1 Section 5: Public Health Insurance Programs Medicare Medical Assistance (Medicaid) MinnesotaCare General Assistance Medical Care (GAMC) Minnesota Comprehensive.

1

Section 5: Public Health Insurance Programs

MedicareMedical Assistance (Medicaid)MinnesotaCareGeneral Assistance Medical Care

(GAMC)Minnesota Comprehensive Health

Association (MCHA)

Medicare

A federal health insurance program for people age 65 or older and people with certain disabilities and end-stage renal disease.

3

Medicare Enrollment and Spending, Minnesota and the U.S., 1997 to 2007

Enrollment

Expenditures

($ millions)

Spending per Enrollee

FY MN U.S. MN U.S. MN U.S.

1997 639,293 38,444,739 $2,415 $207,156 $3,778 $5,388

1998 643,877 38,824,855 $2,442 $209,509 $3,792 $5,396

1999 648,272 39,140,386 $2,430 $208,648 $3,748 $5,331

2000 654,405 39,619,986 $2,509 $215,689 $3,834 $5,444

2001 660,399 40,025,724 $2,760 $237,269 $4,179 $5,928

2002 667,407 40,488,878 $2,937 $251,117 $4,400 $6,202

2003 676,156 41,086,981 $3,184 $274,054 $4,709 $6,670

2004 686,522 42,040,460 $3,486 $300,089 $5,078 $7,138

2005 690,792 42,643,432 $3,902 $335,915 $5,648 $7,877

2006 708,081 43,313,626 $4,053 $349,094 $5,724 $8,060

2007 727,938 44,132,245 $4,352 $374,820 $5,979 $8,493

Sources: Enrollment data from Centers for Medicare and Medicaid Services (CMS) as of July 1 each year; 2007 enrollment data are County estimates for MN and US; Spending estimates by federal fiscal year from the U.S. Census Bureau, Consolidated Federal Funds Report with an MDH adjustment for border crossing; 2007 spending estimates are based on a straight line trend between 2006 and 2008 for MN with an MDH adjustment for border crossing.

4

Medicare Beneficiaries with Dual Coverage, 2007

Beneficiaries Not Eligible for

Medical Assistance,

86%

Beneficiaries with Medicare and Medical Assistance Coverage,

14%

Sources: Minnesota Department of Human Services, data for state fiscal year 2007;Medicare enrollment data from Centers for Medicare and Medicaid Services as of July 1, 2007

5

Minnesota’s Medicare Enrollment as Percent of Population, by Region, 2007

14.2%

19.9% 20.5%

15.3% 15.6%

20.4%19.3%

11.6%14.0%

0%

5%

10%

15%

20%

25%

Central Northeast Northwest SouthCentral

Southeast Southwest WestCentral

TwinCitiesMetro

MinnesotaTotal

For the regional boundaries, see slide 39 at the end of this chartbook.Sources: Centers for Medicare and Medicaid Services, enrollment by county as of July 1, 2007;U.S. Census Bureau, Population Estimates for Minnesota Counties for July 1, 2007

6

Statewide Distribution of Medicare Enrollees, by Region, 2007

Central, 13.9%

Northeast, 8.8%

Northwest, 5.6%

South Central , 6.0%

Southeast, 10.4%

Southwest, 6.1%West Central, 4.9%

Twin Cities Metro, 44.4%

For the regional boundaries, see slide 39 at the end of this chartbook.Source: Minnesota Department of Human Services. Enrollment data for fiscal year 2007;U.S. Census Bureau, Population Estimates of Minnesota Counties for July 1, 2007

7

Sources of Medicare Supplemental Insurance Coverage in Minnesota, 2007

Source: Minnesota Department of Health, Health Economics Program, Minnesota Health Access Survey, 2007

Medigap, 28%

Medicare HMO, 20%

Gov't Programs, 12%

Employer, 29%

Medicare Only, 12%

8

Sources of Medicare Supplemental Insurance Coverage, Minnesota and U.S.

