HF 181

1st Committee Engrossment - 86th Legislature (2009 - 2010) Posted on 03/19/2013 07:28pm

A bill for an act
relating to health; simplifying enrollment and renewal procedures for
medical assistance and MinnesotaCare; changing eligibility provisions for
MinnesotaCare; changing coverage provisions and sliding fee scale for
MinnesotaCare; amending Minnesota Statutes 2008, sections 256.962,
subdivision 2; 256L.04, subdivisions 1, 7a, by adding a subdivision; 256L.05,
subdivisions 3, 3a; 256L.07, subdivisions 1, 2, 3, by adding a subdivision;
256L.15, subdivisions 2, 3; 256L.17, subdivision 5; proposing coding for new
law in Minnesota Statutes, chapter 256; repealing Minnesota Statutes 2008,
section 256L.17, subdivision 6.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

new text begin [256.0122] SIMPLIFICATION OF ENROLLMENT AND RENEWAL
PROCEDURES.
new text end

new text begin Subdivision 1. new text end

new text begin Preprinted forms for renewals. new text end

new text begin For children enrolled in medical
assistance or MinnesotaCare, the commissioner shall develop a preprinted renewal form
that contains the child's income information available to the commissioner. This form
must be mailed to the parent of the child prior to the child's renewal date, along with a
notice to the parent that eligibility of the child for medical assistance or MinnesotaCare
shall be renewed based on the information contained in the form. The parent must review
the information and if the information is no longer accurate, indicate this on the form
and return the form to the commissioner with the current information. If the form is not
returned, the commissioner shall determine eligibility for the child based on information on
the form. Nothing in this subdivision shall be construed as prohibiting the commissioner
from verifying income through electronic or other means. If the commissioner determines
that the child is no longer eligible, the commissioner shall disenroll the child.
new text end

new text begin Subd. 2. new text end

new text begin Continuous eligibility. new text end

new text begin Children under the age of 19 who, at the
time of application or renewal, meet the eligibility criteria for medical assistance or
MinnesotaCare, shall be continuously eligible for the program for 12 months or until the
child reaches age 19, whichever is earlier.
new text end

new text begin Subd. 3. new text end

new text begin Open enrollment and streamlined application and enrollment
process. new text end

new text begin (a) The commissioner and local agencies working in partnership must develop a
streamlined and efficient application and enrollment process for medical assistance and
MinnesotaCare enrollees that meets the criteria specified in this subdivision.
new text end

new text begin (b) The commissioners of human services and education shall provide
recommendations to the legislature by January 15, 2010, on the creation of an open
enrollment process for medical assistance and MinnesotaCare that is tied to the public
education system, including prekindergarten programs. The recommendations must:
new text end

new text begin (1) be developed in consultation with medical assistance and MinnesotaCare
enrollees and representatives from organizations that advocate on behalf of children and
families, low-income persons and minority populations, counties, school administrators
and nurses, health plans, and health care providers;
new text end

new text begin (2) be based on enrollment and renewal procedures best practices, including express
lane eligibility as required under subdivision 4;
new text end

new text begin (3) simplify the enrollment and renewal processes wherever possible; and
new text end

new text begin (4) establish a process to:
new text end

new text begin (i) disseminate information on medical assistance and MinnesotaCare to all children
in the public education system, including prekindergarten programs; and
new text end

new text begin (ii) enroll children and other household members who are eligible.
new text end

new text begin The commissioners of human services and education shall implement an open
enrollment process by August 1, 2010, to be effective beginning with the 2010-2011
school year.
new text end

new text begin (c) The commissioner and local agencies shall develop an online application process
for medical assistance and MinnesotaCare.
new text end

new text begin (d) The commissioner shall develop an application that is easily understandable
and does not exceed four pages in length.
new text end

new text begin (e) The commissioner of human services shall present to the legislature, by January
15, 2010, an implementation plan for the open enrollment period and online application
process.
new text end

