Presented by:Peggy Zimmerman-Belbeck, MCHAKris Messner, MedicaJeanne Ripley, Halleland Health Consulting

Provide an overview of MN’s Low Income Subsidy Program

Eligibility & qualifying criteria Administrative issues and processes Program results Lessons learned Questions and discussion

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

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

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

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

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

2005 2006 2007# Applications Mailed

26,885 24,000 24,709

Program Application Timeframe

July-August February-March May-June

Income Tax Year 2004 2004 2006

Income Cut Off 180% FPL 180% FPL 200% FPL

# Applications Rec’d

1,860 2,688 2,406

# Of Enrollees Who Qualified

1,558 1,392 newly qualified1,315 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

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%)

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