Olmsted County Community Services Department

Family Support & Assistance DivisionProviding quality administration of public programs

that promote the well being self sufficiency and economic stability of children and adults in Olmsted Countythat promote the well-being, self-sufficiency and economic stability of children and adults in Olmsted County

Public Health Care ProgramsPublic Health Care ProgramsImproving the wellImproving the well--being of individuals and families by providing healthcare coverage and supportbeing of individuals and families by providing healthcare coverage and supportImproving the wellImproving the well--being of individuals and families by providing healthcare coverage and supportbeing of individuals and families by providing healthcare coverage and support

Calendar Year-2011

Annual Report

July 2012

Minnesota provides public health care programst t th d fto meet the needs of:

• Families with children under age 21Families with children under age 21• Pregnant women and newborns• Adults without children• Adults with disabilities• People age 65 or older• People living in a nursing home

Most health care programs have income and asset limits

Minnesota’s public health care programs contributet th ll b i f l i l b idi

Most health care programs have income and asset limits

to the well-being of low-income people by providing coverage for health care services including:

• Preventive care• Preventive care

• Hospitalization

• Mental health and chemical dependency services

• Prescription drugs

• Dental care

In Olmsted County over 16,900 peoplehave their health care coverage through public programs

Minnesota’s three “Health Care Programs” are:

have their health care coverage through public programs

Medical Assistance (MA)

MA is a joint federal-state health care program for low-income parents, children, elderly or disabled people, low income adults without children, including subsidized prescription drug benefits and health care coordinated benefits covered under Medicare.

General Assistance Medical Care (GAMC)( )

General Assistance Medical Care (GAMC) was a state-funded program for low-income adults without children who did not qualify for federally funded health care programs. The program ended February 28, 2011 and enrollees were automatically moved to Medical Assistance (MA) Minnesota’s Medicaid programmoved to Medical Assistance (MA), Minnesota s Medicaid program.

MinnesotaCare (MCRE)

MinnesotaCare is a publicly subsidized health insurance program for lower-income p y p g

state residents who do not have access to affordable health care coverage.

Olmsted County Residents (Persons)

Enrolled in MA Healthcare Programs

18,000 15,747 15,792

17,116

14,000

16,000 13,837 13,989

10,000

12,000

There was an overall growth of 8% in Medical Assistance from Calendar Year 2010. 65% of this growth was due to the transfer of

6,000

8,000

growth was due to the transfer of certain adults from MinnesotaCareunder the Affordable Care Act, “MA Expansion” option.

2,000

4,000 Enrollment numbers in CY-2007 and CY-2008 are under represented due to the State data systems undergoing a re-write.

-CY-END 2007 CY-END 2008 CY-END 2009 CY-END 2010 CY-END 2011

Olmsted County

MA – Category of EnrolleesMA Category of Enrollees

Children Ages0-20

MA Expansion

Elderly

Refugee & Emergency Health

Care

Parents of ChildrenDisabled Children & Adults

Data sources:MAXIS REPT/RPTSThe Affordable Care Act passed by Congress offered states the option of expanding eligibility for

Medical Assistance (federal Medicaid). Minnesota elected to participate in this “MA expansion” which moved adults without children in the home from MinnesotaCare into Medical Assistance for their health care benefits if their household income was at or below 75% of the federal poverty guide (FPG).

Olmsted County

MinnesotaCare Enrollees

3,500 3,083

3,000

2,266 2,229

2,000

2,500

1,877 1,993

2,229

1 000

1,500

Adults without children in th h b li ibl f

500

1,000 the home became eligible for benefits under Medical Assistance due to the Affordable Care Act.

