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Medicaid Unwinding: Resources to Keep Minnesotans Covered

375,000 Minnesotans are at risk of losing health coverage as eligibility reviews return for the state’s public programs, Medical Assistance and MinnesotaCare

Last month, Minnesota officially began the process of “unwinding” the COVID-19 pandemic-era policy that paused eligibility reviews for those on the state’s public health care programs, Medical Assistance (Minnesota’s Medicaid program) and MinnesotaCare.

These programs are critically important and currently provide health care coverage for 1 in 4 or 1.5 million Minnesotans. State programs cover 4 in 10 children, 4 in 10 births, 1 in 3 people with disabilities, approximately half of nursing home costs and about half of substance-use-disorder treatment. They also cover a disproportionate number of Black, Indigenous, and other People of Color in the state, highlighting potential health equity impacts for changes in these programs.

As eligibility reviews resume for the state’s public programs, Council members are working diligently to help Minnesotans maintain their coverage or successfully transition to new coverage.

The stakes are high. An estimated 375,000 Minnesotans could potentially move off public coverage during this process. Health care coverage provides many benefits, including helping pay the high costs of medical care and medications, coordinating services, connecting people to social supports and helping people access preventive care. Disruptions in coverage can have a serious negative impact and worsen health outcomes as well as create financial burdens and barriers to accessing timely and needed care. Early data from 20 states that have already resumed renewals show that over a million enrollees have lost coverage during this process between April 1 and June 12. There are wide variations between states in both renewal rates and the share of procedural disenrollments – where people lose coverage because they did not complete the enrollment process but may still be eligible for Medicaid.

These numbers highlight the challenges to make sure Minnesotans most at risk for losing coverage have access to necessary information and resources to maintain coverage during this process. With estimates that nearly half of those losing coverage will likely be due to procedural issues, like incomplete or missing paperwork, public awareness is a serious concern. Data from a recent survey found that nearly two-thirds of Medicaid enrollees were not aware that states are now permitted to resume disenrolling people from Medicaid programs, underscoring the need to increase outreach on this topic and help people learn how to successfully renew their coverage or transition quickly and seamlessly to other coverage.

Confronting the state’s unique challenges to keep Minnesotans covered

In Minnesota, renewals must be completed on paper and all renewal forms and important information will be sent via the mail. Because DHS had not collected eligibility information since the beginning of the COVID-19 public health emergency, many people are at risk of procedural disenrollment if their contact information is no longer correct.

Nearly half of Medicaid enrollees have not been through the renewal process before and certain populations are especially at risk of losing coverage – particularly children, people without stable housing, non-native English speakers, people living in high social vulnerability index (SVI) neighborhoods, and people with complex conditions. Due to the disproportionate share of BIPOC Minnesotans on the state’s public health care programs, a higher burden of coverage loss will also fall on these communities.

National studies show that 30% of people don’t know where they’ll find other coverage if they are no longer eligible. And an analysis of the impact of the expiration of the public health emergency estimates the uninsurance rate in Minnesota – which is now at a historic low of 4% – could increase significantly.

Support from the state’s nonprofit health plans for Minnesotans during the Medicaid Unwinding period

Council members have been working closely with many partners to raise awareness and share resources and best practices to ensure no one faces an avoidable gap in coverage. For example:

The Council developed the following resources (also available on the Medicaid Unwinding Resource Page) for various stakeholders to raise awareness and support Minnesotans in maintaining health care coverage:

Enrollees-

Employers-

Health Care Providers-

Community Partners-

During the COVID-19 pandemic, the state’s nonprofit health plans played a leading role in safeguarding the health of Minnesotans providing over $2.6 billion in COVID-related medical costs, keeping people connected to care, and taking a nimble and innovative approach to support members throughout the state during a time of great need. As the nation and state move on to this next chapter of pandemic recovery, it is important to understand the significant implications of the Medicaid unwinding process and how we can all work together to make sure that Minnesotans stay covered and continue to have access to affordable and timely care.

 

How coordinated care is improving outcomes in Minnesota’s health care programs

Highly individualized, holistic care connects members to resources, removes barriers, and addresses the social drivers of health

Imagine you were about to hike an unfamiliar trail in Minnesota’s Northwoods. You might wonder how difficult the trail is, how long it will take, what kind of gear you might need, and whether there are places to rest along the way. At the trailhead, a park ranger greets you and asks if you have any questions and offers you a trail guide. What would you do? Enlist the support of the trail guide or take your chances and start walking?

