{{Short description|Public health insurance program in Minnesota, U.S.}} {{Use dmy dates|date=January 2020}} '''MinnesotaCare''' is a public health insurance program in the U.S. state of Minnesota for low-income individuals and families who lack employee-sponsored health insurance and who do not qualify for Medical Assistance (Minnesota’s Medicaid program).<ref name=":0">{{Cite web|url=https://www.house.leg.state.mn.us/hrd/topics.aspx?topic=15|title=Health and Human Services – House Research|last=Department|first=House Research|website=www.house.leg.state.mn.us|access-date=13 November 2018}}</ref> It is administered by the Minnesota Department of Human Services. Enrollees pay a monthly fee based on income and family size, among other factors.<ref name=":0" /> As of 2024, roughly 100,000 Minnesotans are enrolled in MinnesotaCare.<ref name="l541">{{cite web | last=Numbers | first=The | title=MinnesotaCare basics / Minnesota Department of Human Services | website=Minnesota Department of Human Services | date=2019-05-10 | url=https://mn.gov/dhs/medicaid-matters/medicaid-minnesotacare-basics/minnesotacare-basics/ | access-date=2025-06-09}}</ref>
== History == MinnesotaCare was established in 1992 by Republican Governor Arne Carlson with bipartisan legislative support.<ref name="l541" /> The founding legislation pledged that the state would help pay for medical care for residents up to 200% of the federal poverty level.<ref name="z621">{{cite web | last=Blake | first=Matthew | title='Always maximize federal dollars': Minnesota's Medicaid history | website=MinnPost | date=2025-05-08 | url=https://www.minnpost.com/state-government/2025/05/we-always-try-to-maximize-federal-dollars-how-minnesota-became-a-national-model-for-medicaid-expansion/ | access-date=2025-06-09}}</ref> To finance the program, the state created the Health Care Access Fund, originally funded by a 2% tax on the gross revenues of health care providers (often called the “provider tax”) and a smaller tax on health plan premiums.<ref name="q065">{{cite web | title=Minnesota Needs the Provider Tax Renewed | website=North Star Policy Action | date=2018-02-08 | url=https://northstarpolicy.org/minnesota-needs-the-provider-tax-renewed/ | access-date=2025-06-09}}</ref> In 1995, the state obtained a federal Medicaid waiver that allowed some MinnesotaCare enrollees and costs to be partially funded with federal Medicaid dollars. The creation of the Children’s Health Insurance Program (CHIP) in 1997 absorbed many lower-income kids and pregnant women, leaving MinnesotaCare mostly for adults.<ref name="h746">{{cite web | title=MinnesotaCare Public Assistance Programs: A Series | url=https://www.house.mn.gov/hrd/pubs/mncare.pdf | access-date=2025-06-09}}</ref>
In 2014, Minnesota received federal approval to operate MinnesotaCare as a Basic Health Program (BHP) under section 1331 of the Affordable Care Act. This meant that the program could be largely funded by federal dollars, and by the late 2010s, federal payments and enrollee premiums were financing nearly 90–97% of program costs, with the remainder coming from the state’s provider tax fund.<ref name="h746" /><ref>{{Cite web|url=http://www.health.state.mn.us/divs/hpsc/hep/publications/coverage/pubprog.pdf|title=Health Care Coverage and Financing in Minnesota: Public Sector Programs|date=January 2003}}</ref>
On June 9, 2025, the Minnesota legislature passed a bill to repeal undocumented adults’ eligibility for MinnesotaCare after Republicans threatened to force a government shutdown otherwise. The vote was largely on party lines, with DFL House caucus leader Melissa Hortman joining all Republicans in the House and DFL Senators Grant Hauschild, Ann Rest, Robert Kupec, and Majority Leader Erin Murphy joining all Republicans in the Senate.<ref>{{cite web | last=McVan | first=Madison | title=Legislature repeals MinnesotaCare for undocumented adults | website=Minnesota Reformer | date=2025-06-09 | url=https://minnesotareformer.com/2025/06/09/legislature-to-repeal-minnesotacare-for-undocumented-adults/ | access-date=2025-06-10}}</ref> On June 14, 2025, DFL Governor Tim Walz signed the bill into law.<ref>{{cite web | title=Governor Walz Signs Two-Year State Budget | url=https://www.revisor.mn.gov/bills/text.php?number=HF1&type=bill&version=0&session=ls94&session_year=2025&session_number=1 | access-date=2025-06-17}}</ref>
== MinnesotaCare coverage, premiums and funding == MinnesotaCare coverage includes "doctor visits, hospitalization, prescriptions, eye exams, eye glasses, dental care" and other services.<ref>[http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=id_006255 MinnesotaCare home page, MHCP Minnesota Health Care Programs] Accessed 14 August 2007</ref> Services are provided through prepaid health plans, who negotiate reimbursement rates with health care providers.<ref name="MinnesotaCare - House Research">[http://www.house.leg.state.mn.us/hrd/issinfo/ssmncare.htm MinnesotaCare – House Research] Accessed 14 August 2007 {{webarchive|url=https://web.archive.org/web/20060621180506/http://www.house.leg.state.mn.us/hrd/issinfo/ssmncare.htm|date=21 June 2006}}</ref>
Public funding covers 94% of the actuarial value cost for a MinnesotaCare plan.<ref name=":0" /> Enrollees cover six percent of the plan's cost in the form of cost sharing for services and a monthly premium based on a sliding income scale.<ref name=":0" /> As of October 2018, MinnesotaCare monthly premiums range from $0 for those with incomes up to 34% of Federal Poverty Guidelines (FPG) to $12 per month for those with incomes at 100% FPG to $80 per month for those at 200% FPG.