new text begin Subd. 4. new text end

new text begin Express lane eligibility. new text end

new text begin (a) Children who complete an application
for educational benefits and indicate an interest in enrolling in medical assistance or
MinnesotaCare on the application form shall have the form considered an application
for those programs.
new text end

new text begin (b) The commissioner of education shall modify the application for educational
benefits to:
new text end

new text begin (1) include a separate section for medical assistance and MinnesotaCare;
new text end

new text begin (2) include a check-box to allow all of the children included on the application for
educational benefits to apply for medical assistance and MinnesotaCare; and
new text end

new text begin (3) specify that if this application box is checked, the information on the application
will be shared with the commissioner of human services.
new text end

new text begin (c) The commissioner of human services shall match the children's Social Security
numbers with the Social Security Administration database to comply with federal
citizenship documentation requirements.
new text end

new text begin (d) The commissioner of education shall forward electronically the information for
families who apply for medical assistance or MinnesotaCare to the commissioner of
human services within five business days of determining an applicant's eligibility for the
free and reduced-price school lunch program.
new text end

new text begin (e) The commissioner of human services shall accept the income determination
made by the commissioner of education in administering the free and reduced-price school
lunch program as proof of income for medical assistance and MinnesotaCare eligibility
until renewal. Within 30 days of receipt of information provided by the commissioner of
education under paragraph (d), the commissioner of human services shall:
new text end

new text begin (1) enroll all eligible children in the medical assistance or MinnesotaCare programs;
and
new text end

new text begin (2) provide information about medical assistance and MinnesotaCare to other
household members.
new text end

new text begin The date of application for the medical assistance and MinnesotaCare programs is
the date on the signed application for educational benefits.
new text end

Sec. 2.

Minnesota Statutes 2008, section 256.962, subdivision 2, is amended to read:

Subd. 2.

Outreach grants.

(a) The commissioner shall award grants to public and
private organizations, regional collaboratives, and regional health care outreach centers
for outreach activities, including, but not limited to:

(1) providing information, applications, and assistance in obtaining coverage
through Minnesota public health care programs;

(2) collaborating with public and private entities such as hospitals, providers, health
plans, legal aid offices, pharmacies, insurance agencies, and faith-based organizations to
develop outreach activities and partnerships to ensure the distribution of information
and applications and provide assistance in obtaining coverage through Minnesota health
care programs; deleted text begin and
deleted text end

(3) providing or collaborating with public and private entities to provide multilingual
and culturally specific information and assistance to applicants in areas of high
uninsurance in the state or populations with high rates of uninsurance new text begin ; and
new text end

new text begin (4) targeting families with incomes below 200 percent of the federal poverty
guidelines or who belong to underserved populations. $2,000,000 shall be allocated out of
the health care access fund for outreach grants new text end .

(b) The commissioner shall ensure that all outreach materials are available in
languages other than English.

(c) The commissioner shall establish an outreach trainer program to provide
training to designated individuals from the community and public and private entities on
application assistance in order for these individuals to provide training to others in the
community on an as-needed basis.

Sec. 3.

Minnesota Statutes 2008, section 256L.04, subdivision 1, is amended to read:

Subdivision 1.

Families with children.

(a) Families with children with family
income equal to or less than 275 percent of the federal poverty guidelines for the
applicable family size shall be eligible for MinnesotaCare according to this section. All
other provisions of sections 256L.01 to 256L.18, including the insurance-related barriers
to enrollment under section 256L.07, shall apply unless otherwise specified.

(b) Parents who enroll in the MinnesotaCare program must also enroll their children,
if the children are eligible. Children may be enrolled separately without enrollment by
parents. However, if one parent in the household enrolls, both parents must enroll, unless
other insurance is available. If one child from a family is enrolled, all children must
be enrolled, unless other insurance is available. If one spouse in a household enrolls,
the other spouse in the household must also enroll, unless other insurance is available.
Families cannot choose to enroll only certain uninsured members.

(c) Beginning October 1, 2003, the dependent sibling definition no longer applies
to the MinnesotaCare program. These persons are no longer counted in the parental
household and may apply as a separate household.

