Minnesota Council of Health Plans and MNsure provide update on coverage retention efforts in the midst of Medicaid unwinding process


Hannah Saunders


In its ongoing redetermination of Medicaid eligibility, Minnesota is reevaluating eligibility for a record high of 1.5 million enrollees on Medical Assistance, Minnesota’s Medicaid program, and MinnesotaCare, Minnesota’s basic health program. Ineligible individuals began to lose coverage in July, and the last cohort will undergo eligibility redeterminations in July of 2024. 

As of Nov. 14th, Minnesota’s Medicaid renewal data shows that 377,227 individuals have retained coverage, while 892,371 still have an unknown or pending outcome. A total of 11,051 of the individuals who have undergone redeterminations so far are eligible for MinnesotaCare, while 23,134 are eligible for a qualified health plan (QHP) (meaning they’re ineligible for public coverage and will need to obtain commercial coverage). 

Several months into the redetermination process, Minnesota paused procedural disenrollments to allow extra time for members to return their information and renewal packets and minimize gaps in coverage. Cohorts one to three and cohort seven are receiving a one-month extension to return their renewal packets, while cohorts four through six will receive a three-month extension to return the paperwork. 

Data also shows that 12,334 individuals have been deemed ineligible for Minnesota Health Care Programs (MCHP), while 97,324 individuals didn’t return their renewal packets and were thus procedurally disenrolled. As of September, a total of 119,942 individuals were disenrolled, with 42 percent of those disenrolled being children, and 58 percent adults. 

Hannah Fairman, director of communications at Minnesota Council of Health Plans, spoke with State of Reform about the group’s work throughout the unwinding period. She explained how just like 28 other states, Minnesota took an auto-renewal approach that evaluated eligibility across households, rather than at the individual level. 

“That approach created challenges because for some households—especially those with kids—an individual might qualify for Medicaid benefits even if their parents would not because of different eligibility thresholds.”

— Fairman

Earlier this fall, the Centers for Medicare and Medicaid Services paused disenrollments in 30 states, including Minnesota, due to system errors. CMS cited how some states were renewing the eligibility of people as whole households, even if individuals in a household had different eligibility requirements, resulting in inaccurate coverage losses. Half a million individuals regained their Medicaid or Children’s Health Insurance Program coverage due to this action.

The federal government called for all states using the auto-renewal approach to alter the process, which has allowed Minnesota to restore health insurance coverage for 12,745 residents, many of which are children, for the state to adjust their approach to eligibility reviews.

State of Reform reached out to MNsure, Minnesota’s health insurance marketplace, to hear about their efforts to help Minnesotans retain coverage when they lose Medicaid coverage. Mary Robinson, communications manager for MNsure, said MNsure’s top priority throughout the redetermination process is to reduce coverage gaps. 

“MNsure understands that losing public program eligibility is a new and potentially challenging circumstance for individuals and families,” Robinson said. “We are here to help eligible Minnesotans make a smooth transition from Medical Assistance or MinnesotaCare to a private health plan so they do not experience disruption in care.” 

Robinson highlighted how those determined eligible for a QHP might not always choose coverage through MNsure. She said individuals may have access to affordable coverage through their employer, while others may have aged into Medicare, among other reasons. 

“We are confident that our direct outreach campaign is effectively reaching the newly QHP-eligible population, providing relevant, useful information for consumers, and helping them connect with brokers and navigators who provide free enrollment help.” 

— Robinson

To promote the continuity of coverage, MNsure extended the special enrollment period from 60 days to 90 days, which provides newly QHP-eligible Minnesotans additional time to explore their health coverage options, receive assistance, make informed plan choices, and enroll. 

Robinson added that MNsure is providing an opportunity for eligible consumers who enroll after the date they lost public healthcare program coverage to begin their new QHP the first day of the month after they lost coverage. This optional choice allows for continuous coverage for individuals. MNsure is also providing navigator partners with additional training and support. 

“We’ve also transitioned our payment schedule for navigators from a quarterly basis to monthly, as increasing the frequency will provide better support for our valued navigator partners,” Robinson said. 

Fairman noted how public awareness is an ongoing concern, citing national survey findings that nearly two-thirds of Medicaid enrollees were unaware of eligibility redeterminations. She highlighted the work managed care organizations (MCOs) are undertaking with the Minnesota Department of Human Services (DHS), like leveraging trusted relationships with members to provide information and resources on the renewal process. 

“Through this process, MCOs can now receive more timely data from DHS identifying which members were approaching their renewal date, who had received their renewal packet, and resources to communicate with those members in a clear, uniform way,” Fairman said. “With this information, MCOs used customer service staff, care coordinators and their provider networks to assist members with questions or reminders to complete their paperwork.” 

Fairman said this outreach was intended to alleviate strain on counties and Tribes, who she said would otherwise be the only source of information on renewals for MHCP enrollees. Minnesota’s Medicaid eligibility renewals are conducted on paper, and the state had not collected eligibility information since the beginning of the COVID-19 public health emergency. As a result, individuals are at risk of procedural disenrollments if their contact information is not updated on these paper forms. 

“One of the first waivers that DHS and MCOs sought was the ability for MCOs to collect updated contact information from their members to supply to DHS and their county [and] Tribal partners. Because MCOs have significantly more touch points with members, their proactive outreach and support of this initiative led to a significant reduction in returned mail or undeliverable addresses,” Fairman said. 

According to Fairman, nearly half of current Medicaid enrollees haven’t undergone the renewal process before, and certain populations—like children, people experiencing housing insecurity, people living with complex conditions, and non-native English speakers—are at an especially high risk for losing coverage. Fairman said MCOs and DHS have  enacted a dedicated, equity-and-data-informed strategy to target outreach and resources to populations that are most at risk. 

“This is one of the best examples of a public-private partnership supporting innovative approaches to health equity that is constantly evaluated and evolving to meet the most pressing needs across the state at any given time. Outcomes of this partnership include the development and dissemination of culturally-specific resources, consistent engagement with key stakeholders such as FQHCs [Federally Qualified Health Centers], community-based organizations and providers, and a dedicated forum to discuss best practices.” 

— Fairman

Fairman said MCOs remain committed to finding innovative and timely solutions to ensure all Minnesotans keep their health coverage throughout this process. During the second half of the unwinding period, MCOs will continue to focus on core messaging that members need to successfully renew their coverage. This messaging includes the need for members to update their contact information, check their mailbox for important DHS letters, and return their renewal packets as soon as possible. 

“We are also focused on developing responsive and data-driven improvements to our outreach efforts as we learn more about what works and where gaps persist,” Fairman said. 

Going forward, the Minnesota Council of Health Plans is looking to advocate for policies that will make the Medical Assistance and MinnesotaCare programs stronger in the future, like increasing the rates of auto-renewals, streamlining applications for benefit programs, and reestablishing trusted relationships with community partners.