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Medicaid, SCHIP, & Federal Authority

  • SCHIP Section 1115 Waiver – In 2001, Minnesota received approval under a Section 1115 waiver to use Title XXI funds to cover parents and caretaker relatives of Medicaid and State Children’s Health Insurance Program (SCHIP)-eligible children with family incomes between 100 percent and 200 percent of the federal poverty level (FPL). These individuals are subject to premiums established on a sliding scale.  This is a component of the state’s MinnesotaCare program.

     Medicaid Section 1115 Health Reform Demonstration – In 1995, Minnesota received approval to implement the Minnesota Prepaid Medical Assistance Project Plus (PMAP+) Section 1115 Health Reform Demonstration. Through this initiative, children and pregnant women with incomes up to 275 percent of the FPL who were previously covered under the state-funded MinnesotaCare program became part of a Medicaid waiver component of the MinnesotaCare program.  Under subsequent modifications of the waiver, Medicaid waiver coverage in MinnesotaCare is available to parents in families with gross incomes up to 275 percent of the FPL (but not above $50,000 per year).  These individuals are subject to premiums based on a sliding scale.  In Minnesota, individuals who are eligible for Medicaid may instead choose to join MinnesotaCare and pay a premium.


High-Risk Pools

  • Minnesota Comprehensive Health Association (MCHA) was established in 1976 by the Minnesota legislature to offer policies of individual health insurance to Minnesota residents who have been turned down for health insurance by the private market due to pre-existing health conditions. MCHA is sometimes referred to as Minnesota’s “high-risk pool” for health insurance or health insurance of last resort.  By law premiums are set at 101 percent – 125 percent of the weighted average for comparable policies.  The program is funded through member premiums and an annual assessment on all health plans. At the end of 2007, about 28,900 Minnesota residents were insured by MCHA throughout the state.


Limited-Benefit Plans

  • In 1992, the Minnesota legislature enacted a law (62L.05) mandating that each health carrier in the small employer market must make available to qualifying small employers both a deductible-type and a co-payment-type small employer plan.  In addition, the legislation requires that these plans include limited coverage for certain benefits (e.g., mental health, chemical dependency and prescription drugs).   

    In 1999, the Minnesota legislature passed SF 84 which allowed for benefit plans that may alter or eliminate coverage that is required by law, other than the requirement that care provided for covered services such as osteopaths, optometrists, and chiropractors be reimbursed on a nondiscriminatory basis.  No carriers ever sold the plans and the law was allowed to expire in 2003.


    In 2005, the Minnesota legislature enacted a new law that allows health plans to sell “small employer flexible benefit plans” that do not include any of the benefit mandates. However, all plans must comply with federal health mandates (maternity for employers with 15 or more employees, mastectomy-women’s health & cancer rights act, newborns 48/96 hours, HIPAA, COBRA, ERISA, etc.)


Dependent Coverage

  • Legislation was enacted in 2007 (HF 1078) which expanded the definition of dependent coverage such that a commercial health plan may not terminate coverage of an unmarried child under the age of 25, regardless of student status.

State Specific Strategies

  • MinnesotaCare - In 1992, MinnesotaCare was established to provide health coverage to the growing number of uninsured via a risk-based managed care delivery system.  It is funded through a tax on health care providers and enrollee premiums.  Since 1995 a portion of MinnesotaCare has also been funded with federal Medicaid funds for some eligible individuals, and since 2001 with SCHIP funds, under the 1115 waivers described above.  There have been several expansions in eligibility over the years.   The program currently enrolls families with children up to 275 percent FPL under Medicaid and childless adults up to 200 percent of FPL without federal funding.

    GAMC – GAMC is a state-funded (general fund) health care program for low-income adults, ages 21 through 64, who have no dependent children under age 18 and who do not qualify for federal health care programs.  There are two levels of covered services. Adults with income at or below 75 percent of the FPL and assets within $1,000 per household may qualify for the comprehensive benefit package that includes doctor visits, hospitalization, prescriptions, eye exams, eye glasses, dental care and more.  Adults with incomes above 75 but at or below 175 percent of the FPL and assets within $10,000 for a household of 1 or $20,000 for a married couple may qualify for GAMC-Hospital Only, which provides inpatient hospital coverage, including physician services during hospitalization.

    Effective July 1, 2009 eligibility for this program will extend to 250 percent of FPL for childless adults.

    Health Care Coverage for non-citizens –
    Minnesota has state-funded MA and MinnesotaCare “look-alike” programs for individuals and families who meet all eligibility requirements for MA or MinnesotaCare, but who are not qualified for federal health care programs solely due to their immigrations status.  The MA state-funded program is paid with general funds, and the MinnesotaCare state-funded program is paid out of the Health Care Access Fund.