Minnesota

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Managed LTSS Programs

In 2011, the Minnesota Legislature directed Minnesota DHS to reform its Medical Assistance Program to improve community integration and independence; improve health; reduce reliance on institutional care; and ensure the long-term sustainability of needed services through better alignment of available services. (Source: State Register Notice, 6/18/2012)

Minnesota Senior Care Plus (MSC+) operates under §1915(b) and §1915(c) waiver authorities and provides LTSS; primary, acute and behavioral health services; and prescription drug services at a capitated rate to adults age 65 and over. Enrollment is mandatory, but dual eligibles can opt into Minnesota Senior Health Options (MSHO) as an alternative to MSC+. MSHO operates under §1915(a) and §1915(c) waiver authorities and provides the same services as Minnesota Senior Care Plus for dual eligible adults age 65 and older. (Source: CMS and Truven Health Analytics, 7/2012)
State Website on Senior Care Plus
State Website on Senior Health Options

In February 2012 and November 2012, the state submitted a Minnesota Long Term Care Realignment §1115 Demonstration Waiver to revise its nursing facility level of care criteria (LOC). This LOC revision impacts eligibility not only for nursing facilities, but also for three of the state’s §1915(c) HCBS waivers: Community Alternatives for Disabled Individuals (CADI), the Brain Injury waiver (BI), and the Elderly Waiver (EW). In its LTC Realignment waiver, the state also requested federal financial participation (FFP) for two limited benefit HCBS programs: the Alternative Care Program (ACP) and the Essential Community Supports program (ECS). The ACP serves individuals age 65 and older who meet LOC criteria but have income exceeding Medicaid standards; while ECS serves individuals who do not meet the revised LOC criteria, regardless if income meets Medicaid standards. (Source: Medicaid.gov)

In August 2012, the state submitted to CMS its initial Reform 2020 Initiative: Alternative Care Program (ACP) §1115 Demonstration Waiver. In November 2012, the state resubmitted to CMS an updated Reform 2020 §1115 Demonstration Application. (Source: Medicaid.gov)
Initial Reform 2020 §1115 Demonstration Application (8/2012)
Updated Reform 2020 §1115 Demonstration Application (11/21/2012)
State’s Reform 2020 §1115 Waiver website

In October 2013, CMS approved the state’s Reform 2020 Initiative, approving federal financial participation in the ACP, designed to provide HCBS pre-level-of-care in order to prevent and delay transitions to nursing facilities. Federal approval for the state’s ACP will free up an additional $58 million over four years in state funds to reinvest in services to keep seniors and people with disabilities in their homes and communities. (Source: State DHS website, 11/2013; DHS News Release, 11/20/2013; Alternative Care Program Fact Sheet, 2/2014)

State Demonstration to Integrate Care for Dual Eligible Individuals (Withdrawn)

The original financial alignment demonstration proposal included two phases: the first phase included dual eligibles over age 65 who qualified for Medicaid managed care and were enrolled in or chose to enroll in Minnesota Senior Health Options and Minnesota SeniorCare Plus; the second phase included dual eligibles age 18-64 with disabilities who were enrolled in Special Needs BasicCare. Older adults would receive partial NF services and LTSS under a capitated model; and persons with disabilities would receive partial NF services and LTSS under a fee-for-service model. (Source: Demonstration Proposal; State Demonstration website)

In June 2012, the state decided not to pursue the financial alignment demonstration because Medicare financing under the demonstration would result in significantly lower payments for senior Medicare beneficiaries than the state’s current programs. (Source: State Demonstration website)

State Demonstration to Integrate Care for Dual Eligible Individuals

In January 2013, the state issued a Notice of Request for Public Input on its Duals Demonstration website to identify best practices for developing Integrated Care System Partnerships (ICSPs) between managed care organizations and primary, acute, long-term care and mental health providers serving seniors and people with disabilities under managed care programs. (Source: State website)
State Register, Vol. 37, No. 30 (1/22/2013)

On September 12, 2013, the state and CMS signed an MOU for the duals demonstration for seniors enrolled in MSHO and MSC+ managed care programs. (Source: State Website)
State Website on Demonstration to Integrate Care for Dual Eligibles
Memorandum of Understanding (9/12/2013)
Minnesota’s Alternative Demonstration for People with Medicare and Medicaid (6/18/2013)

On February 25, 2015, CMS posted a Memorandum of Understanding Addendum for Minnesota’s duals demonstration. (Source: CMS website)
Memorandum of Understanding Addendum (1/21/2015)

According to Bloomberg BNA, a recent report from the Urban Institute and RTI International conducted for the Assistant Secretary for Planning and Evaluation (ASPE) on Minnesota’s dual eligible demonstration, Senior Health Options, notes positive outcomes for the program. Of particular note: dual eligibles in the program are 48 percent less likely to end up in the hospital, have a 6 percent lower chance of needing an outpatient emergency admission, and  are 13 percent more likely to receive home and community based services (HCBS)—when compared to the regular Medicaid managed care population. (Source: Bloomberg 6/21/2016; ASPE report 3/31/2016)  

Section 1915(k) Community First Choice and 1915(i) State Plan Options

The state will implement CFCO in FY 2014 under its §1115 LTC Realignment Waiver. (Source: Waiver Application; Kaiser Commission on Medicaid and the Uninsured, 4/2013; Kaiser CFCO website, 5/2014)

As of November 2014, the state has officially submitted a Section 1915(k) Community First Choice Option SPA to CMS for approval.  (Source:  Kaiser Community First Choice website, 10/2014)

On July 19, 2017, Minnesota submitted a request to renew the state’s section 1115 waiver, Reform 2020, with an effective date of July 1, 2018. First approved in 2013, the waiver renewal would extend the Reform 2020 waiver through June 30, 2021. The renewal request aims to continue to promote community integration, and contains the following programmatic changes: 

  • Extending the Alternative Care program that allows community supports for older adults that are near but not fully eligible for Medicaid in order to support those individuals in their homes, and avoid institutionalization;
  • Implementing a new Community First Services and Supports (CFSS) program that will include both the 1915(k) Community First Choice option and 1915(i) state plan option.
  • Continuing to cover individuals under 21 who now do not meet the states revised institutional level of care requirements.

The Alternative Care Program was first authorized in 2013 under the Reform 2020 waiver and provides HCBS to adults over 65 that require nursing facility (NF) level of care, but are not yet eligible for Medicaid medical assistance and do not have excess assets that would allow them to pay for over 135 days of NF care. The program aims to prevent institutionalization of individuals and also facilitate effective use of services if individuals became fully Medicaid eligible.

The Community First Services and Supports (CFSS) program aims to redesign the state’s personal care assistance (PCA) benefit by implementing two state plan amendments, 1915(k) and 1915(i). CFSS will be available to individuals who meet institutional level of care (LOC) under 1915(k), and 1915(i) will be available to those who do not meet institutional LOC. CFSS will also be available to two additional populations through the 1115 waiver: individuals with income over 150 percent of FPL who will receive CFSS services but do not meet an institutional LOC (the 1915(i)-like group); and the 1915(k)-like group, who meet an institutional LOC and will receive CFSS services, but would have met financial eligibility rules for HCBS waivers. CFSS will be implemented for all relevant populations once CMS approves the state’s state plan amendments. (Source: MN 1115 Waiver 7/19/2017

Health Homes

CMS has approved Minnesota’s State Health Home Planning Request. MN-15-0004: Creates behavioral health homes for adults with serious mental illness and children and youth experiencing severe emotional disturbances (approved 3/21/2016, effective 7/1/2016). (Source: State-by-State Health Home State Plan Amendment Matrix 7/2016)