A daunting challenge for health care

Opinion editor's note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.

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Minnesota lawmakers have moved with astonishing speed to pass abortion rights and other important legislation early in the 2023 session. The same sense of urgency is vital in handling a massive health care challenge looming in the months ahead — preventing coverage gaps or loss of coverage altogether for the 1.5 million Minnesotans reliant on medical assistance programs.

In health care circles, the issue is often referred to as the great "unwinding." It's happening because the nation is moving out of its emergency COVID-19 response.

As the viral threat became clear in the pandemic's earliest weeks, Congress took a conscientious step. It boosted Medicaid funding for states willing to keep people enrolled continuously through the end of the public health emergency, ensuring people who contracted COVID would be able to access care.

Medicaid is the federal-state health insurance program for low-income Americans. It is a particularly important program for seniors and those with disabilities because it assists with long-term care costs.

Enrollees have to meet financial income requirements. This is an ongoing periodic process to ensure the program only serves the truly needy. These checks were suspended after the continuous enrollment was put in place in 2020.

But in late 2022, Congress put a March 31 sunset on its continuous enrollment policy, meaning eligibility checks are resuming for all who rely on this public assistance. Restarting this is a daunting undertaking.

Enrollment in Minnesota's Medicaid programs (known as Medical Assistance and MinnesotaCare) has increased 28% since 2019. In addition, the eligibility process remains paper-based, requiring forms to be sent to enrollees and returned through the mail. Addresses may not be up-to-date, further complicating the situation. Counties and the state, which shoulder redetermination responsibilities, also face the same workforce shortages as other employers.

There's little room for error. Enrollees who don't receive forms or mail them back in a timely fashion could lose coverage even if they remain eligible. Those who no longer meet program requirements will also lose coverage and need clear guidance on what their options are. For example, many may be eligible for subsidized private health plans sold through MNsure, and they need to be aware of that.

The state Department of Human Services has rolled out a sensible response plan and presented it to legislators recently. The plan breaks the work into manageable chunks to avoid redetermining eligibility for everyone all once.

The Minnesota process will take about a year and logically divides Medical Assistance enrollees into 12 groups based on the month when they became eligible for the program. Those first up for the resumed eligibility checks are those with a July eligibility date. The process will then move to enrollees with August eligibility dates and so on.

In contrast, there will be a fall focus on the smaller group of MinnesotaCare enrollees. The program has about 105,000 enrollees, while there are 1.36 million in Medical Assistance.

Lawmakers have a role to play because they need to determine how much is needed to do this well, and then appropriate the necessary dollars. The state will need resources. So will counties, which will be on the front lines of Medical Assistance redetermination. County aid is a must in any bill.

Legislators also need to authorize flexibility during "unwinding" — in particular to give extra time to Minnesotans whose long-term care the program pays for. This is a concern because of these enrollees' age or disabilities and because of the program's low and strict asset requirements that long-term care enrollees must meet.

Last week, key Minnesota House legislators were still working on a draft of a Medicaid "unwinding" bill. This isn't moving fast enough.

Enrollees, or families with a loved one who rely on these programs, can also proactively take steps to smooth the process. It is important to ensure that an up-to-date address is on file. Information about where to call is available online at tinyurl.com/MNHealthCareInfo.

Navigators, who are local trusted community organizations specializing in Medical Assistance and MinnesotaCare enrollment, can also help with renewal paperwork or questions. To find one close to you, go to tinyurl.com/FindMNNavigator.

This is an all-hands-on-deck situation to ensure that people eligible stay on medical assistance programs and that those who lose eligibility have a smooth path to other coverage options. A perennial state health standout like Minnesota should show the rest of the nation how to do this well.