State Marketplace Profiles: Minnesota

Final update made on November 12, 2013 (no further updates will be made)

Establishing the Marketplace

On October 31, 2011, Governor Mark Dayton (D) signed Executive Order 11-30 which charged the Minnesota Health Care Reform Task Force with recommending strategies to improve overall health care delivery in Minnesota, including advising and overseeing an Exchange Advisory Task Force.¹  Building on the work of the Advisory Task Force, on March 20, 2013, Dayton signed into law legislation creating the Minnesota Insurance Marketplace, which was branded MNsure.²

Structure: The legislation defines Minnesota’s Marketplace 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.

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.

Current appointed Board members are:

• Brian Beutner, Independent Business Advisor, Chair

• Thompson Aderinkomi, RetraceHealth

• Pete Benner, Independent Consultant

• Kathryn Duevel, OBGYN (retired)

• Tom Forsythe, General Mills

• Phil Norrgard, Fond du Lac Reservation

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 Marketplace will function as a clearinghouse in the first year of operation, accepting all plans that meet the minimum standards.  Beginning in 2015, MNsure 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 2012.³ The guidance requires QHPs to meet federal certification standards and existing state standards related to network adequacy and essential community providers.

On September 6, 2013, MNsure announced that five insurers will participate in the Marketplace and will offer some of the lowest rates in the nation.⁴ The five insurers will offer 141 plans in the individual Marketplace. Three insurers will participate in the SHOP marketplace and will offer 63 plans. Initially, residents in two Minnesota counties had a choice of plans from only one insurer; however, on October 30, 2013, the Department of Commerce announced that it had secured the participation of an additional insurer to provide residents of these counties with additional plan choices.⁵

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.⁶ 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.^7,8

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).⁹  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. On February 4, 2013, MNsure released guidance on the certification requirements for stand-alone QDPs.¹⁰

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 2015.¹¹ 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.¹²

Consumer Assistance and Outreach: In January 2013, the state launched a consumer-friendly website for the Marketplace 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.¹³ The campaign is expected to run from June 2013 to March 2014.

Navigators, In-person Assisters, and Certified Application Counselors, collectively known as Consumer Assistance Partners, will provide outreach and education and will assist consumers with enrolling in coverage through MNsure. All consumer assistance partners must complete an online training program and must be certified. For the first year of the Marketplace, the requirements of the Navigator program will be met by an existing outreach and assistance program operated by the Department of Human Services, the Minnesota Community Application Agent (MNCAA) program. Navigators will be paid $70 per successful enrollment into a QHP and into MinnesotaCare and $25 per successful enrollment into Medicaid.

MNsure will also run an In-person Assister program in addition to the Navigator program. In May 2013, MNsure issued an RFP for outreach and in-person assister grants. On August 23, 2103, MNsure announced 30 recipients of the consumer assistance partner grants. The 30 organizations will provide outreach and enrollment assistance to consumers throughout the state.¹⁴ In September, MNsure announced an additional $750,000 in Outreach and Infra structure grant funding would be available.¹⁵

Agents and brokers will also play a role in enrolling individuals and small employers into coverage. Agents and brokers must be certified by MNsure and must complete a three-hour online training program.

The MNsure Contact Center opened on September 3, 2013 to answer consumers’ questions about health insurance coverage and the Marketplace. Assistance will be available in English, Spanish, Hmong, and Somali and interpreter services will be available in an additional 140 languages. Staffing of the Contact Center will be adjusted throughout the open enrollment period to meet consumers’ needs.¹⁶

MNsure has developed a multi-pronged marketing and education campaign involving mass media, social media, and on-the-ground outreach. With a budget of $8.6 million, MNsure launched TV advertising in September 2013, featuring the folk hero, Paul Bunyan. MNsure also has a presence on social media, including Facebook, Twitter, Linked-In and YouTube. The education campaign is expected to last through the open enrollment period. For the Field Operations Program, MNsure has divided the state into Targeted Area Networks, where On-site Field Operations Liaisons will be available to provide outreach, distribute information about MNsure, and coordinate with enrollment assisters and agents and brokers.¹⁷

Small Business Health Options Program (SHOP) Exchange: Small employers with up to 50 employees can purchase coverage through the MNsure SHOP Marketplace. To purchase through the SHOP, employers must contribute at least 50% of the premium and at least 75% of eligible employees must participate. Employees who have signed a waiver declining coverage do not count toward the participation requirement. These contribution and participation requirements are waived during the Special Enrollment period that runs from November 15 through December 15, 2013. MNsure SHOP offers employers a choice of coverage options. Employers may choose a single plan, a metal level and offer choice of all plan within that tier, or a contribution level and allow employees full choice of plans.

Financing: In August 2012, the finance workgroup explored multiple long-term funding options for the Marketplace and compared different options, including a user fee, an assessment on premiums in the Marketplace, 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.¹⁸

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 MNsure to fund 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 coverage 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 the Marketplace. Subcontractors provided Minnesota with an assessment of the impact of a BHP and implementation of other ACA provisions in April 2012.¹⁹

Although federal regulations implementing the BHP were delayed meaning states cannot officially set up a BHP until 2015, Minnesota announced that it will move forward with the BHP. For 2014, the state will continue its MinnesotaCare program, which will provide coverage to individuals with incomes 133-200% of the poverty level.  The state made some changes to the MinnesotaCare benefit package to ensure it complies with the requirements of the ACA and eliminated some waiting periods for coverage.²⁰ Beginning in 2015, the MinnesotaCare program will become the 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  the Marketplace, 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.²¹ 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.²²

Marketplace Funding

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, in October 2013, the state received a $41 million Level Two Establishment grant to support general operations, IT and related systems, technology-related costs including security training and system improvements,  and to evaluate future quality rating systems and consumer satisfaction surveys. ²³

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.²⁴

Next Steps

On December 20, 2012, Minnesota received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a State-based Marketplace.²⁵   The MNsure Marketplace opened on October 1, 2013.

For more information on Minnesota’s health insurance Marketplace, visit: http://www.mnsure.org/