2013 Legislative preview from page 31
Medicaid expansion Gov. Dayton has never made any secret of his desire to expand the state’s Medical Assistance (Medicaid) program. Minnesota opted into the ACA’s Medicaid expansion program, thus positioning the state to receive significant federal funding. It’s estimated that Minnesota’s implementation of this option will save $1.7 billion through 2015, in part by ending the state-funded General Assistance Medical Care program and moving beneficiaries into a federally matched Medicaid program. Such savings are partially responsible for the state reaching a balanced budget agreement for fiscal year 2012–2013. The Legislature has not completed implementing this option, however, and must decide several aspects of Medicaid expansion. One of the more pressing is the future of MinnesotaCare recipients with incomes greater than 138 percent of the federal poverty line (FPL). Under the ACA, Medicaid coverage for adults can be eliminated beginning in 2014 for those with incomes greater than 138 percent of the FPL and states may not use federal funds provided under the ACA to support this demographic. This could be a particularly serious problem for Minnesota because of the breadth of coverage it has offered under its MinnesotaCare plan. In 2011, the state obtained a waiver through which federal Medicaid funds now help finance MinnesotaCare coverage for childless adults with incomes between 75 percent and 205 percent of the FPL, but that is a temporary fix. One option is to adopt a Basic Health Program (BHP). The ACA contains a little-known provision that allows states to create a more affordable alternative to health insurance exchanges: a BHP. Under a BHP, Minnesota would contract with health plans or providers to cre-
ate a managed care plan that meets essential health benefit requirements. Individuals with incomes between 133 percent and 200 percent of the FPL (i.e., $15,000 to $21,800) would be eligible to participate in this BHP. The 2013 Legislature may consider this a reasonable solution to the 138 percent FPL Medicaid qualification minimum. Policymakers have not yet decided whether or how to implement a BHP. Another question facing the 2013 Legislature is whether to increase Medicaid provider payments beyond federally approved increases for 2013 and 2014. The state also faces issues relating to Medicaid benefit changes that start in 2014, when newly eligible adults can receive “benchmark benefits” rather than standard Medicaid coverage. There is some concern over how essential health benefits would be defined and how they would compare to current Medical Assistance and MinnesotaCare benefits. No decisions have been made. Finally, the Legislature will need to figure out how to implement ACA-mandated expansion of Medicaid coverage without worsening provider shortages. Primary care providers already are in particularly short supply in rural areas, especially in the area of behavioral health care. Gov. Dayton has created a workgroup to address this problem, and some suggest expanding opportunities for midlevel practitioners such as advanced practice nurses and physician assistants. Although proponents of the ACA control the capitol, much of this law’s implementation in Minnesota remains to be determined. The 2013 Legislature’s decisions will shape health care in Minnesota for the foreseeable future. Jeremy L. Johnson, JD, is a principal with Gray Plant Mooty in Minneapolis, practicing law in the areas of health care and nonprofit/taxexempt organizations.
Minnesota
Health Care Consumer January survey results ... Association
1. I have acted as an extended care provider for a member of my family.
Each month, members of the Minnesota Health Care Consumer Association are invited to participate in a survey that measures opinions around topics that affect our health-care delivery system. There is no charge to join the association, and everyone is invited. For more information, please visit www.mnhcca.org. We are pleased to present the results of the January survey.
60
50
46.2%
40 30 20 10
60 50 40 30 20 10 0
32
12.8%
12.8%
7.7%
2.6% Strongly agree
Agree
Does not apply
Disagree
Strongly disagree
MINNESOTA HEALTH CARE NEWS FEBRUARY 2013
30
10
17.9%
17.9%
20 7.7%
0.0% Strongly agree
Agree
Does not apply
Disagree
5. This work had a significant impact on my relationships with other family members. 60 53.8%
50 40 30 20
0
40
69.2%
60
10
50
0
No
Percentage of total responses
70 Percentage of total responses
Percentage of total responses
80
70
64.1%
Yes
4. This work had a significant impact on my personal finances.
80
56.4%
53.8% Percentage of total responses
Percentage of total responses
60
0
3. I found adequate support from state and community programs in providing this care.
2. I felt I had sufficient training to provide this care.
15.4% 10.3% 5.1% Strongly agree
0.0% Agree
Does not apply
Disagree
Strongly disagree
50 40 28.2%
30 20 12.8% 10 0
5.1% 0.0% Strongly agree
Agree
Does not apply
Disagree
Strongly disagree
Strongly disagree