28%

20%

12%

29%

12%15%

32%

15%18%

20%

Medigap Medicare HMO Gov't Programs Employer Medicare Only

MN U.S.

Sources: Minnesota Department of Health, Health Economics Program, Minnesota Health Access Survey 2007; CMS, Medicare Current Beneficiary Survey, preliminary data for 2006

9

Types of Prescription Drug Coverage for Medicare Enrollees, Minnesota and U.S., 2008

Medicare Part D Prescription Drug Coverage:

41%

26%

10% 11% 12%

39%

18%15%

12%15%

Stand-AlonePrescription Drug

Plan*

MedicareAdvantage*

Employer planw/subsidy for retiree

drug coverage

Federal Retirees^ No identified sourceof creditable

coverage

Minnesota U.S.

Source: Centers for Medicare and Medicaid Services (CMS) enrollment data as of January 18, 2008. *Includes beneficiaries who were auto-enrolled and additional beneficiaries receiving the low-income subsidy.^Includes enrollees in Federal Employee Health Benefit Plan, TRICARE, Veteran Administration, and active workers.

Note: These estimates by type of prescription drug plan are not comparable to estimates of Medicare supplemental coverage by source of funding on the previous slide. (For example, employer-paid coverage could appear in several categories above.) “Creditable coverage” is defined as coverage that meets or exceeds the actuarial value of the standard Medicare Part D benefit.

10

Medicare Private Plan Enrollment (Medicare Advantage) Trends, Minnesota and U.S., 1997 to 2007

0%

5%

10%

15%

20%

25%

30%

35%

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Minnesota U.S.

Medicare Enrollees in Private Plans as % of Total Beneficiaries

Source: Centers for Medicare and Medicaid Services, State County Plan Market Penetration File (1997 to 2005) and State/County/Contract Reports (2006 and 2007)

11

Minnesota Medicare Private Plan Enrollment in Urban and Rural Counties, 2004 & 2007

22.3%

4.5%

15.1%

33.9%

24.1%

30.3%

0%

10%

20%

30%

40%

50%

Urban Rural Statewide

2004 2007

Source: Centers for Medicare and Medicaid Services, Monthly Enrollment from State/County/Contract Report, Dec. 2007; State County Plan Market Penetration File, 2004

12

Distribution of Minnesota Medicare Advantage Enrollees by Region and Type of Plan, 2007

40.7%

15.1%27.7%

33.4%

18.7%

49.8%33.3%

36.1%

26.7%

8.5%

4.4%

5.6%

0%

20%

40%

60%

80%

100%

Urban Rural Statewide

Cost Local CCP Regional CCP PFFS

Percent of Medicare Advantage Enrollees by Type of Health Plan

CCP is Coordinated Care Plans; PFFS is Private Fee For Service PlansSource: CMS, Monthly Enrollment by State/County/Contract Report as of December 2007

Medical Assistance (MA)

Minnesota’s Medicaid program – jointly financed by the state and the federal government – provides health insurance to low-income senior citizens, children and families, and people with disabilities.

14

Medical Assistance Enrollment and Spending History, 1999 to 2009

Growth in:

State FY

Avg. Monthly

Enrollment

Spending

($ millions)