When it comes to dealing with a health challenge, many Minnesotans prefer to have a guide to help provide support, so they do not have to go it alone.

That’s where care coordination comes in. Minnesota’s nonprofit managed care organizations (MCOs) provide care coordination as a unique benefit for members who are covered by state programs, like Medical Assistance and MinnesotaCare. Through care coordination, members receive highly individualized, holistic care to support their health and wellbeing.

Because many of the factors that support health and wellbeing happen outside the clinic’s walls—like housing, transportation, education, and access to healthy food, good jobs, and childcare—care coordinators focus on addressing these social drivers of health, connecting members to resources, and removing barriers to care. Care coordinators take the time to get to know members, understand their goals and needs, and connect them to the right resources at the right time.

Minnesota’s leadership in delivering Medicaid through managed care

Nearly forty years ago, Minnesota was an early adopter of the managed care model, which began as an innovative partnership between the state nonprofit plan community and providers to address severe access issues, a fragmented health care system, and growing and unpredictable costs. The model has helped the state improve access to care and provides much needed support to Minnesotans and has been replicated across the country. Forty-three other states now utilize managed care to support their public program enrollees, with both North Carolina and Oklahoma moving the Medicaid programs to managed care just this year. More states are moving toward managed care because of the high-quality care enrollees receive and the budget stability gained by the state.

Integrating services for Minnesota seniors

One example of Minnesota’s leadership in this area is Minnesota Senior Health Options (MSHO), a fully-integrated Medicare and Medicaid managed care service delivery system which provides those who are eligible for Medicare and Medicaid-funded services (or dual eligible) a full suite of services to ensure they get the care they need to maintain their best health.

“Sometimes it’s just a matter of connecting the person with the right resource at the right time,” said Janice Hubert, care coordinator at HealthPartners. “Part of care coordination is gathering the pieces together and helping our clients come up with a plan that’s going to work for them to help manage their healthcare, so they can be the healthiest they can be, and manage the best way that they can.”

MSHO assigns members a care coordinator who helps them identify their goals and how to best meet them as well as find the services they need when they need them. Over time, research shows members tend to have fewer preventable hospital stays and fewer trips to the emergency department. Further, members with chronic diseases were able to obtain more community-based services or assisted living care.1

By helping seniors navigate appointments, coordinating transportation for clinic visits, and providing education about chronic disease management, care coordinators ensure enrollees get the right care when they need it. By reducing emergency department visits, hospital stays and trips to see physician specialists, coordinators are reducing health care costs.

For example, a hospital system in Wisconsin found that for every $1 invested in care coordination for their highest-risk population, the hospital realized an $8 reduction in health care charges. When managed appropriately, inpatient visits were less frequent, less critical, and were, on average, 30% shorter. 2

Leveraging data to connect enrollees with the right care at the right time

Care coordinators also play a critical role helping reduce fragmented care in the delivery of both physical and behavioral health services. They work to connect enrollees with the appropriate level of high-quality care when they need it. The net result can be a better experience for members, with better care at a lower cost.

They might use a variety of strategies. For example, care coordinators use data to identify at-risk members and determine their care needs. They reach out and engage with members in their communities and work together to make their care more efficient and effective. Care coordinators can identify plan members who are using care services at a high rate and develop a management plan that addresses the underlying health conditions that might be contributing. For example, identifying and addressing diabetes, asthma, or high blood pressure in the primary care setting with chronic disease management strategies could prevent some of those emergency room visits or hospital stays.3

Care coordinators make things easier for individuals by helping them navigate the complex health care landscape, get them connected to needed medical care, behavioral services, and community-based supports. In short, they are the trail guides that help members find their way to better health and wellness.

Watch the video to learn more about how care coordination is enhancing the patient experience, reducing the cost of care, and improving the health of communities throughout Minnesota.

For more information on this topic and to learn more, check out our Fact Sheets on Managed Care and Care Coordination.

References

  1. Wayne L. Anderson, and Zhanlian Feng, “Minnesota Managed Care Longitudinal Data Analysis,” Minnesota Managed Care Longitudinal Data Analysis (Office of the Assistant Secretary for Planning and Evaluation (ASPE), March 30, 2016), https://aspe.hhs.gov/reports/minnesota-managed-care-longitudinal-data-analysis-0.
  2. “U.S. Department of Health and Human Services Assistant Secretary – ASPE,” INNOVATIVE MEDICAID MANAGED CARE COORDINATION PROGRAMS FOR CO-MORBID BEHAVIORAL HEALTH AND CHRONIC PHYSICAL HEALTH CONDITIONS: FINAL REPORT (U.S. Department of Health and Human Services Assistant Secretary for Planning and Evaluation Office of Disability, Aging and Long-Term Care Policy, May 2015), https://aspe.hhs.gov/sites/default/files/private/pdf/158526/comorbid.pdf.
  3. Ibid.

