Background: Resuming public health care program renewals
Maintaining coverage for Minnesotans when federal continuous coverage requirements ended
Coverage during the pandemic
Like all states, Minnesota maintained health care coverage for its Medicaid enrollees during the COVID-19 pandemic. From March 2020, Minnesotans who newly gained eligibility or already had eligibility for Medicaid (called Medical Assistance in Minnesota) or MinnesotaCare remained enrolled in the coverage regardless of most changes in their lives that previously would have affected their coverage.
Continuous coverage helped Minnesotans access care during a global pandemic and maintained high insurance coverage rates in the state. It also allowed the state to receive billions in additional federal funding under the Families First Coronavirus Response Act, the first major federal stimulus package passed by Congress. Those federal funds were used during the public health emergency to help pay for health care services, make COVID-19 testing and treatment accessible at no cost to Minnesotans, and help support the direct care workforce, however the majority went into the state’s general fund.
Growth of enrollment
With these continuous coverage provisions in place, enrollment in Medical Assistance (Minnesota’s Medicaid program) and MinnesotaCare grew by more than 360,000 people, or greater than 30%, to more than 1.5 million Minnesotans. Roughly one in four residents living in the state now get their health care coverage through these public health care programs.
Congress passed legislation requiring states to return to standard Medicaid eligibility procedures, which includes an annual eligibility review through a renewal process, in spring 2023. That meant that most of the 1.5 million Minnesotans enrolled in Medical Assistance and MinnesotaCare needed to have their eligibility for these programs reviewed through the renewal process. Given the caseload growth, this represented a significantly larger volume of work than had ever occurred in the state’s public health care programs history. Experts across the country agreed that the resumption of these renewal processes created the biggest challenge to health care coverage since the implementation of the Affordable Care Act.
The Centers for Medicare & Medicaid Services (CMS) issued federal guidance outlining the expectations that states must take all possible actions to maintain coverage for eligible individuals when renewal processes resumed. States were required to conduct full eligibility reviews for most Medicaid enrollees before coverage was terminated.