(d) Beginning July 1, 2003, or upon federal approval, whichever is later, parents are
not eligible for MinnesotaCare if their gross income exceeds $57,500.

(e) Children formerly enrolled in medical assistance and automatically deemed
eligible for MinnesotaCare according to section 256B.057, subdivision 2c, are exempt
from the requirements of this section until renewal.

new text begin (f) Children deemed eligible for MinnesotaCare under section 256L.07, subdivision
8, are exempt from the requirements of this subdivision.
new text end

Sec. 4.

Minnesota Statutes 2008, section 256L.04, is amended by adding a subdivision
to read:

new text begin Subd. 1b. new text end

new text begin Children with family income greater than 275 percent of federal
poverty guidelines. new text end

new text begin Children with family income greater than 275 percent of federal
poverty guidelines for the applicable family size shall be eligible for MinnesotaCare. All
other provisions of sections 256L.01 to 256L.18, including the insurance-related barriers
to enrollment under section 256L.07, shall apply unless otherwise specified.
new text end

Sec. 5.

Minnesota Statutes 2008, section 256L.04, subdivision 7a, is amended to read:

Subd. 7a.

Ineligibility.

deleted text begin Applicants deleted text end new text begin Adults new text end whose income is greater than the limits
established under this section may not enroll in the MinnesotaCare program.

Sec. 6.

Minnesota Statutes 2008, section 256L.05, subdivision 3, is amended to read:

Subd. 3.

Effective date of coverage.

(a) The effective date of coverage is the
first day of the month following the month in which eligibility is approved and the first
premium payment has been received. As provided in section 256B.057, coverage for
newborns is automatic from the date of birth and must be coordinated with other health
coverage. The effective date of coverage for eligible newly adoptive children added to a
family receiving covered health services is the month of placement. The effective date
of coverage for other new members added to the family is the first day of the month
following the month in which the change is reported. All eligibility criteria must be met
by the family at the time the new family member is added. The income of the new family
member is included with the family's gross income and the adjusted premium begins in
the month the new family member is added.

(b) The initial premium must be received by the last working day of the month for
coverage to begin the first day of the following month.

(c) Benefits are not available until the day following discharge if an enrollee is
hospitalized on the first day of coverage.

(d) Notwithstanding any other law to the contrary, benefits under sections 256L.01 to
256L.18 are secondary to a plan of insurance or benefit program under which an eligible
person may have coverage and the commissioner shall use cost avoidance techniques to
ensure coordination of any other health coverage for eligible persons. The commissioner
shall identify eligible persons who may have coverage or benefits under other plans of
insurance or who become eligible for medical assistance.

(e) The effective date of coverage for single adults and households with no children
formerly enrolled in general assistance medical care and enrolled in MinnesotaCare
according to section 256D.03, subdivision 3, is the first day of the month following the
last day of general assistance medical care coverage.

new text begin (f) The effective date of coverage for children eligible under section 256L.07,
subdivision 8, is the first day of the month following the date of termination from foster
care or release from a juvenile residential facility.
new text end

Sec. 7.

Minnesota Statutes 2008, section 256L.05, subdivision 3a, is amended to read:

Subd. 3a.

Renewal of eligibility.

(a) Beginning July 1, 2007, an enrollee's eligibility
must be renewed every 12 months. The 12-month period begins in the month after the
month the application is approved.

(b) Each new period of eligibility must take into account any changes in
circumstances that impact eligibility and premium amount. An enrollee must provide all
the information needed to redetermine eligibility by the first day of the month that ends
the eligibility period. If there is no change in circumstances, the enrollee may renew
eligibility at designated locations that include community clinics and health care providers'
offices. The designated sites shall forward the renewal forms to the commissioner. The
commissioner may establish criteria and timelines for sites to forward applications to the
commissioner or county agencies. The premium for the new period of eligibility must be
received as provided in section 256L.06 in order for eligibility to continue.

(c) For single adults and households with no children formerly enrolled in general
assistance medical care and enrolled in MinnesotaCare according to section 256D.03,
subdivision 3, the first period of eligibility begins the month the enrollee submitted the
application or renewal for general assistance medical care.

