Minnesota Health Exchange Profile
Establishing the Exchange
On October 31, 2011, Governor Mark Dayton (D) signed Executive Order 11-30 which charged the Minnesota Health CareReform Task Force with recommending strategies to improve overall health care delivery in Minnesota, including advising and overseeing an Exchange Advisory Task Force. Building on the work of the Advisory Task Force, on March 20, 2013, Dayton signed into law legislation creating the Minnesota Insurance Marketplace.[MN2013]
The Minnesota Health Insurance Exchange Advisory Task Force formed in October 2011 and continues to meet. The 15 Task Force members include representatives of employers, consumers, organized labor, and tribes, as well as four majority and minority Legislators from the House and Senate. The three ex officio members are the Commissioners of the Department of Commerce, the Department of Human Services, and the Department of Health. The Advisory Task Force established 10 technical workgroups to discuss exchange options and provide technical assistance directly to the Commerce Commissioner and indirectly to the Advisory Task Force. In December 2012, the Health Care Reform Task Force issued recommendation to the Legislature and Governor for implementing the Affordable Care Act, including expanding Medicaid, establishing a state-based health insurance exchange, and providing affordability and coverage support for individuals with income 138-200% of the federal poverty level.
Structure: The legislation defines Minnesota’s Exchange as a “board” or agency within the Executive Branch.
Governance: The Minnesota Marketplace will be governed by a seven-member board, including one ex officio member (or their designee): the Commissioner of Human Services. The Governor appoints six members with the advice and consent of the Senate and the House of Representatives. The six appointed members must include a representative of consumers eligible for individual coverage; a representative of consumers eligible for public coverage; a small employer; an expert in health administration or finance; an expert in public health, health disparities, public health care programs and the uninsured; and an expert in the individual and small group insurance markets. Appointed Board members will serve staggered four-year terms. The Governor must appoint members by April 30, 2013.
Board members cannot be affiliated with a carrier, institutional health care provider or other entity providing health care, navigator, insurance producer, or other entity in the business of selling items or services to or through the exchange. Board members must recuse themselves from discussion and voting on issues in which there is a conflict of interest.
The Board will establish advisory committees to provide insurance producers, health care providers, the health care industry, consumers and other stakeholders the opportunity to advise the Board.
Contracting with Plans: The legislation specifies that the Exchange will function as a clearinghouse in the first year of operation, accepting all plans that meet the minimum standards. Beginning in 2015, the Exchange may consider issues such as affordability, quality and value, promotion of prevention and wellness, efforts to reduce health disparities, market stability, meaningful choices, and access in deciding which plans to make available.
In Minnesota, the Commissioner of Commerce enforces the state’s insurance laws, while the Commissioner of Health has authority over Health Maintenance Organizations (HMOs). To avoid duplication, existing regulatory structures within the Departments of Commerce and Health will be used to certify qualified health plans (QHPs). The Departments released QHP certification guidance in October 2012.
Minnesota has also examined accreditation and quality measurements of QHPs. In July 2012, the Department of Commerce issued a Request for Proposals (RFP) for assistance with the development of a quality rating system and enrollee satisfaction survey system for insurance carriers and QHPs. This contract is expected to run from September 2012 to June 2013. Also in 2012, the plan certification subgroup released draft recommendation regarding certification requirements for carriers and QHPs and the measurement and reporting workgroup released proposed criteria for selection of a health plan quality rating system.
Dental and Vision Benefits: In November 2012, the plan certification and adverse selection work groups released recommendations for certification criteria of stand-alone qualified dental plans (QDPs). The workgroups concluded that QDPs should be meet many of the requirements for dental plans that are already in state law, included those related to licensure, marketing, rating variation, and essential community providers.
Risk Adjustment, Reinsurance, and Risk Corridors: Based on recommendations from the workgroup focused on risk sharing and risk adjustment, Minnesota decided the federal government should operate the state exchange’s reinsurance program and the risk adjustment program for 2014 and 2015. The workgroup also recommended that the exchange should pursue obtaining authority to use the state’s existing all payer claims database and develop a risk adjustment methodology that could be implemented in the future.
Consumer Assistance and Outreach: In August 2012, a subcontractor presented the results of market research findings and recommendations, including that the state should begin outreach, engage brokers as intermediaries because small businesses seek their advice and expertise, and explore naming the exchange with some variation of the terms “marketplace” and or “choices.” In January 2013, the state launched a consumer-friendly website for the exchange that includes a subsidy calculator with the branding MNsure. The state also released an RFP for a Public Awareness Marketing/Outreach Campaign to raise awareness of the Exchange and to promote enrollment. The campaign is expected to run from June 2013 to March 2014.
The Board of the Exchange is required to develop policies and procedures for Navigator and In-person Assister programs to be implemented in January 2015. Until those policies go into effect, the requirements of the Navigator program will be met by an existing outreach and assistance program operated by the Department of Human Services. In October 2012 the navigators and agents/brokers workgroup released draft training requirements for in-person assistors.
