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ACA Implementation, MNsure & DHS Systems Modernization NAMI Annual Conference November 16, 2013

ACA Implementation, MNsure & DHS Systems Modernization

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ACA Implementation, MNsure & DHS Systems Modernization. NAMI Annual Conference November 16, 2013. Agenda. Minnesota’s New Health Care Landscape MA and MinnesotaCare Changes MNsure New Options for Certain Lower Income Groups Moving from Legacy Systems to the new system - PowerPoint PPT Presentation

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Page 1: ACA Implementation,  MNsure & DHS Systems Modernization

ACA Implementation, MNsure &

DHS Systems Modernization

NAMI Annual ConferenceNovember 16, 2013

Page 2: ACA Implementation,  MNsure & DHS Systems Modernization

Agenda

Minnesota’s New Health Care Landscape

MA and MinnesotaCare Changes

MNsure

New Options for Certain Lower Income Groups

Moving from Legacy Systems to the new system

MNsure Consumer Assistance

Q & A

Page 3: ACA Implementation,  MNsure & DHS Systems Modernization

New Vocabulary Advance Premium Tax Credits (APTC)

Payments of a premium tax credit on an advance basis to help individuals purchase and enroll in a qualified health plan (QHP) through MNsure.

Insurance Affordability Programs (IAPs) Financial assistance programs available through MNsure including Medical Assistance

(MA), MinnesotaCare, and APTC.

Modified Adjusted Gross Income (MAGI) The measurement of income for eligibility determination for all Insurance Affordability

Programs (IAPs) starting in 2014.

MNsure A new, one-stop health insurance marketplace where Minnesotans can find, compare,

choose, and obtain private and public health care coverage that best fits their needs.

Qualified Health Plan (QHP) A private health insurance plan that is certified to be issued through MNsure.

Page 4: ACA Implementation,  MNsure & DHS Systems Modernization
Page 5: ACA Implementation,  MNsure & DHS Systems Modernization

MA Eligibility Changes 1/1/2014

Changes to Income and Asset Standards Increase in income standards

Children under age 19 – 275% FPG

Children ages 19-20 – 133% FPG

Parents and caretakers – 133% FPG

Adults without children – 133% FPG

Asset test for parents and caretakers is eliminated

Changes to Income Methodology Modified Adjusted Gross Income (MAGI) methodology for children

and adults under age 65 whose MA eligibility is not based on disability

MAGI is based on a household’s taxable income and tax filing unit as stated on the tax return with some adjustments

Page 6: ACA Implementation,  MNsure & DHS Systems Modernization

MinnesotaCare Eligibility Changes 1/1/2014 Changes to Income and Asset Standards

19-20 year old children and adults with income > 133%-200% FPG

Children under 19 who are not eligible for MA solely due to federal household composition rules with income 0%-200% FPG

Lawfully present noncitizens who are ineligible for MA because of immigration status with income 0%-200% FPG

Asset test for parents and caretakers is eliminated

Individuals who are eligible for MA are not eligible for MinnesotaCare

Changes to Income Methodology Modified Adjusted Gross Income (MAGI)

Page 7: ACA Implementation,  MNsure & DHS Systems Modernization

MinnesotaCare Eligibility Changes 1/1/2014 (continued) Changes to Insurance Barriers

4-month waiting period for individuals who had access to other coverage or who fail to pay a premium is eliminated

18-month waiting period for individuals who had access to employer-subsidized insurance is eliminated

Insurance barrier on other current health insurance remains

Individuals who have access to affordable ESI where the employee premium is within 9.5% of household income and the employer plan covers at least 60% of the costs incurred by those covered under the plan.

Page 8: ACA Implementation,  MNsure & DHS Systems Modernization

MinnesotaCare Eligibility Changes 1/1/2014 (continued) Changes to Verification Requirements

Relies on electronic data sources. If not available, self-attestation accepted and used to determine eligibility. Verification must be provider during the reasonable opportunity period (95 days).

Changes to Covered Services $10,000 annual cap on inpatient hospital services eliminated

10% co-pay (up to $1,000) on inpatient hospital services eliminated

Changes to Premium Scale Each individual required to pay a premium based on income level

Aligns premiums across all family sizes based on income level

Page 9: ACA Implementation,  MNsure & DHS Systems Modernization

MinnesotaCare Premium Table 1/1/14FPG Greater Than or Equal

ToFPG Less Than Individual Premium

Amount

0% 55% $455% 80% $680% 90% $890% 100% $10

100% 110% $12110% 120% $15120% 130% $18130% 140% $21140% 150% $25150% 160% $29160% 170% $33170% 180% $38180% 190% $43190% $50

Page 10: ACA Implementation,  MNsure & DHS Systems Modernization

Changes Affecting MA and MinnesotaCare 1/1/2014 Applications may be submitted via the web, mail, telephone or in

person.

Eligibility renewed on an annual basis.

Verification of eligibility factors will be conducted via electronic data sources to the extent possible.

Hospitals participating in MA may make presumptive eligibility determinations for all populations.

Page 11: ACA Implementation,  MNsure & DHS Systems Modernization

New Option in Medical Assistance – 1/1/14

MA Adult Group

MADisability

MA-EPD MinnesotaCare

Income Limit

133% FPL 100% FPL N/A Earned Income

200% FPL

Asset Test No $3,000 $20,000 No

Premiums None None Yes Yes

Disability Certification

Required

No Yes Yes No

Waiver Services

Not Available

Available Available Not Available

Other Insurance

Allowed Allowed Allowed Not Allowed

Page 12: ACA Implementation,  MNsure & DHS Systems Modernization

Coverage Changes

45,000 new enrollees in MA

MinnesotaCare enrollment expected to be 193,000 by 2016

110,000 current MinnesotaCare enrollees move to MA

10,000 current MinnesotaCare enrollees move to Tax Credits

32,000 current MinnesotaCare enrollees remain on MinnesotaCare

40,500 new MinnesotaCare enrollees in January 2014

143,000 new MinnesotaCare enrollees by January 2015

Number of Uninsured Expected to Decline

From 500,000 to 160,000 by 2016 – 68% reduction!

Page 13: ACA Implementation,  MNsure & DHS Systems Modernization

Thank You!

Questions?

Page 14: ACA Implementation,  MNsure & DHS Systems Modernization

Questions?

April Todd-Malmlov, [email protected]

651.539.1320

James Golden, [email protected]

651-431-2151

Karen Gibson, [email protected]

651-431-2297

Susan Hammersten, [email protected]

651-431-4869

Jennifer [email protected]

651.539.1996