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S.F. No. 643 - Health Care for Low-Income Uninsured Adults and Children
 
Author: Senator Jeff Hayden
 
Prepared By: Katie Cavanor, Senate Counsel (651/296-3801)
 
Date: February 26, 2015



 

SF 643 requires the Commissioner of Human Services to establish a health care program for low-income uninsured adults who are not eligible for medical assistance or MinnesotaCare, who have or are likely to have an emergency medical condition, and a health care program for low-income uninsured children who are not eligible for medical assistance (MA) or MinnesotaCare.

Section 1 (256B.06, subd. 6) Paragraph (a) establishes a program to provide health care coverage to low-income adults.

Paragraph (b) specifies that to be eligible for the program, an individual must not be eligible for medical assistance or MinnesotaCare; have a family income that is equal to or less than 133 percent of FPG; and has been determined eligible for the emergency medical assistance (EMA) program or has been certified by their treating provider that the individual has an emergency medical condition that is likely to lead to the individual being admitted to a hospital or emergency room unless intervening treatment is provided.

Paragraph (c) specifies that program eligibility continues for as long as the individual continues to have the underlying condition that gave rise to the initial emergency medical condition.

Paragraph (d) specifies that the services that are covered under this program will be the medical assistance covered services, and that the services that would currently be covered under EMA will continue to be covered under that program.  Requires the commissioner to coordinate the two programs to ensure, to the extent possible, a seamless and invisible transition between programs for the individual.

Paragraph (e) specifies that all cost-sharing requirements under MA apply to this program.

Paragraph (f) permits the commissioner to contract with health care delivery systems to administer the program and requires the commissioner to contract on a capitated or fixed budget basis.  Authorizes the commissioner to separate nursing facility services, home and community-based services, and pharmacy services from the contracted services and provide payment for these services on a fee-for-service basis.  If no health care delivery systems are willing to contract in a geographic area of the state, the commissioner is required to administer the program on a fee-for-service basis in that area.

Paragraph (h) requires the commissioner to ensure that an individual who is eligible for the program has the opportunity to receive covered services from an essential community provider.

Section 2 (256L.30) requires the commissioner to establish a program that provides coverage to low-income uninsured children who are under the age of 21.

Subdivision 1 specifies that to be eligible for the program, the child must not be eligible for MA or MinnesotaCare; must have a family income that is equal to or less than 275 percent of FPG; and must meet the other eligibility requirements of the MinnesotaCare program with the exception of the citizenship requirement.  Specifies that the requirements and procedures of the MinnesotaCare program in terms of application, premiums, enrollment, disenrollment, and eligibility determination apply to this program.

Subdivision 2 specifies that the services covered under this program are the MinnesotaCare covered services with the exception of services that are covered under EMA.  The commissioner is required to coordinate this program with the EMA program in order to make the transitions between programs as seamless and invisible to the enrollee as possible.

Subdivision 3 specifies that the MinnesotaCare premiums and cost-sharing provisions apply.

Subdivision 4 authorizes the commissioner to contract with managed care plans, county-based purchasing plans, provider networks, nonprofit coverage programs, counties, or health care delivery systems to administer the program.  Requires the commissioner to ensure that an individual who is eligible for the program has the opportunity to receive covered services from an essential community provider.

Section 3 requires the Commissioner of  Human Services to seek federal approval for changes to the emergency medical assistance program to allow coverage and payment for cost-effective, community-based, and outpatient services as an alternative to hospital inpatient and emergency department services in order to reduce the total cost of care.

 

 

 

 
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