In fiscal year 2017, the MinnesotaCare program paid $397.2 million for health care services provided to enrollees. State funds covered less than three percent of the cost.<ref name=":0" />
==Managed care organizations== According to Minnesota Department of Human Services, in year 2018, following health plans were available for MinnesotaCare applicants:<ref>[http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_160040 Managed care reporting: Contracts] Accessed 30 December 2012</ref> * HealthPartners *Hennepin Health *Itasca Medical Care *PrimeWest Health *South Country Health Alliance *UCare
== Proposed expansions ==
=== Raising income limit === In 2016, then-state Senator Tony Lourey (DFL–Kerrick) and State Representative Jennifer Schultz (DFL–Duluth) proposed increasing the income limit for MinnesotaCare eligibility from 200% FPG to 275% FPG.[https://www.revisor.mn.gov/bills/bill.php?b=Senate&f=SF2541&ssn=0&y=2016&keyword_type=all&keyword=minnesotacare+percent] This change would have raised the annual income limit for a family of four from $48,600 to $66,825 under 2016 guidelines.<ref>{{Cite web|url=https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines/prior-hhs-poverty-guidelines-federal-register-references|title=Prior HHS Poverty Guidelines and Federal Register References|date=23 November 2015|website=ASPE|language=en|access-date=17 February 2019}}</ref>
During the 2017 State of the State, DFL Governor Mark Dayton proposed expanding the eligibility limit for MinnesotaCare to 400% FPG.<ref>{{Cite web|url=http://www.startribune.com/dayton-proposes-major-buy-in-expansion-for-minnesotacare/475541923/|title=Governor proposes 'public option' expansion for MinnesotaCare health insurance|website=Star Tribune|date=8 March 2018 |access-date=17 February 2019}}</ref> This change would have allowed families of four earning up to $98,400 under 2017 guidelines to purchase MinnesotaCare coverage for an undetermined premium.
=== "Buy in" proposal === In 2016, the DFL-controlled Minnesota Senate passed legislation to begin the process of allowing Minnesotans with incomes exceeding the limit for traditional MinnesotaCare to "buy in" to MinnesotaCare coverage.<ref name=":1">{{Cite web|url=https://www.senate.mn/committees/2017-2018/3096_Committee_on_Human_Services_Reform_Finance_and_Policy/Supplemental%20Budget%20Proposal%20Packet%2003-21-18.pdf|title=2018 Governor's Health & Human Services Supplemental Budget}}</ref><ref>{{Cite web|url=https://www.revisor.mn.gov/bills/text.php?number=HF2749&version=1&session=ls89&session_year=2016&session_number=0&type=ue&keyword=minnesotacare%20400&keyword_type=all|title=HF 2749 1st Unofficial Engrossment – 89th Legislature (2015–2016)|website=www.revisor.mn.gov|access-date=17 February 2019}}</ref>
The 2016 legislation authorized the state to seek federal waivers necessary to allow the program to operate. Operational costs for the program and per member per month premium prices were not disclosed at that time. The proposal did not become law.
