State of Minnesota Office of the Legislative Auditor _____________________________________ Department of Human Services Oversight of MNsure Eligibility

State of Minnesota

Office of the Legislative Auditor _____________________________________

Department of Human ServicesOversight of MNsure Eligibility

Determinations for Public Health Care Programs

Issued November 12, 2014

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Health and Human Services Reform CommitteeMinnesota House of Representatives

February 25, 2015 1

DHS Oversight of MNsure Eligibility Determinations for Public Health Care Programs

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DHS is responsible for ensuring that the state correctly determines whether people are eligible to receive benefits from the state’s public health care programs

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Minnesota’s Public Health Care Programs– Medical Assistance (MA)– MinnesotaCare (MinnCare)– Children's Health Insurance Program (CHIP)

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DHS has struggled to effectively oversee its eligibility determination responsibilities

– OLA concerns for over 10 years– In the 5 most recent federal compliance audits

we found that DHS did not have adequate internal controls to ensure compliance

– In the 2 most recent federal compliance audits we found that DHS had not complied with eligibility requirements

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In a 2014 report we stated that DHS “was ill prepared to determine how changes to its enrollment and eligibility verification processes” because of MNsure “either decreased or increased its risk of noncompliance with federal program requirements, or to identify the ways it needed to adjust its internal controls to address those risks.”

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Because of DHS’s history with eligibility determinations and the rough roll-out of MNsure, we thought it was important to test the eligibility of people enrolling in the state’s public health care programs through MNsure.

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Primary Objective

To determine whether DHS ensured that people who enrolled in a state public health care program through MNsure met federal and state eligibility requirements for the program in which they were enrolled.

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Conclusion

DHS did not ensure that Medical Assistance, MinnesotaCare, and Children’s Health Insurance Program recipients who enrolled through MNsure were eligible for the benefits they received.

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Conclusion

DHS had many instances where it did not comply with the federal and state legal requirements related to recipients’ eligibility for Medical Assistance, MinnesotaCare, and the Children’s Health Insurance Program.

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Methodology

Using data from the state’s medical payment system (MMIS) we identified the 167,179 people who enrolled into MA, MinnCare, and CHIP through MNsure, from October 1, 2013 through April 30, 2014.

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• This included– People who enrolled through the website– People who worked with Mnsure, DHS,

counties, navigators, brokers, or assisters to enroll through the website

– People who submitted paper applications to MNsure, DHS, or counties

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• This DID NOT include– People who were already on one of the public

health care programs on October 1, 2013– People who were denied enrollment in a public

health care program

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Methodology

We met with staff from DHS, MNsure, MN.IT, and county human service offices to understand:

– Problems resulting from MNsure’s implementation and how they were (or were not) resolved

– Training provided to DHS and county human services staff to access and use MNsure

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Methodology• Selected a sample of 100 cases

– 60 from Medical Assistance– 25 from MinnesotaCare– 15 from Children’s Health Insurance Program

• These 100 cases included 193 people

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Methodology• Accessed data in MNsure about these cases

and the people included in these cases• Verified information to other sources

– Tax filings– Wage and unemployment data– Other DHS and county data

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Methodology• Where we could, we analyzed the entire

population of public health care program enrollments through MNsure to determine the full scope of an exception

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Overall results• Nearly 17% of the people we tested were

not eligible for the public health care program in which they were enrolled– Some belonged in another public health care

program– A few should not have been enrolled in any of

the public health care programs

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• Finding 1 (Page 7)– Overall finding, with some examples

• Findings 5 – 10 (Pages 14 – 29)– Further discussion of specific types of

exceptions

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Exception Examples

MNsure provided applicants with wrong income information (Finding 1, page 7)

Employer ID numbers were shown as income:

Employer ID 41-5777140 was shown as

$415,777,140

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Exception Examples

24 enrollees (out of the whole population) had duplicate accounts (Finding 1, page 8)

– Same Social Security Number– Same name and birthdate– Almost $45,000 in duplicate payments– A third of the duplicate accounts had not been

detected

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Program Citizenship / Immigration Status

Social Security Numbers

MA 36% 65%

CHIP 20% 64%

MinnCare 88% 75%


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Exception Examples

DHS and Counties had difficulty resolving certain discrepancies within 95 days (Finding 5, Page 14)

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Exception Examples

Enrollees’ incomes exceeded program limits (Finding 6, Page 17)• At the time they applied• After enrollment

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Exception Examples

Enrollees had errors in household size and family relationships• Parents reported as children• Spouse or children reported as “other”

relatives• Mother not included in household

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Exception Examples

Enrollees were in MinnesotaCare but should have been in Medical Assistance (Finding 8, Page 23)

– Children– People whose income dropped– People whose reported income was not accurate

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Exception Examples• MinnesotaCare recipients were also

enrolled in Medicare (Finding 9, Page 27)• Women still enrolled in Children’s Health

Insurance Program more than 60 days after pregnancies end (Finding 10, Page 27)

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Other Findings• County workers were not well trained

(Finding 3, Page 10)• County workers could not close cases

(Finding 4, Page 12)

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Other Findings• DHS did not ensure that data accurately and

securely transferred from MNsure to the state’s medical payment system (Finding 2, Page 9)

• DHS charged incorrect premium amounts to people who enrolled in MinnesotaCare through MNsure (Finding 11, Page 29)

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State of Minnesota

Office of the Legislative Auditor_____________________________________

Department of Human ServicesOversight of MNsure Eligibility

Determinations for Public Health Care Programs

is available at:

www.auditor.leg.state.mn.us

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Documents

State of Minnesota Office of the Legislative Auditor _____________________________________ Department of Human Services Oversight of MNsure Eligibility