-CY-END 2007 CY-END 2008 CY-END 2009 CY-END 2010 CY-End 2011

Olmsted County

MinnesotaCare- Category of EnrolleesMinnesotaCare Category of EnrolleesAdults w/out children

37%

Parents of Children28%

Children & Pregnant Women

35% Data sources:35% DHS Reports & Forecasts;PMAP Enrollment Data Reports

Public Health Care Paymentsfor Olmsted County Residents

$190,000,000

$188,626,708

for Olmsted County Residents

$180,000,000

$185,000,000 $179,565,000 $177,872,987

$165,000,000

$170,000,000

$175,000,000

$163,603,000

$155,000,000

$160,000,000

$165,000,000

$158,130,063

$145,000,000

$150,000,000

$140,000,000 CY-END 2007 CY-END 2008 CY-END 2009 CY-END 2010 CY-END 2011

CY-2011 Public Health Care Paymentsfor Olmsted County Residentsfor Olmsted County Residents

$177,872,987 in public health care services was

Other State Funded1%

$177,872,987 in public health care services was paid for Olmsted County residents in CY-2011

Minnesota Care5%

Medical Assistance94%

Data sources:DHS Reports and Forecasts

A dAppendix

• Managing for Results (M4R) – Manage the Resources• Managing for Results (M4R) – Initiatives• Managing for Results (M4R) – Run the Business• Managing for Results (M4R) – Develop the Employees• Chart: Health Care Program Income Limits• Chart: Health Care Program Asset Limits• Terms and Definitions• Staff Contacts

Mission: Providing quality administration of public programs that promote the well-being,self-sufficiency and economic stability of children and adults in Olmsted County.

Vision: A safe, thriving and inclusive community

M th R Strategic Priority: Effective local administration of

, g y

Manage the Resources Strategic Priority: Effective local administration of programs within available resources

Performance Measure Target CY-2010 Results CY-2011 Results

Incentive earnings, bonus funding Earn maximum Estate /Recoveries: Estate /Recoveries:g , f gincentives, bonus funding

Benchmark: previous earnings and bonuses

/$ 290,374.48

$ 67,058.53 was retained by the county to offset local levy

/$ 346,295.86

$ 89,061.25 was retained by the county to offset local levy

Collections have a cost benefit to taxpayers and to medical/health care providers in the county.

2010 Health Care Annual Report- Olmsted County

Mission: Providing quality administration of public programs that promote the well-being,self-sufficiency and economic stability of children and adults in Olmsted County.

Vision: A safe, thriving and inclusive community

M th RStrategic Priority: Effective local administration of

, g y

Manage the Resources programs within available resources

Performance Measure Target CY-2010 Results CY-2011 Results

Telecommuting for maximizing Percent of 53% of Healthcare, 53% of Healthcare, g f gproductivity

ftelecommuters

f ,Placement & Waiver Services (PAWS) workers telecommute

f ,Placement & Waiver Services (PAWS) workers telecommute

Caseload productivity15-20%

Telecommuter caseloads range from

280-309

Telecommuter caseloads average 303

Use of technology for online forms, scanning of mail, and related processes has improved the effectiveness of telecommuting and allowed for increased productivity.

Mission: Providing quality administration of public programs that promote the well-being,self-sufficiency and economic stability of children and adults in Olmsted County.

Vision: A safe, thriving and inclusive community

R th B iStrategic Priority: Positive outcomes and successful

, g y

Run the Business program performance results

Initiatives2011 B t P ti I iti ti2011 Best Practice Initiatives:

• Utilized our case aide staff for coordination of our MA volunteer driver program. One case aide is now processing all volunteer driver requests for our division, allowing consistency and assuring dedication to the task. To further improve efficiency in this area, we converted to sending electronic referrals to our vendors for ride authorization and we moved to electronic billing for MA transportationreferrals to our vendors for ride authorization and we moved to electronic billing for MA transportation payments.

• Realigned our health care contact worker duties to integrate both community and long term care workers Continued to lead the regional Long Term Care collaborative• Continued to lead the regional Long Term Care collaborative.

• Streamlined the determination of Cost Effective Insurance eligibility by utilizing three health care experts to process for the cash and food team. This allows consistency and assures program integrity in this area.E t bli h d t li f th thi b f b d i th ll t

2010 Health Care Annual Report- Olmsted County

• Established a customer care line for the agency; this began our process of broadening the call center into a two-tier model. We are now using eligibility specialists for front-line callers to assist in one-stop resolution to eligibility questions.