Avg. Monthly Spending

per Enrollee EnrollmentTotal

Spending

Spending per

Enrollee

1999 370,054 $2,997 $675 -4.6% 2.7% 7.7%

2000 367,737 $3,233 $733 -0.6% 7.9% 8.5%

2001 378,884 $3,582 $788 3.0% 10.8% 7.5%

2002 403,668 $4,136 $854 6.5% 15.5% 8.4%

2003 442,585 $4,740 $892 9.6% 14.6% 4.5%

2004 463,650 $4,991 $897 4.8% 5.3% 0.5%

2005 482,861 $5,224 $902 4.1% 4.7% 0.5%

2006 498,406 $5,462 $913 3.2% 4.6% 1.3%

2007 510,155 $5,846 $955 2.4% 7.0% 4.6%

2008 527,001 $6,268 $991 3.3% 7.2% 3.8%

2009 557,337 $6,775 $1,013 5.8% 8.1% 2.2%

Source: Minnesota Department of Human Services, data for state fiscal years

15

Medical Assistance Enrollment and Spending Growth, 1999 to 2009

-10%

-5%

0%

5%

10%

15%

20%

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

% c

ha

ng

e fr

om

pre

vio

us

yea

r

Enrollment Total Spending Spending per Enrollee


16

Medical Assistance Enrollees as Percent of Population, by Region, 2009

9.9%

13.1%

16.3%

10.1% 9.9%

12.9%

11.1%10.2% 10.6%

0%

3%

6%

9%

12%

15%

18%



TwinCitiesMetro

MinnesotaTotal

For the regional boundaries, see slide 39 at the end of this chartbook.Source: Minnesota Department of Human Services, enrollment data for fiscal year 2009; U.S. Census Bureau, population estimates of Minnesota counties for July 1, 2008 and the state for July 1, 2009

17

Statewide Distribution of Medical Assistance Enrollees, by Region, 2009

Central, 12.7%

Northeast, 7.6%

Northwest, 5.8%


Southeast, 8.6%

West Central, 3.7%

Southwest, 5.0%


For the regional boundaries, see slide 39 at the end of this chartbook.Source: Minnesota Department of Human Services, enrollment data for fiscal year 2009

18

Medical Assistance Enrollment by Eligibility Category, 1999 and 2009

68.4% 70.8%

18.6% 19.2%

13.0% 10.0%

1999 2009

Families with children Disabled/Blind Elderly

Source: Minnesota Department of Human Services

19

Medical Assistance Enrollment and Spending by Eligibility Category, 2009

70.8%

28.0%

19.2%

48.8%

10.0%23.2%

Enrollment Spending

Families with children Disabled/Blind Elderly

Source: Minnesota Department of Human Services, data for state fiscal year 2009

MinnesotaCare

A sliding-fee-scale Minnesota health insurance program - financed by state funds, federal funds, and enrollee premiums - for low income Minnesotans who are not offered insurance through their employer.

21

MinnesotaCare Enrollment and Spending History, 1999 to 2009

Growth in:

State FY

Avg. Monthly

Enrollment

Spending

($ millions)

Avg. Monthly Spending

per Enrollee EnrollmentTotal

Spending

Spending per

Enrollee

1999 106,552 $164 $129 8.9% 51.7% 39.3%

2000 108,999 $187 $143 2.3% 13.8% 11.2%

2001 122,247 $240 $164 12.2% 28.3% 14.4%

2002 138,022 $351 $212 12.9% 46.3% 29.6%

2003 151,206 $435 $240 9.6% 23.8% 13.0%

2004 148,505 $487 $273 -1.8% 11.9% 14.0%

2005 141,822 $409 $240 -4.5% -16.0% -12.1%

2006 128,727 $438 $283 -9.2% 7.1% 18.0%

2007 117,893 $434 $307 -8.4% -0.8% 8.3%

2008 114,350 $463 $337 -3.0% 6.6% 9.9%

2009 117,706 $526 $372 2.9% 13.7% 10.4%


22

MinnesotaCare Enrollment and Spending Growth, 1999 to 2009

-20%

-10%

0%

10%

20%

30%

40%

50%

60%

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

% c

ha

ng

e fr

om

pre

vio

us

yea

r



23

MinnesotaCare Enrollees as Percent of Population, by Region, 2009

2.9%3.1%

3.8%

1.9%1.7%

2.6%2.9%

1.6%

2.2%

0%

1%

2%

3%

4%



Twin CitiesMetro

MinnesotaTotal

For the regional boundaries, see slide 39 at the end of this chartbook.Source: Minnesota Department of Human Services, enrollment data for fiscal year 2009;U.S. Census Bureau, population estimates of Minnesota counties for July 1, 2008 and the state for July 1, 2009