(d) deleted text begin An enrollee deleted text end new text begin Notwithstanding paragraph (e), an enrollee new text end who fails to submit
renewal forms and related documentation necessary for verification of continued eligibility
in a timely manner shall remain eligible for one additional month beyond the end of the
current eligibility period before being disenrolled. The enrollee remains responsible for
MinnesotaCare premiums for the additional month.

new text begin (e) Children in families with family income equal to or below 275 percent of federal
poverty guidelines who fail to submit renewal forms and related documentation necessary
for verification of continued eligibility in a timely manner shall remain eligible for the
program. The commissioner shall use the means described in subdivision 2 or any other
means available to verify family income. If the commissioner determines that there has
been a change in income in which premium payment is required to remain enrolled, the
commissioner shall notify the family of the premium payment, and that the children
will be disenrolled if the premium payment is not received effective the first day of the
calendar month following the calendar month for which the premium is due.
new text end

new text begin (f) For children enrolled in MinnesotaCare under section 256L.07, subdivision 8, the
first period of renewal begins the month the enrollee turns 21 years of age.
new text end

Sec. 8.

Minnesota Statutes 2008, section 256L.07, subdivision 1, is amended to read:

Subdivision 1.

General requirements.

(a) Children enrolled in the original
children's health plan as of September 30, 1992, children who enrolled in the
MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549,
article 4, section 17, and children who have family gross incomes that are equal to or
less than deleted text begin 150 deleted text end new text begin 200 new text end percent of the federal poverty guidelines are eligible without meeting
the requirements of subdivision 2 and the four-month requirement in subdivision 3, as
long as they maintain continuous coverage in the MinnesotaCare program or medical
assistance. deleted text begin Children who apply for MinnesotaCare on or after the implementation date
of the employer-subsidized health coverage program as described in Laws 1998, chapter
407, article 5, section 45, who have family gross incomes that are equal to or less than 150
percent of the federal poverty guidelines, must meet the requirements of subdivision 2 to
be eligible for MinnesotaCare.
deleted text end

deleted text begin Families deleted text end new text begin Parents new text end enrolled in MinnesotaCare under section 256L.04, subdivision 1,
whose income increases above 275 percent of the federal poverty guidelines, are no longer
eligible for the program and shall be disenrolled by the commissioner. Beginning January
1, 2008, individuals enrolled in MinnesotaCare under section 256L.04, subdivision
7, whose income increases above 200 percent of the federal poverty guidelines or 250
percent of the federal poverty guidelines on or after July 1, 2009, are no longer eligible for
the program and shall be disenrolled by the commissioner. For persons disenrolled under
this subdivision, MinnesotaCare coverage terminates the last day of the calendar month
following the month in which the commissioner determines that the income of a family or
individual exceeds program income limits.

(b) deleted text begin Notwithstanding paragraph (a), deleted text end Children may remain enrolled in MinnesotaCare
if deleted text begin ten percent of deleted text end their deleted text begin gross individual or deleted text end gross family income as defined in section
256L.01, subdivision 4, is deleted text begin less than the annual premium for a policy with a $500
deductible available through the Minnesota Comprehensive Health Association. Children
who are no longer eligible for MinnesotaCare under this clause shall be given a 12-month
notice period from the date that ineligibility is determined before disenrollment deleted text end new text begin greater
than 275 percent of federal poverty guidelines new text end . The premium for children remaining
eligible under this deleted text begin clause deleted text end new text begin paragraph new text end shall be the maximum premium determined under
section 256L.15, subdivision 2, paragraph (b).

(c) Notwithstanding deleted text begin paragraphs deleted text end new text begin paragraph new text end (a) deleted text begin and (b) deleted text end , parents are not eligible for
MinnesotaCare if gross household income exceeds $57,500 for the 12-month period
of eligibility.

Sec. 9.

Minnesota Statutes 2008, section 256L.07, subdivision 2, is amended to read:

Subd. 2.

Must not have access to employer-subsidized coverage.