Mission: Providing quality administration of public programs that promote the well-being,self-sufficiency and economic stability of children and adults in Olmsted County.

Vision: A safe, thriving and inclusive community

D l th E l i i i lifi d d di ff

, g y

Develop the Employees: Strategic Priority: Qualified and diverse staff

Performance Measure Target CY-2010 Results CY-2011 Results

Diversity of workforce Workforce reflects 16% of Healthcare 17% of Healthcare y f f f fdiversity of service population

Benchmark: customer diversity

fWorkers are persons of color

22% of Healthcare Workers are bilingual

fWorkers are persons of color

23% of Healthcare Workers are bilingual

Customer service population demographics (most currently available):62% of persons enrolled in public health care programs are white;62% of persons enrolled in public health care programs are white; 38% of persons enrolled in public health care programs are from communities of color

Health Care Program Income Limits g

75% FPG Medical Assistance Elderly, Blind, Disabled (with spenddown)Medical Assistance Adults without Children

100% FPG M di l A i Child 19 20100% FPG Medical Assistance Children, age 19-20Medical Assistance Adults with childrenMedical Assistance Elderly, Blind, Disabled (no spenddown)Qualified Medicare Beneficiaries

120% FPG S i Li it d M di B fi i i120% FPG Service Limited Medicare Beneficiaries

135% FPG Medical Assistance Qualifying Individuals

150% FPG MinnesotaCare $48 Annual PremiumMedical Assistance Children ages 2 through 18

185% FPG Transition Year Medical Assistance (with excess earnings for regular health care)

200% FPG Medical Assistance Qualified Working Disabled IndividualsMinnesota Family Planning Program

215% FPG MinnesotaCare parents – no cap on inpatient services

250% FPG MinnesotaCare adults without children

275% FPG MinnesotaCare Children to age 21MinnesotaCare Families with Children

2010 Health Care Annual Report- Olmsted County

MinnesotaCare Families with ChildrenMedical Assistance Pregnant Women

280% FPG Medical Assistance Infants under age 2

Health Care Program Asset Limits

Medical AssistanceElderly / Disabled

$3,000 for 1 person$6,000 for 2 people

g

Medical AssistanceFamilies

$10,000 for 1 person$20,000 for 2 or more people

MinnesotaCare:Families / Adults with no children

$10,000 for 1 person$20,000 for 2 or more people

EXEMPT from asset test(for all programs)

Pregnant WomenChildren under the age of 21Single Adults without Children in the home (MA expansion)expansion)

EXCLUDED assets One vehicleHomestead (with certain exceptions)Burial fund/space items (with limitations)

Health Care Terms & DefinitionsHealth Care Terms & Definitions

• Fee for Service• Fee for ServiceA service delivery model in which a Health Care consumer receives medical services at any Medical A i t th i d id d bli b fitAssistance authorized provider, and public benefits are paid based on each service.

P id M di l A i t P (PMAP)• Prepaid Medical Assistance Program (PMAP)A capitated service delivery model in which a public entity pays a set per-member-per-month rate to a Health Plan. The Health Plan is then responsible for all of the consumer’s health care costs.

Health Care Terms & DefinitionsHealth Care Terms & Definitions

• SpenddownA cost-sharing method available to people who do not qualify for Medical Assistance because of excess income.

A “spenddown” is similar to an insurance deductible. People may become eligible by incurring medical expenses equal to or greater than the excess income.

There are several types of spenddowns, including monthly, six-month, and long-term care.

For Additional Information, contact:For Additional Information, contact:

B th A dt S iBeth Arendt, Supervisor328-6541

Meridee Brown SupervisorMeridee Brown, Supervisor328-6513

Keith Onstad, Supervisor, p

328-6704

Mina Wilson, Division Director,328-6354