnesotaCare’s low premiums and cost-sharing.

2. For the 2015 coverage year, use Minnesota Medicaid managed care plans to provide care.

   Why: These plans already have experience providing care to low-income residents, and they will allow beneficiaries to maintain continuity of care when people’s eligibility for Medicaid and Basic Health changes. Given the unstable nature of low-wage work, the population with incomes below 200 percent of the federal poverty level often experiences changes in income. [Note: Minnesota is asking for an additional year to comply with the federal Basic Health requirement that states offer consumers a choice of at least two plans in all counties. Some rural counties do not have two plans yet. In 2016, Minnesota will renegotiate contracts to give consumers that choice.]

3. Allow enrollment at any time of year, as in the Medicaid program. Renewal will take place annually, and dates will align with marketplace open enrollment periods. 

   Why: Continuous open enrollment increases opportunities for people to get covered so that they can obtain health services in a timely manner. Enrollees must still report changes in circumstances when they occur, and this could affect their eligibility.

   Note: Other states may wish to opt for continuous eligibility for 12 months with no requirement to report changes in income during the course of the year. The federal Basic Health rules offer this as an option, which can save states and consumers the trouble of updating information midyear and eases the administrative burden on states. Continuous eligibility also helps people maintain coverage throughout a year when their incomes may fluctuate.

4. Use the same appeals process that is used by Medicaid beneficiaries.

   Why: This is already the practice in MinnesotaCare (before it becomes a Basic Health program). The administrative hearing office has experience with MinnesotaCare cases.

5. Use electronic data, when available, to verify information on the application. If data are inconsistent or unavailable, individuals have 90 days to provide correct of missing information. This is the same approach that is used in the marketplace.

   Why:  This allows applicants to get care while they gather the necessary documentation and the state processes it.

6. Offer a set of benefits that is similar to Medicaid and more generous than the “essential health benefits” offered by  private plans sold to individuals. 

   Why: In addition to the essential health benefits, MinnesotaCare currently provides limited dental care for adults, hearing aids, and eyeglasses—services that enrollees need and would not be able to afford on their own. Minnesota will continue providing its current package of benefits.  These benefits play a critical role in enabling people to work.

7. Provide a look-alike program that is state-funded for people ages 65 and over, including lawful residents who are not eligible for Medicaid for five years and those who are not eligible for premium-free Medicare Part A. 

   Why: Federal Basic Health rules restrict eligibility to people under age 65. However, Minnesota has some residents over age 65 who are not eligible for premium-free Medicare because, for example, they and their spouses have less than 10 years of Social Security work history. It also has residents who are not yet eligible for Medicaid because they have resided in the United States for less than five years. Minnesota has provided coverage to this group before with state funds, and it plans to continue to do so.

Read more about Minnesota’s Basic Health program: A discussion draft of Minnesota’s Blueprint for Basic Health, minus the financial section, is available. The comment period ended on November 12. Minnesota will formally submit its Blueprint to the Centers for Medicare and Medicaid Services (CMS) for approval and plans to implement the program in 2015.