Calendar Year-2011 Annual Report

Olmsted County Community Services Department Family Support & Assistance Division Providing quality administration of public programs that promote the well-being, self-sufficiency sufficiency and economic stability of children and adults in Olmsted County Public Health Care Programs Improving the well-being of individuals and families by providing healthcare coverage and support Calendar Year-2011 Annual Report July 2012

Minnesota provides public health care programs to meet tthe needs of: Families with children under age 21 Pregnant women and newborns Adults without children Adults with disabilities People age 65 or older People living in a nursing home

Most health care programs have income and asset limits Minnesota s public health care programs contribute to the well-being of flow-income people by providing coverage for health care services including: Preventive care Hospitalization Mental health and chemical dependency services Prescription drugs Dental care

In Olmsted County over 16,900 people have their health care coverage through public programs Minnesota s three Health Care Programs are: Medical Assistance (MA) MA is a joint federal-state health care program for low-income parents, children, elderly or disabled people, low income adults without children, including subsidized prescription drug benefits and health care coordinated benefits covered under Medicare. General Assistance Medical Care (GAMC) General Assistance Medical Care (GAMC) was a state-funded program for lowincome adults without children who did not qualify for federally funded health care programs. The program ended February 28, 2011 and enrollees were automatically moved to Medical Assistance (MA), Minnesota ss Medicaid program. MinnesotaCare (MCRE) MinnesotaCare is a publicly subsidized health insurance program for lower-income state residents who do not have access to affordable health care coverage.

Olmsted County Residents (Persons) Enrolled in MA Healthcare Programs 18,000 15,747 15,792 17,116 16,000 14,000 13,837 13,989 12,000 10,000 8,000 There was an overall growth of 8% in Medical Assistance from Calendar Year 2010. 65% of this growth was due to the transfer of certain adults from MinnesotaCare under the Affordable Care Act, MA Expansion option. 6,000 4,000 Enrollment numbers in CY-2007 and CY- 2008 are under represented due to the State data systems undergoing a re-write. 2,000 - CY-END 2007 CY-END 2008 CY-END 2009 CY-END 2010 CY-END 2011

Olmsted County MA Category of Enrollees MA Expansion Children Ages 0-20 Refugee & Emergency Health Care Elderly Disabled Children & Adults Parents of Children The Affordable Care Act passed by Congress offered states the option of expanding eligibility for Medical Assistance (federal Medicaid). Minnesota elected to participate in this MA expansion which moved adults without children in the home from MinnesotaCare into Medical Assistance for their health care benefits if their household income was at or below 75% of the federal poverty guide (FPG). Data sources: MAXIS REPT/RPTS

Olmsted County MinnesotaCare Enrollees 3,500 3,083 3,000 2,500 2,000 1,877 1,993 2,266 2,229 1,500 Adults without children in 1,000 the home became eligible ibl for benefits under Medical Assistance due to the Affordable Care Act. 500 - CY-END 2007 CY-END 2008 CY-END 2009 CY-END 2010 CY-End 2011

Olmsted County MinnesotaCare- Category of Enrollees Adults w/out children 37% Parents of Children 28% Children & Pregnant Women 35% Data sources: 35% DHS Reports & Forecasts; PMAP Enrollment Data Reports

Public Health Care Payments for Olmsted County Residents $188,626,708 $190,000,000 $185,000,000 $179,565,000 $177,872,987 $180,000,000 $175,000,000 $170,000,000 $163,603,000 $165,000,000 $160,000,000 $158,130,063 $155,000,000 $150,000,000 $145,000,000 $140,000,000 CY-END 2007 CY-END 2008 CY-END 2009 CY-END 2010 CY-END 2011

CY-2011 Public Health Care Payments for Olmsted County Residents Other State Funded 1% $177,872,987 in public health care services was paid for Olmsted County residents in CY-2011 Minnesota Care 5% Medical Assistance 94% Data sources: DHS Reports and Forecasts

Appendix Managing for Results (M4R) Manage the Resources Managing for Results (M4R) Initiatives Managing for Results (M4R) Run the Business Managing for Results (M4R) Develop the Employees Chart: Health Care Program Income Limits Chart: Health Care Program Asset Limits Terms and Definitions Staff Contacts

Mission: Providing quality administration of public programs that promote the well-being, self-sufficiency and economic stability of children and adults in Olmsted County. Vision: A safe, thriving and inclusive community Manage the Resources Strategic Priority: Effective local administration of programs within available resources Performance Measure Target CY-2010 Results CY-2011 Results Incentive earnings, g, bonus funding Earn maximum Estate /Recoveries: Estate /Recoveries: incentives, bonus $ 290,374.48 $ 346,295.86 funding Benchmark: previous earnings and bonuses $ 67,058.53 was retained by the county to offset local levy $ 89,061.25 was retained by the county to offset local levy Collections have a cost benefit to taxpayers and to medical/health care providers in the county. 2010 Health Care Annual Report- Olmsted County

Mission: Providing quality administration of public programs that promote the well-being, self-sufficiency and economic stability of children and adults in Olmsted County. Vision: A safe, thriving and inclusive community Manage the Resources Strategic Priority: Effective local administration of programs within available resources Performance Measure Target CY-2010 Results CY-2011 Results Telecommuting gfor maximizing Percent of 53% of Healthcare, 53% of Healthcare, productivity telecommuters Placement & Waiver Services (PAWS) workers telecommute Placement & Waiver Services (PAWS) workers telecommute Caseload productivity 15-20% Telecommuter caseloads range from 280-309 Telecommuter caseloads average 303 Use of technology for online forms, scanning of mail, and related processes has improved the effectiveness of telecommuting and allowed for increased productivity.