24

Statewide Distribution of MinnesotaCare Enrollees, by Region, 2009

Central, 19.2%

Northeast, 9.2%

Northwest, 7.0%


Southeast, 7.7%Southwest, 5.3%

West Central, 5.0%


For the regional boundaries, see slide 39 at the end of this chartbook.Sources: Minnesota Department of Human Services, enrollment data for fiscal year 2009;

25

MinnesotaCare Enrollment by Eligibility Category, 1999 to 2009

State FYAvg. Monthly

Enrollment Parents ChildrenAdults without

Children

1999 106,552 32,707 59,941 13,904

2000 108,999 35,813 58,836 14,350

2001 122,247 39,812 63,862 18,573

2002 138,022 44,544 70,299 23,179

2003 151,206 47,329 73,046 30,831

2004 148,505 45,172 69,612 33,721

2005 141,822 43,222 65,949 32,651

2006 128,734 39,280 59,580 29,874

2007 117,893 32,957 50,918 34,018

2008 114,359 28,983 44,229 41,147

2009* 117,701 28,366 41,680 47,655

Source: Minnesota Department of Human Services, data for state fiscal years*Average monthly enrollment based on different calculation than in slide 21.

26

MinnesotaCare Enrollment by Eligibility Category, 1999 and 2009

30.7% 24.8%

56.3%

36.4%

41.7%

13.0%

0%

20%

40%

60%

80%

100%

1999 2009

Parents Children Adults without Children


27

MinnesotaCare Funding Sources

61% 56%65%

36%29%

16% 8% 6%

23%

0%

20%

40%

60%

80%

100%

1999 2004 2009

State Federal Enrollee Premiums


General Assistance Medical Care (GAMC)

A state health insurance program for low-income adults, ages 21 to 64, who have no dependent children under 18 and who do not qualify for federal health care programs.

29

General Assistance Medical Care Enrollment and Spending History, 1999 to 2009

Growth in:

State FY

Avg. Monthly

Enrollment

Spending

($ millions)

Avg. Monthly Spending per

Enrollee EnrollmentTotal

Spending

Spending per

Enrollee

1999 26,794 $132 $411 -13.9% 9.5% 27.2%

2000 23,347 $128 $456 -12.9% -3.4% 10.8%

2001 24,592 $135 $457 5.3% 5.5% 0.1%

2002 29,886 $182 $508 21.5% 35.3% 11.3%

2003 37,340 $248 $553 24.9% 36.1% 8.9%

2004 34,957 $246 $586 -6.4% -1.0% 5.8%

2005 36,797 $237 $536 5.3% -3.7% -8.5%

2006 39,199 $289 $614 6.5% 22.1% 14.6%

2007 33,824 $281 $692 -13.7% -2.7% 12.8%

2008 28,853 $263 $759 -14.7% -6.5% 9.6%

2009 31,961 $288 $751 10.8% 9.6% -1.0%


30

General Assistance Medical Care Enrollment and Spending Growth, 1999 to 2009

-20%

-10%

0%

10%

20%

30%

40%

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

% c

ha

ng

e fr

om

pre

vio

us

yea

r



31

General Assistance Medical Care Enrollees as Percent of Population, by Region, 2009

0.3%

0.6% 0.6%

0.2%

0.3% 0.3% 0.3%

0.6% 0.6%

0.0%

0.2%

0.4%

0.6%

0.8%



TwinCitiesMetro

MinnesotaTotal

For the regional boundaries, see slide 39 at the end of this chartbook.Sources: Minnesota Department of Human Services, enrollment data for fiscal year 2009;U.S. Census Bureau, population estimates of Minnesota counties for July 1, 2008 and the state for July 1, 2009

32

Statewide Distribution of General Assistance Medical Care Enrollees, by Region, 2009

For the regional boundaries, see slide 39 at the end of this chartbook.Sources: Minnesota Department of Human Services, enrollment data for fiscal year 2009

Northeast, 8.7%

Northwest, 4.7%


Southeast, 5.2%

Southwest, 2.3%

West Central, 2.5%Twin Cities Metro, 65.9%

Central, 7.7%

Minnesota Comprehensive Health Association (MCHA)

High-risk pool that offers health insurance to Minnesotans who have been turned down in the private market, due to preexisting conditions.

