state of minnesota office of the legislative auditor _____________________________________...
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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
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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DHS Oversight of MNsure Eligibility Determinations for 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 Oversight of MNsure Eligibility Determinations for Public Health Care Programs
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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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DHS Oversight of MNsure Eligibility Determinations for Public Health Care Programs
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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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DHS Oversight of MNsure Eligibility Determinations for Public Health Care Programs
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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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DHS Oversight of MNsure Eligibility Determinations for Public Health Care Programs
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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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DHS Oversight of MNsure Eligibility Determinations for Public Health Care Programs
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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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DHS Oversight of MNsure Eligibility Determinations for Public Health Care Programs
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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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DHS Oversight of MNsure Eligibility Determinations for Public Health Care Programs
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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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DHS Oversight of MNsure Eligibility Determinations for Public Health Care Programs
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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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DHS Oversight of MNsure Eligibility Determinations for Public Health Care Programs
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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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DHS Oversight of MNsure Eligibility Determinations for Public Health Care Programs
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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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DHS Oversight of MNsure Eligibility Determinations for Public Health Care Programs
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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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DHS Oversight of MNsure Eligibility Determinations for Public Health Care Programs
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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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DHS Oversight of MNsure Eligibility Determinations for Public Health Care Programs
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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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DHS Oversight of MNsure Eligibility Determinations for Public Health Care Programs
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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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DHS Oversight of MNsure Eligibility Determinations for 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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DHS Oversight of MNsure Eligibility Determinations for Public Health Care Programs
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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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DHS Oversight of MNsure Eligibility Determinations for Public Health Care Programs
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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%
DHS Oversight of MNsure Eligibility Determinations for Public Health Care Programs
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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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DHS Oversight of MNsure Eligibility Determinations for Public Health Care Programs
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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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DHS Oversight of MNsure Eligibility Determinations for Public Health Care Programs
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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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DHS Oversight of MNsure Eligibility Determinations for Public Health Care Programs
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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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DHS Oversight of MNsure Eligibility Determinations for Public Health Care Programs
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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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DHS Oversight of MNsure Eligibility Determinations for Public Health Care Programs
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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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DHS Oversight of MNsure Eligibility Determinations for Public Health Care Programs
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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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