(a) To be
eligible, a family or individual must not have access to subsidized health coverage through
an employer and must not have had access to employer-subsidized coverage through
a current employer for 18 months prior to application or reapplication. A family or
individual whose employer-subsidized coverage is lost due to an employer terminating
health care coverage as an employee benefit during the previous 18 months is not eligible.

(b) This subdivision does not apply to a family or individual who was enrolled
in MinnesotaCare within six months or less of reapplication and who no longer has
employer-subsidized coverage due to the employer terminating health care coverage as an
employee benefit. new text begin This subdivision does not apply to children with family gross incomes
that are equal to or less than 200 percent of federal poverty guidelines.
new text end

(c) For purposes of this requirement, subsidized health coverage means health
coverage for which the employer pays at least 50 percent of the cost of coverage for
the employee or dependent, or a higher percentage as specified by the commissioner.
Children are eligible for employer-subsidized coverage through either parent, including
the noncustodial parent. The commissioner must treat employer contributions to Internal
Revenue Code Section 125 plans and any other employer benefits intended to pay
health care costs as qualified employer subsidies toward the cost of health coverage for
employees for purposes of this subdivision.

Sec. 10.

Minnesota Statutes 2008, section 256L.07, subdivision 3, is amended to read:

Subd. 3.

Other health coverage.

(a) Families and individuals enrolled in the
MinnesotaCare program must have no health coverage while enrolled deleted text begin or for at least four
months prior to application and renewal deleted text end . new text begin Children with family gross incomes greater than
200 percent of federal poverty guidelines, and adults, must have had no health coverage
for at least four months prior to application and renewal. new text end Children enrolled in the original
children's health plan and children in families with income equal to or less than deleted text begin 150 deleted text end new text begin 200
new text end percent of the federal poverty guidelines, who have other health insurance, are eligible if
the coverage:

(1) lacks two or more of the following:

(i) basic hospital insurance;

(ii) medical-surgical insurance;

(iii) prescription drug coverage;

(iv) dental coverage; or

(v) vision coverage;

(2) requires a deductible of $100 or more per person per year; or

(3) lacks coverage because the child has exceeded the maximum coverage for a
particular diagnosis or the policy excludes a particular diagnosis.

The commissioner may change this eligibility criterion for sliding scale premiums
in order to remain within the limits of available appropriations. The requirement of no
health coverage does not apply to newborns.

(b) Medical assistance, general assistance medical care, and the Civilian Health and
Medical Program of the Uniformed Service, CHAMPUS, or other coverage provided under
United States Code, title 10, subtitle A, part II, chapter 55, are not considered insurance or
health coverage for purposes of the four-month requirement described in this subdivision.

(c) For purposes of this subdivision, an applicant or enrollee who is entitled to
Medicare Part A or enrolled in Medicare Part B coverage under title XVIII of the Social
Security Act, United States Code, title 42, sections 1395c to 1395w-152, is considered to
have health coverage. An applicant or enrollee who is entitled to premium-free Medicare
Part A may not refuse to apply for or enroll in Medicare coverage to establish eligibility
for MinnesotaCare.

(d) Applicants who were recipients of medical assistance or general assistance
medical care within one month of application must meet the provisions of this subdivision
and subdivision 2.

(e) Cost-effective health insurance that was paid for by medical assistance is not
considered health coverage for purposes of the four-month requirement under this
section, except if the insurance continued after medical assistance no longer considered it
cost-effective or after medical assistance closed.

Sec. 11.

Minnesota Statutes 2008, section 256L.07, is amended by adding a subdivision
to read:

new text begin Subd. 8. new text end

new text begin Automatic eligibility for certain children. new text end

new text begin Any child who was residing in
foster care or a juvenile residential facility on the child's 18th birthday is automatically
deemed eligible for MinnesotaCare upon termination or release and exempt from the
requirements of this section until the child reaches the age of 21.
new text end

Sec. 12.

Minnesota Statutes 2008, section 256L.15, subdivision 2, is amended to read:

Subd. 2.

