2008 NASCHIP Conference October 16, 2008 Minnesota’s Low Income Subsidy Program Presented by: Peggy Zimmerman-Belbeck, MCHA Kris Messner, Medica Jeanne Ripley, Halleland Health Consulting

Today’s Objectives Provide an overview of MN’s Low Income Subsidy Program Eligibility & qualifying criteria Administrative issues and processes Program results Lessons learned Questions and discussion

Overview Low Income Subsidy Program funding from the Federal Grant opportunity–Consumer Bonus Grant Oversight by Board of Directors Subcommittee Subcommittee recommendations to the Board Program conducted 4 consecutive years 2005- 2008 One time application process per year Based on household income and not tied to premium paid

Eligibility Criteria Must be an MCHA enrollee Enrollee’s whose premium is paid by 3rd party are ineligible Completion of entire application- including signature, etc. Provide information and documentation of annual household income for ALL individuals in the household and Provide information on household size Application must be postmarked by deadline

Total 2007 Household Income Qualifying Criteria MCHA enrollees qualify for the Low Income Subsidy if their total annual household income is at or below a defined percentage of the FPL for their household size (all house- hold members, not just MCHA enrollees) 2008 program based on 220% of FPL Total Number in Household Total 2007 Household Income 1 $22,462 2 $30,118 3 $37,774

Administrative Issues/Guidelines HIPAA issues/protection of enrollee information Business associate agreements in place Program “buy in” of regulators Administrative expenses - from “operational” grant funds so all bonus grant funds are distributed to enrollees Initial program tied to premium - now divide total bonus grant funds by the number of qualifying enrollees No appeal process – all decisions final No contacting enrollees for additional information- decision based on application and documentation submitted

Administrative Process Utilize a project management approach Goal – conduct the program within a 6 month period of time “Enrollee friendly” approach – yet maintain strict criteria to assure a “fair” process Coordination and communication Key participants: MCHA – Oversight of the program Halleland Health Consulting (HHC) – Responsible for managing the application and screening process Medica (Writing Carrier) – Responsible for all administrative functions and outside vendors (printer and check vendor, and banking functions) Wipfli- MCHA’s Accounting firm

Administrative Process Develop program timeframe Establish eligibility guidelines Material development: cover letter, application, Instructions, reminder notice, denial letter, & checks Printer cost quotes for mailed materials & checks Establish bank account and verify check format 1) Planning Process (4 weeks) Identify eligible enrollees Eliminate ineligible enrollees Mailing of applications in batches (3 batches to 23,000+ households) Application and instructions available or downloading on web site 2)Application Mailing

Administrative Process Develop enrollee Q & A’s for each phase of the program (available on web site) Address application inquiries, processing questions and check and denial inquiries Staff available from date application is mailed through duration of the program 3) Helpline staff/customer service Reminder Notice – increases participation Update address changes Reminder Notice mailed 3 weeks following application mailing 4) “Reminder” Notice Mailing

Administrative Process Establish clear deadline date using postmarked date No applications accepted after deadline Allow U.S. Mailed applications only Allow 3-4 weeks for application completion and mailing 5)Application Deadline Process applications per qualifying criteria Identify those who qualify/those who do not Extranet access by helpline/customer service staff to track status Begins when first applications are received & completed 3 weeks following deadline 6)Application Processing

Administrative Process Identify enrollees who qualify Deposit funds/mail checks Allow enrollees 30-45 days to cash checks Letters/calls regarding non cashed checks Stop payment issued after a defined timeline Reissuance of checks only due to theft 7) Issuing checks Identification of the those that did not qualify Letters mailed with reason for denial Identify that “all decisions are final” – there is no appeal process Extranet updated with denial reason 8) Denial Notices

Summary of Results 2005 2006 2007 # Applications Mailed 26,885 24,000 24,709 Program Application Timeframe July-August February-March May-June Income Tax Year 2004 Income Cut Off 180% FPL 200% FPL # Applications Rec’d 1,860 2,688 2,406 # Of Enrollees Who Qualified 1,558 1,392 newly qualified 1,315 prequalified-2005 2, 07 total 2,442 $ Distributed $267,039.81 $2,700,000 $2,000,000 Distribution Method Based on monthly premium paid Total funds divided by # of qualifying enrollees Average Check Amt. Per Member $171.40 $857.69 $716.08 # Denied 302 (16.2%) 440 (25%) 566 (19%)

Lessons Learned Every year the process is refined & enhanced Every year application format and instructions are enhanced Every year the percent of FPL needs to be reviewed Target enrollees who have difficulty paying premiums Evaluate program for “unintended consequences” (Medicare population)

Questions and Discussion