With the support of DFL Governor Mark Dayton, DFL legislators introduced a similar proposal in 2017.<ref name=":2">{{Cite web|url=https://www.revisor.mn.gov/bills/bill.php?b=House&f=HF0092&ssn=0&y=2017|title=HF 92 Status in the House for the 90th Legislature (2017–2018)|website=www.revisor.mn.gov|access-date=9 February 2019}}</ref>
In 2018, the Dayton administration estimated the average statewide cost of MinnesotaCare buy-in to be $659 per person per month, or $7,908 per year, for a silver level health plan. Silver level plans generally qualify as high deductible health plans, with individual deductibles exceeding $3,000 and family deductibles exceeding $11,000.<ref>{{Cite web|url=https://www.medica.com/-/media/documents/individual/2019-sales-documents/2019_minnesota_offmarketplace_plan_options.pdf?la=en&hash=21A9AB9F96106CFAE2055A6A682D52612C89E1BE|title=2019 Medica Individual and Family Plan Options}}</ref><ref>{{Cite web|url=https://www.bluecrossmn.com/healthy/public/portalcomponents/PublicContentServlet?contentId=P11GA_16992982|title=Blue Plus Strive – Metro Region HSA Silver $4,000 Plan 291|website=www.bluecrossmn.com|access-date=9 February 2019|archive-url=https://web.archive.org/web/20190209124317/https://www.bluecrossmn.com/healthy/public/portalcomponents/PublicContentServlet?contentId=P11GA_16992982|archive-date=9 Feb 2019}}</ref>
In comparison, for 2018, the Kaiser Family Foundation estimated the average cost of a privately sold silver level health plan to be $326 per person per month, or $3,912 per year, with similar deductibles.<ref>{{Cite web|url=https://www.kff.org/health-reform/state-indicator/marketplace-average-benchmark-premiums/|title=Marketplace Average Benchmark Premiums|date=31 October 2018|website=The Henry J. Kaiser Family Foundation|language=en-us|access-date=9 February 2019}}</ref>
To start the buy in program, Governor Dayton proposed spending roughly $100,000,000 in public funding for a financial reserve to back up the government-run insurance option.<ref name=":1" /> In addition, his administration estimated $13,000,000 in annual operating costs.
Governor Dayton has argued the buy-in plans would be eligible for federal premium tax credits (PTC) for those under 400% FPG, but this would require federal approval from the Trump Administration.<ref name=":2" /> Healthcare experts suggest a buy-in plan would not meet the definition of a "health plan" under federal regulations and therefore would not qualify for PTC.<ref>{{Cite web|url=https://www.law.cornell.edu/cfr/text/45/144.103|title=45 CFR § 144.103 – Definitions.|website=LII / Legal Information Institute|language=en|access-date=9 February 2019}}</ref>
Dayton's term as governor expired in January 2019, but his successor, Governor Walz, continues to support a buy-in option for MinnesotaCare and supported it in his 2018 gubernatorial campaign.<ref>{{Cite web|url=https://www.mprnews.org/story/2018/11/29/the-minnesota-care-buy-in-explained|title=The MinnesotaCare buy-in, explained|date=29 November 2018 }}</ref>
Critics have expressed three primary concerns about the viability of a MinnesotaCare buy-in.<ref>{{Cite web|url=https://www.winonadailynews.com/news/opinion/columnists/local/rep-greg-davids-government-option-not-the-cure-for-rural/article_1cce646c-d33e-5356-a494-770cd2ad3661.html|title=Rep. Greg Davids: Government option not the cure for rural Minnesota healthcare|website=Winona Daily News|date=21 August 2017 |language=en|access-date=9 February 2019}}</ref> They argue low healthcare provider reimbursement rates set by the government for MinnesotaCare will result in few providers accepting patients with public option coverage. Were providers mandated to accept public option coverage, they argue rural hospitals and clinics would be driven to bankruptcy.<ref>{{Cite web|url=https://www.hometownsource.com/monticello_times/free/rep-o-neill-continues-to-fight-for-priorities-of-our/article_95d452f4-1aa3-11e9-9120-ab84e01ab527.html|title=Rep. O'Neill continues to fight for priorities of our communities|last=O'Neill|first=Rep Marion|website=hometownsource.com|date=17 January 2019 |language=en|access-date=9 February 2019}}</ref>
Critics have also questioned the feasibility of modifying the state-run MNsure marketplace to sell the buy-in plan due to MNsure's technological deficiencies.<ref>{{Cite web|url=https://www.mprnews.org/story/2016/11/01/mnsure-hobbled-minnesota-lawmakers-seek-fix|title=Tech woes hobble MNsure; vexed lawmakers seek insurance fix|last=Zdechlik|first=Mark|website=www.mprnews.org|date=November 2016 |access-date=9 February 2019}}</ref>
In addition, critics question the affordability of a buy-in based on the Dayton administration's premium estimate, which is more than double current premiums for comparable value plans in the private market.
==References== {{Reflist}}
==External links== * [http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=id_006255 Minnesota Department of Human Services MinnesotaCare page] * [http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=id_000094 MHCP Provider Manual] * [https://www.revisor.mn.gov/pubs/ Minnesota Statutes, Laws, and Rules]
{{DEFAULTSORT:Minnesotacare}} Category:Government of Minnesota Category:Health insurance in the United States