Sliding fee scale; monthly gross individual or family income.

(a) The
commissioner shall establish a sliding fee scale to determine the percentage of monthly
gross individual or family income that households at different income levels must pay to
obtain coverage through the MinnesotaCare program. The sliding fee scale must be based
on the enrollee's monthly gross individual or family income. The sliding fee scale must
contain separate tables based on enrollment of one, two, or three or more persons. Until
June 30, 2009, the sliding fee scale begins with a premium of 1.5 percent of monthly gross
individual or family income for individuals or families with incomes below the limits for
the medical assistance program for families and children in effect on January 1, 1999, and
proceeds through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8, 4.8, 5.9, 7.4, and
8.8 percent. These percentages are matched to evenly spaced income steps ranging from
the medical assistance income limit for families and children in effect on January 1, 1999,
to 275 percent of the federal poverty guidelines for the applicable family size, up to a
family size of five. The sliding fee scale for a family of five must be used for families of
more than five. The sliding fee scale and percentages are not subject to the provisions of
chapter 14. If a family or individual reports increased income after enrollment, premiums
shall be adjusted at the time the change in income is reported.

(b) Children in families whose gross income is above 275 percent of the federal
poverty guidelines shall pay the maximum premium. The maximum premium is defined
as a base charge for one, two, or three or more enrollees so that if all MinnesotaCare
cases paid the maximum premium, the total revenue would equal the total cost of
MinnesotaCare medical coverage and administration. In this calculation, administrative
costs shall be assumed to equal ten percent of the total. The costs of medical coverage
for pregnant women and children under age two and the enrollees in these groups shall
be excluded from the total. The maximum premium for two enrollees shall be twice the
maximum premium for one, and the maximum premium for three or more enrollees shall
be three times the maximum premium for one.

(c) Beginning July 1, 2009, MinnesotaCare enrollees shall pay premiums according
to the premium scale specified in paragraph (d) with the exception that children in families
with income at or below deleted text begin 150 deleted text end new text begin 200 new text end percent of the federal poverty guidelines shall pay
deleted text begin a monthly premium of $4 deleted text end new text begin no premiums new text end . For purposes of paragraph (d), "minimum"
means a monthly premium of $4.

(d) The following premium scale is established for individuals and families with
gross family incomes of 300 percent of the federal poverty guidelines or less:

Federal Poverty Guideline Range	Percent of Average Gross Monthly Income
0-45%	minimum
46-54%	1.1%
55-81%	1.6%
82-109%	2.2%
110-136%	2.9%
137-164%	3.6%
165-191%	4.6%
192-219%	5.6%
220-248%	6.5%
249-274%	7.2%
275-300%	8.0%

Sec. 13.

Minnesota Statutes 2008, section 256L.15, subdivision 3, is amended to read:

Subd. 3.

Exceptions to sliding scale.

Children in families with income at or below
deleted text begin 150 deleted text end new text begin 200 new text end percent of the federal poverty guidelines new text begin shall new text end pay deleted text begin a deleted text end new text begin no new text end monthly deleted text begin premium of
$4 deleted text end new text begin premiums new text end .

Sec. 14.

Minnesota Statutes 2008, section 256L.17, subdivision 5, is amended to read:

Subd. 5.

Exemption.

This section does not apply to pregnant women new text begin or children new text end .
For purposes of this subdivision, a woman is considered pregnant for 60 days postpartum.

Sec. 15. new text begin FEDERAL APPROVAL.
new text end

new text begin The commissioner of human services shall resubmit for federal approval the
following:
new text end

new text begin (1) the elimination of depreciation for self-employed farmers in determining income
eligibility for MinnesotaCare passed in Laws 2007, chapter 147, article 5, section 33; and
new text end

new text begin (2) extending for two months medical assistance eligibility for children under the
age of 19 and automatic MinnesotaCare eligibility until renewal passed in Laws 2007,
chapter 147, article 13, sections 1, 2, and 3.
new text end

Sec. 16. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2008, section 256L.17, subdivision 6, new text end new text begin is repealed.
new text end