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Some MinnesotaCare clients paying too much

Roughly 30,000 MinnesotaCare enrollees are still paying monthly premiums higher than they are supposed to be charged in the wake of changes to the program enacted by state lawmakers last year as part of federal health reform.

The margin of overpayment varies. But owing to the 2013 changes in the law, nearly 14,000 MinnesotaCare enrollees — mainly single adults making up to 200 percent of federal poverty guidelines — were supposed to see premiums reduced by roughly 50 percent.

“I think it is certainly important that people not be required to pay more than they are supposed to be required to pay for the longer term,” said Sarah Greenfield, health care program manager at TakeAction Minnesota, a progressive organization. “It’s not clear to me if that’s something that’s already being resolved.”

DHS representatives say the department plans to pay the money back to consumers once the transition is completed. Just how much the state will have to pay for reimbursements is unclear, according to the agency.

“It is a problem that these MinnesotaCare enrollees are not in MNsure and paying the new premiums,” DHS Deputy Commissioner Chuck Johnson said in an email.

The issue is one of many problems with MNsure’s rocky rollout. Though the state appears to have stopped the bleeding, technical issues made it nearly impossible for some consumers to secure coverage and created headaches for many others. So far, problems with the private consumer experience have been more widely reported than issues with public program enrollment.

“We are delaying their conversion to the MNsure system to ensure that the new system has the functionality to re-enroll them without issues,” wrote Johnson. “When they are moved to the new system, enrollees will receive refunds for the difference between the new premiums and the premiums they are now paying.”

The move doesn’t affect new MinnesotaCare enrollees, so advocates have noted that the higher monthly price likely didn’t dissuade eligible people from enrolling in the public program. There are at least 37,000 new MinnesotaCare enrollees, according to the exchange.

Single adults will see lower cost

Childless adults that are between 133 percent and 200 percent of the federal poverty level would see the most benefits in MinnesotaCare’s new premium structure. The previous premiums sat at between 2.9 percent and 5.6 percent of consumers’ income, while the new ones fell to between 1.7 percent and 2.7 percent of the same measure.

For a childless adult at 150 percent of the federal poverty level, that plays out to a $49 premium under the old pricing, while the new premium for that person should be $29.

“When your budget is smaller, every dollar counts.” Greenfield said.

The state plans to move those people onto the new system by June 2014, according to a DHS document obtained by Capitol Report. DHS had hoped to make the transition before 2014.

Other technical issues with state systems leading into December made the exchange late in sending out membership cards to 27,000 public program enrollees. Those issues didn’t affect coverage.

The premium reduction for single parents with children is “less dramatic,” according to the Department of Human Services. Parents with children would see premium payments decrease from a range of 1 percent to1.9 percent of their income to between 1 percent and 1.6 percent. Nearly 14,000 parents are paying the slightly higher rate.

Greenfield credited the state for taking a conservative approach to the new system in order to make sure consumers maintain coverage — as long as they’re eventually reimbursed for the extra costs.

Program in transition

MinnesotaCare currently operates as a Medicaid waiver program for the working poor, and it will transition into a “Basic Health Program” — as prescribed in the federal Affordable Care Act — with a different funding structure beginning in 2015. Greenfield praised MinnesotaCare for providing significant benefits to low-income Minnesotans who would otherwise fall into the “bronze trap” of low-premium, high-deductible private insurance.

Incomes for a single adult MinnesotaCare enrollee range from about $15,000 to roughly $23,000. A family of four would need to earn between roughly $31,000 and $47,000 to be eligible for the program. People who earn less than those thresholds are typically eligible for Medical Assistance (Medicaid). Enrollment in that program has far exceeded what state forecasters originally expected.

DFL Rep. Tom Huntley, who chairs the House Health and Human Services Finance Committee, said he wasn’t familiar with the disparity. DFL Rep. Tina Liebling, chairwoman of the House HHS Policy Committee said it’s troubling that two groups of people accessing the same program aren’t being treated the same.

“If it’s occurring, sure, I mean it means some people haven’t been transitioned to the new program entirely, and I can’t imagine why that would be happening, so I’ll have to check into that,” Liebling said when asked about the disparity, with which she was also unfamiliar. “I’ll have to check in and see what this is about.”

There are slightly more than 2,000 people unaffected by the lag in moving over to the new system. More than 180,000 people have signed up for coverage on the commercial side of MNsure, which offers tax credits to subsidize people buying insurance.

About James Nord

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