34

MCHA Enrollment and Spending History, 1998 to 2008

Growth in:

Calendar Year

Enrollment as of 12/31

Claims

($ millions)

Avg. Monthly Claims per

Enrollee EnrollmentTotal

Claims

Claims per

Enrollee

1998 24,954 $91 $294 -5.2% -0.5% 4.6%

1999 25,433 $102 $336 1.9% 12.3% 14.3%

2000 25,938 $112 $364 2.0% 10.3% 8.2%

2001 27,428 $125 $389 5.7% 11.3% 7.1%

2002 31,088 $141 $402 13.3% 13.3% 3.3%

2003 33,705 $175 $450 8.4% 23.9% 11.9%

2004 33,063 $205 $512 -1.9% 17.1% 13.6%

2005 31,049 $206 $536 -6.1% 0.6% 4.8%

2006 29,089 $221 $613 -6.3% 7.2% 14.3%

2007 28,859 $225 $647 -0.8% 1.7% 5.5%

2008 27,386 $246 $728 -5.1% 9.3% 12.6%

Claims per enrollee estimated by MDH using average of year-end enrollment figures.Source: Minnesota Comprehensive Health Association

35

MCHA Enrollment and Spending Growth, 1998 to 2008

-10%

-5%

0%

5%

10%

15%

20%

25%

30%

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

% c

ha

ng

e fr

om

pre

vio

us

yea

r

Enrollment Claims Claims per enrollee

Claims per enrollee estimated by MDH using average of year-end enrollment figures. Source: Minnesota Comprehensive Health Association

36

MCHA Claims, Premiums, and Losses from Operations, 1998 to 2008

Calendar Year

Claims

($ millions)

Premiums

($ millions)

Losses from Operations

($ millions)

Premiums as

% of Claims

1998 $91 $48 $47 52.8%

1999 $102 $52 $57 51.1%

2000 $112 $59 $59 52.4%

2001 $125 $65 $67 52.2%

2002 $141 $77 $72 54.7%

2003 $175 $93 $90 53.4%

2004 $205 $107 $110 52.3%

2005 $206 $113 $103 54.9%

2006 $221 $112 $118 50.6%

2007 $225 $114 $120 50.7%

2008 $246 $116 $139 47.3%

Source: Minnesota Comprehensive Health Association (MCHA)

37

MCHA Enrollees as Percent of Population, by Region, 2008

0.6%

0.5%

0.6% 0.6%

0.5%

0.8%

0.7%

0.4%

0.5%

0.0%

0.2%

0.4%

0.6%

0.8%

1.0%



Twin CitiesMetro

MinnesotaTotal


38

Statewide Distribution of MCHA Enrollees, 2008

Includes only enrollees currently residing in Minnesota.Sources: Minnesota Comprehensive Health Association (MCHA)

Northeast, 6.5%

Northwest, 4.7%


Southeast, 9.9%

Southwest, 6.9%West Central, 4.8%


Central, 16.1%

39

Age Distribution of MCHA Enrollees, 2008

30 to 44 years, 15.8%

45 to 54 years, 24.4%

55 to 64 years, 44.5%

14 years and under, 1.7%

15 to 29 years, 9.2%

65 years and older, 4.5%


Minnesota Counties and Regions Used in the Geographic Analysis

1 Section 5: Public Health Insurance Programs Medicare Medical Assistance (Medicaid) MinnesotaCare General Assistance Medical Care (GAMC) Minnesota Comprehensive.

Documents

medicare enrollment

minnesotas medicare

medicare beneficiaries

standard medicare

medicare supplemental

minnesota department

monthly enrollment spending

previous slide