Small Business Health Options Program (SHOP) Exchange: In November 2012, the small employer workgroup provided a report summarizing the results of market analyses and discussions to date. Notably, the workgroup had not yet reached consensus on whether transitioning from a defined benefit model to a defined contribution model would be both feasible and attractive to small employers.
Information Technology (IT): Information Technology (IT): Minnesota plans to develop a single, integrated eligibility determination system that would sort applicants into the appropriate coverage program, including Medicaid, the Children’s Health Insurance Program (CHIP), the Exchange, and potentially the Basic Health Program. In June 2011, the Departments of Commerce, Human Services, and Health completed a joint Gap Analysis of the state’s IT infrastructure. They concluded that a Minnesota exchange could utilize some existing systems, but most functionality will need to be derived from new elements. Minnesota expects to use flexible and interoperable solutions developed through an IT RFP and to leverage efforts from other states. Also in June 2011, Minnesota published an RFP as a two-stage, proof-of-concept approach to evaluate IT options for an exchange. During the first stage, RFP respondents proposed prototypes for either a fully functional exchange technical infrastructure or for specific component modules. Minnesota’s strategy was to allow multiple vendors to propose prototypes for one or more of the eight distinct modules in order to identify the vendors that best met the needs of each particular IT component. In October, the state awarded select respondents with stipends to create the proposals and prototypes within the second stage. The proposals and prototypes were made public in November 2011 and online feedback was collected through January 30, 2012.
In July 2012, Minnesota announced the selection of a prime contractor to lead a team of specialized technology firms with the design and development of the exchange’s technological capabilities and with major technology improvements to the state’s Medicaid systems. The exchange and the Department of Human Services created an Exchange/Medicaid Collaboration Steering Committee and an Eligibility and Enrollment Workgroup to streamline decision-making and communicate with the IT vendor. The Department of Human Services has also issued an Implementation Advanced Planning Document to coordinate Medicaid and Exchange activities, focusing on determining eligibility for state health programs through a single set of process using a single IT system. To assist in financing the information technology upgrades of the state’s Medicaid eligibility systems, Minnesota applied for and received CMS approval of an Advanced Planning Document for the enhanced federal match.
Minnesota was asked to participate in an Early Innovator sub-workgroup consisting of multiple states discussing technical topics related to exchange development. Minnesota is also one of multiple states participating in the Enroll UX 2014 project, which is a public-private partnership creating design standards for exchanges that all states can use.
Financing: In August 2012, the finance workgroup explored multiple long-term funding options for the exchange and compared different options, including a user fee, an assessment on premiums in the exchange, an assessment on fully-insured products sold by insurers, a broad-based health care tax, an appropriation, or some combination of these options. In October 2012, the workgroup released a report highlighting the results of subcontractors’ projections of budgetary needs and enrollment, and recommendations on financial transparency, accountability, flexibility, and timing.
Prior to January 1, 2015, the authorizing legislation imposes a 1.5% user fee on individual and small group plans and dental plans sold through the Exchange to fund the Exchange’s operations. Beginning in January 2015, the user fee will increase to 3.5% of premiums.
Basic Health Program (BHP): Minnesota has considered establishing an optional bridge program available through the Affordable Care Act (ACA) that allows states to use federal funding to offer subsidized health insurance to adults with incomes between 139 and 200% of the federal poverty level (FPL) who would otherwise be eligible to purchase subsidized coverage through an exchange. Subcontractors provided Minnesota with an assessment of the impact of a BHP and implementation of other ACA provisions in April 2012. In November 2012, the access workgroup of the Health Care Reform Task Force recommended that Minnesota expand Medicaid to 138% FPL and provide affordable, comprehensive coverage for those with incomes 138-200%. The workgroup indicated it will continue to assess the coverage options for this population, including coverage through the exchange without additional subsidies, providing wrap-around benefits and/or subsidies for coverage purchased through the exchange, or creating a BHP.
Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through an exchange, cover certain defined health benefits. In the summer of 2012, the access workgroup of the Health Care Reform Task Force compared multiple benchmark plan options and concluded that all are subject to Minnesota’s current state mandated benefits and therefore are very similar. Since Minnesota has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Blue Cross Blue Shield Major Medical.
The Minnesota Department of Commerce received a federal Exchange Planning grant of $1 million in February 2011. The state has also received four Level One Establishment grants: $4.2 million in August 2011, $26 million in February 2012, $42.5 million in September 2012, and $39 million in January 2013 to support the development and implementation of the exchange.
In addition, Minnesota, along with nine other states, is receiving technical assistance from the Robert Wood Johnson Foundation through the State Health Reform Assistance Network; this assistance includes help with setting up health insurance exchanges, expanding Medicaid to newly eligible populations, streamlining eligibility and enrollment systems, instituting insurance market reforms and using data to drive decisions.
On December 20, 2012, Minnesota received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a state-based exchange. Final approval is contingent upon the state demonstrating its ability to perform all required Exchange activities on time, complying with future guidance and regulations, and demonstrating legal authority to operate the state-based exchange. Governor Dayton has indicated that key policy decisions would be made during the 2013 legislative session.
For more information on Minnesota’s health insurance exchange, visit: http://www.mn.gov/hix