State will consider beefing up notices for Medical Assistance applicants

State officials said Wednesday they want to better notify Medical Assistance applicants about chances the state could seek to recover the cost of their medical coverage in certain circumstances after their death.

The issue came up Wednesday during a meeting of the MNsure board of directors in St. Paul, where health exchange officials said they have heard complaints about a policy that predates MNsure.

When people age 55 and older use MNsure and wind up with Medical Assistance coverage, there's a chance the state will claim repayment for coverage costs from the enrollee's estate.

If the enrollee's spouse is still living at the time of the enrollee's death, or if they have dependent children, the state would delay any such claim.

Earlier this month, the Duluth News Tribune reported about three cases in the Pine County area where enrollees say they didn't know about the clawback provision, although MNsure and the state's Department of Human Services (DHS) say notice is provided when people apply.

"Given the recent news that this provision is surprising to Minnesotans, we are working with DHS to try and clarify some of the language that's right on the application," said Allison O'Toole, the MNsure chief executive, during Wednesday's board meeting.

In a statement Wednesday, DHS said was reviewing communications to see if improvements could be made.

Minnesota created the MNsure exchange in 2013 to implement the federal Affordable Care Act, which requires almost all Americans to have health insurance or pay a tax penalty. People use the MNsure website to enroll in Medical Assistance, which is Minnesota's version of the state-federal Medicaid program.

People speaking out about the liens are part of a group that wouldn't have qualified for Medical Assistance coverage before the federal health law, said Sen. Tony Lourey, DFL-Kerrick.

The Affordable Care Act eliminated several rules that previously blocked people with financial assets from Medicaid coverage, Lourey said. Plus, as part of the federal law, Minnesota expanded eligibility for adults who don't have dependent children.

"These are small farmers that are frugal and live a very modest life and have some assets," Lourey said in an interview.

Lourey plans to put forward a bill in the coming legislative session that would eliminate the repayments for people who received Medical Assistance health insurance coverage. The bill would not eliminate liens in cases where Medical Assistance has paid for long-term care — the context where more people are familiar with the clawback provisions.

Lourey said he thinks the cost to the state would be small, since he doesn't think Minnesota has actually pursued any claims related to the health insurance side of Medical Assistance. In the meantime, MNsure and DHS should look at improving the notice provided by current materials.

In a statement, DHS said the number of liens against real property have not gone up since the health law changes went into effect.

"Because the people under the ACA and affected by estate recovery are relatively young (55-65) recovery numbers are not going to be higher," the department said.

MNsure board member Phil Norrgard said Wednesday the issue highlights inconsistencies in Minnesota's public health insurance programs, since the state doesn't attempt to recover from the estates of people covered in the MinnesotaCare program. People going through MNsure also can wind up with coverage in MinnesotaCare, which covers a group often described as the "working poor."

O'Toole said the state does not seek to recover costs for people who obtain tax credits through MNsure for private health insurance policies. She called the situation "a DHS, not a MNsure issue."

Christopher Snowbeck • 612-673-4744

Twitter: @chrissnowbeck