Working to solve racial disparities in Minnesota’s birth outcomes and experiences by keeping a spotlight on the issue

No other developed nation has a higher maternal mortality rate than the U.S. and the rate today is higher than it was 25 years ago. A look behind these overall numbers shows even worse outcomes for Black families: Black women are about three times more likely to die of pregnancy related complications than white women and Black infants are more than twice as likely to die as white infants.

The mission to improve maternal and birth outcomes in the U.S., especially for Black families, grows more urgent each year. As we recognize Black Maternal Health Week April 11-17, it’s important to keep a spotlight on these issues to find opportunities to address and resolve racial disparities in birth outcomes and birth experiences.

The Minnesota Department of Health (MDH) Maternal Mortality Review Committee at the Minnesota Department of Health (MDH) recently released a report on maternal mortality documenting significant disparities in maternal mortality; Black Minnesotans, who comprise 13% of the birthing population, accounted for 23% of maternal deaths during the study period. The report made several recommendations to address disparities in maternal health and prevent maternal deaths, including:

Dr. Rachel Hardeman, co-chairs the committee that conducted the analysis for the report and also leads the Center for Antiracism Research for Health Equity at the University of Minnesota and has called for Minnesota to lead the way in implementing change in communities to improve outcomes.

The Minnesota Council of Health Plans and our member plans are working together to tackle these disparities in a variety of ways, including through advocating for systems change at the legislature, helping grow the workforce, centering patients to improve the birthing experience, developing educational initiatives, and partnering with communities.

The Council and member plans are also working collaboratively through the Healthy Start Performance Improvement Project, which began in the spring of 2021.

The project focuses on ensuring a “healthy start” for Minnesota children by concentrating on improving services provided to pregnant women and infants, with a particular focus on reducing racial and ethnic disparities. Interventions will include working with a wide variety of partners to improve access and coordination of resources to help mothers and children get the right care at the right time in the right setting.

In addition to our collaborative work, member plans are leading a variety of efforts to improve outcomes. See just some of the recent examples of this innovative work below.

Keeping Minnesotans Covered as Renewals Return for Medicaid and MinnesotaCare

With the March 31 sunset of the federal continuous coverage mandate, 1.5M Minnesotans will need to go through an eligibility review to maintain coverage in the state’s public programs

During the federal public health emergency, special rules meant Minnesotans covered by state programs, Medical Assistance (Minnesota’s Medicaid program) and MinnesotaCare, didn’t need to submit eligibility on a yearly basis. This was a good thing throughout the pandemic because it kept people connected to needed care. It also led to a record number of enrollees – Minnesota Health Care Programs reached an all-time high enrollment of over 1.5 million people, a nearly 30% increase. Now, recent federal actions will require states to begin unwinding some of those temporary policies starting next month. The state will have a one-year timeframe to review the eligibility of each of those Minnesotans enrolled in state programs—a process called ‘Redetermination’. Restarting renewals for the record number of enrollees in Minnesota’s Health Care Programs after a three-year hiatus will be an unprecedented amount of work for the state, counties and tribes who process the renewals, as well as for the health plans who support these enrollees to maintain coverage.

Recent media coverage, “One of four Minnesotans will have to requalify for Medicaid this year” and “A Daunting Challenge for Health Care” framed up the task ahead of us. While the state will undergo a gradual return to program operations that were in place prior to the pandemic, resuming normal operations will be far from simple. State estimates indicate as many as 15-25% of enrollees could move off state programs during this process. While some of those may no longer meet eligibility criteria, nearly half will lose coverage for procedural reasons, like incomplete or missing paperwork. Gaps in coverage lead to gaps in care and it will be critical to ensure Minnesotans have the support they need to keep their coverage or transition to new coverage.

Partnering to Support Minnesotans

To support Minnesotans during this process, a public-private partnership among state, tribal, county and health plan leaders has been underway for nearly two years with the shared goal of keeping people connected to health insurance coverage.