Mission: Providing quality administration of public programs that promote the well-being, self-sufficiency and economic stability of children and adults in Olmsted County. Vision: A safe, thriving and inclusive community Run the Business Strategic Priority: Positive outcomes and successful program performance results 2011 Best Practice Initiatives: Initiatives Utilized our case aide staff for coordination of our MA volunteer driver program. One case aide is now processing all volunteer driver requests for our division, allowing consistency and assuring dedication to the task. To further improve efficiency in this area, we converted to sending electronic referrals to our vendors for ride authorization and we moved to electronic billing for MA transportation payments. Realigned our health care contact worker duties to integrate both community and long term care workers Continued to lead the regional Long Term Care collaborative. Streamlined the determination of Cost Effective Insurance eligibility by utilizing three health care experts to process for the cash and food team. This allows consistency and assures program integrity in this area. Established a customer care line for the agency; this began our process of broadening the call center into a two-tier model. We are now using eligibility specialists for front-line callers to assist in one-stop resolution to eligibility questions. 2010 Health Care Annual Report- Olmsted County

Mission: Providing quality administration of public programs that promote the well-being, self-sufficiency and economic stability of children and adults in Olmsted County. Vision: A safe, thriving and inclusive community Develop the Employees: Strategic Priority: i Qualified and diverse staff Performance Measure Target CY-2010 Results CY-2011 Results Diversity of workforce Workforce reflects 16% of Healthcare 17% of Healthcare diversity of service population Workers are persons of color Workers are persons of color Benchmark: customer diversity 22% of Healthcare Workers are bilingual 23% of Healthcare Workers are bilingual Customer service population demographics (most currently available): 62% of persons enrolled in public health care programs are white; 38% of persons enrolled in public health care programs are from communities of color

Health Care Program Income Limits 75% FPG Medical Assistance Elderly, Blind, Disabled (with spenddown) Medical Assistance Adults without Children 100% FPG Medical Assistance Children, age 19-20 Medical Assistance Adults with children Medical Assistance Elderly, Blind, Disabled (no spenddown) Qualified Medicare Beneficiaries 120% FPG Service Limited it Medicare Beneficiaries i i 135% FPG Medical Assistance Qualifying Individuals 150% FPG MinnesotaCare $48 Annual Premium Medical Assistance Children ages 2 through 18 185% FPG Transition Year Medical Assistance (with excess earnings for regular health care) 200% FPG Medical Assistance Qualified Working Disabled Individuals Minnesota Family Planning Program 215% FPG MinnesotaCare parents no cap on inpatient services 250% FPG MinnesotaCare adults without children 275% FPG MinnesotaCare Children to age 21 MinnesotaCare Families with Children Medical Assistance Pregnant Women 2010 Health Care Annual Report- Olmsted County 280% FPG Medical Assistance Infants under age 2

Health Care Program Asset Limits Medical Assistance Elderly / Disabled $3,000 for 1 person $6,000 for 2 people Medical Assistance Families MinnesotaCare: Families / Adults with no children EXEMPT from asset test (for all programs) $10,000 for 1 person $20,000 for 2 or more people $10,000 for 1 person $20,000 for 2 or more people Pregnant Women Children under the age of 21 Single Adults without Children in the home (MA expansion) EXCLUDED assets One vehicle Homestead (with certain exceptions) Burial fund/space items (with limitations)

Health Care Terms & Definitions Fee for Service A service delivery model in which a Health Care consumer receives medical services at any Medical Assistance authorized provider, and public benefits are paid based on each service. Prepaid Medical Assistance Program (PMAP) A capitated service delivery model in which a public entity pays a set per-member-per-month rate to a Health Plan. The Health Plan is then responsible for all of the consumer s health care costs.

Health Care Terms & Definitions Spenddown A cost-sharing method available to people who do not qualify for Medical Assistance because of excess income. A spenddown is similar to an insurance deductible. People may become eligible by incurring medical expenses equal to or greater than the excess income. There are several types of spenddowns, including monthly, six-month, and long-term care.

For Additional Information, contact: Beth tharendt, Supervisor 328-6541 Meridee Brown, Supervisor 328-6513 Keith Onstad, Supervisor 328-6704 Mina Wilson, Division Director, 328-6354