This partnership is implementing innovative approaches to support a smooth transition, including using new methods to contact enrollees, working with community media partners to raise awareness, and building on the relationship between enrollees and their health plans to provide timely information on what to expect. We are also advocating at the Capitol to expedite important legislation to support the unwinding work. The Legislature is considering several key proposals which would make a difference: Establishing continuous coverage for children to help reduce churn and ensure children have consistent access to health care; funding to expand Navigator organizations to increase the amount of help available to Minnesotans for eligibility and enrollment support; upgrading IT systems to improve the enrollee experience and facilitate processing. Finally, for those no longer eligible, Minnesotans shopping for coverage in the individual market will benefit from enhanced federal premium subsidies and last year’s bipartisan legislation that continued the state’s reinsurance program and reduces premiums an average of 20%.

Inequities will persist during the renewal period unless we take action

We also know that not all Minnesotans will be impacted the same during the unwinding period. Black, Indigenous and communities of color are overrepresented in Medical Assistance and the numbers are even greater for children. For example, while 4 in 10 children in Minnesota are on Medicaid, 64% of Black Minnesotan children are covered by state health care programs. That is why, together with the state, counties, tribal agencies and community partners, we are adopting a dedicated equity strategy to make sure Minnesotans most at risk for losing coverage have access to the necessary information and resources to maintain coverage. One specific tactic was developed as part of Minnesota’s COVID-19 vaccine equity strategy, prioritizing outreach to members living in areas with the most barriers to renewing their coverage. By applying the Center for Disease and Control’s (CDC) Social Vulnerability Index (SVI), which takes into account things like housing, transportation, income, race and ethnicity, language and other social factors to identify ZIP codes for those most at risk, we can look at which communities should be targeted for extra support and pair them with the right resources to keep them covered. This support will include partnering with local media outlets, community leaders and other cultural institutions to disseminate information; providing translated materials in multiple languages and accessible formats; following up with those who don’t have a regular address; and making sure Minnesotans get all their questions answered.

What you can do right now

We know that many Minnesotans experienced big changes during the COVID-19 pandemic like moving to a new address, getting married, growing their families, or getting a new job. There are many changes that could impact a person’s eligibility, however, the most critical piece of information that Medical Assistance enrollees can provide to their county is updated contact information, and m

ost importantly, their current address. Over the coming months, the state and counties will be sending important information the mailing addresses of enrollees. To make sure you receive these messages, go to mn.gov/dhs/mycontactinfo to learn more and to find the contact information for your county. To learn more about the upcoming redetermination period and find key dates, visit mn.gov/dhs/renewmycoverage.

Picture shows person filling out paperwork
Be prepared to renew. Report address and phone number changes to make sure you receive renewal information when the time comes.

For more information on this issue and to learn more about how the Council and member plans are working to support Minnesotans during this process, check out our Fact Sheet.

 

The State of Minnesota recently announced new managed care contracts serving 600,000 Minnesotans in 80 outstate counties, along with older adults and adults with disabilities statewide. The seven-county metro area contracts, covering 700,000 Minnesotans, were finalized late last year.

Minnesota’s public health care programs, including prepaid Medical Assistance and MinnesotaCare, serve low-income families and children. Seniors who need extra help beyond Medicare are covered through Minnesota Senior Health Options and Minnesota Senior Care Plus. People with disabilities can choose to be covered by the Special Needs BasicCare program. Health plans also submitted details demonstrating how they are working to improve health equity and eliminate disparities.

The announcement, from the Department of Human Services (DHS), follows a robust two-and-a-half-year competitive procurement process. Every member of the Minnesota Council of Health Plans received a contract to continue providing reliable and high-quality care around the state for the 1.3 million Minnesotans enrolled in Medical Assistance and MinnesotaCare.

Minnesota’s nonprofit health plans are nationally recognized for their efforts to improve the well-being of Minnesotans by identifying gaps in care, assisting with making appointments, coordinating rides, providing resources for managing chronic disease, and connecting members with community-based services. Our health plans even help communities tackle social issues that have a critical impact on a person’s health, like access to healthy food or stable housing. In many cases, our members are partnered with a dedicated care coordinator to ensure their care is timely, effective, and convenient.

These services can help reduce hospitalizations, trips to the emergency department and other high-cost care. Coordinators help members stay connected to their clinics and social service providers, which helps them manage their complex medical conditions. If you’d like to learn more about the important work of Minnesota’s nonprofit health plans, our website contains FAQs and background information on numerous topics, including managed care and the value of care coordination. Find out how Minnesota’s nonprofit health plans are working to support Minnesotans with access to the affordable, equitable and quality-based care they need today and in the future.