Minnesota Health Care Programs: News, initiatives, reports and advisory committees

Get the facts on Minnesota’s state health coverage programs with the new Medicaid Matters and MinnesotaCare Matters data dashboards. Use the dashboards to get data on Medicaid (called Medical Assistance in Minnesota) and MinnesotaCare enrollees, spending, providers and dental care.

These easy-to-navigate tools let you dig in and analyze information on the health insurance programs that serve one in five Minnesotans. The goal of the tools: to provide greater transparency and help inform the conversation about health care coverage and long-term care in our state.

Medicaid and MinnesotaCare serve as a lifeline for many providers in Greater Minnesota and contribute significantly to the state’s health care system, supporting public health infrastructure, hospitals, mental health centers, at-home care, community clinics, nursing homes, physicians and many other health professionals by reducing the number of Minnesotans that go without health care coverage. Medicaid — not Medicare — is the primary source of coverage for people who need long-term care services.

Some other highlights from the data:

• Average monthly enrollment in Minnesota’s Medicaid program has remained relatively consistent since 2015 with about 1.1 million people covered. 
• Roughly 2/3 of those covered by Medicaid in 2018 are parents, children or pregnant women, who accounted for only about 25 percent of spending. Medicaid serves more than half a million children each year. 
• Adults 65 or older and people with disabilities make up about 16 percent of the people served by Medicaid yet account for about 60 percent of spending.
• Minnesota Medicaid and MinnesotaCare enrollment is split nearly evenly between the seven-county metro area and Greater Minnesota. However, enrollment in both health insurance programs makes up a higher percentage of the total population in many Greater Minnesota counties compared to the metro area.

Read current information and announcements for providers about billing, claims processing, policy changes, system information and more. Check back frequently – information can change as updates become available.

Get notices of provider news through our free provider email lists.

The Patient Protection and Affordable Care Act of 2010 (ACA) created an optional “health home” benefit so that states could better coordinate care for Medicaid enrollees with chronic conditions. Behavioral health home (BHH) services are Minnesota’s version of the federal “health home” benefit for Medical Assistance (MA) enrollees.

It provides an opportunity to build a person-centered system of care that achieves improved outcomes for individuals and reduced costs to the health care system.

This health home model expands upon the concept of person-centered medical homes (health care homes in Minnesota) and makes a more concerted effort through design, policy levers and outcome measures to serve the whole person across primary care, mental health, substance use disorder treatment, long-term services and supports, and social service components of our health care delivery system.

With the Integrated Health Partnerships demonstration project, Minnesota is one of a growing number of states implementing an accountable care organization (ACO) model in its Medical Assistance (Medicaid) program, with the goal of improving the health of the population and of individual members. 

In their first year of participation, delivery systems can share in savings. After the first year, they also share the risk for losses. Delivery systems’ total costs for caring for Medical Assistance members are measured against targets for cost and quality.

Integrated Care for High Risk Pregnancies (ICHRP): low birth weight focus initiative addresses African American pregnancy disparities, and several groups are working to share knowledge and services with families, the African American community, paraprofessionals and primary care providers. If you are a U.S. born African American, who is eligible for Medicaid in the Twin Cities learn more about services to promot healthy African American pregnancies.

Learn more about the ICHRP initiative

Minnesota's Demonstration to Integrate Care for Dual Eligibles, also called the Dual Demo, began Sept. 13, 2013, and continues until Dec. 31, 2018. It is designed to do the following:

• Enhance integration of services for Medicare-Medicaid beneficiaries through payment reform and new provider payment models with beneficiaries who are dually eligible for both Medicare and Medicaid.
• Clarify and simplify information and processes about Medicare and Medicaid coverage for beneficiaries and their families.
• Better align oversight of Minnesota Senior Health Options (MSHO) plans by the state and CMS.
• Improve administrative efficiencies for the MSHO plans and government agencies that serve MSHO enrollees.
• Avoid unnecessary duplication through a joint federal-state monitoring and quality oversight process and a coordinated set of reporting requirements.

The term “dually eligible” refers to people who have benefits through Medicare and Medicaid (known in Minnesota as Medical Assistance). 

DHS intends to continue discussions with CMS in a second phase of the Dual Demo Project for the Special Needs BasicCare (SNBC) population.

Changes to the state’s Medicaid and Children’s Health Insurance Program (CHIP) often require approval from the federal Centers for Medicare & Medicaid Services in order to receive federal funding. Learn more about:

• Federal waivers that the department has applied for or received to test new or existing ways to deliver and pay for health care services. Examples of such initiatives are: Reform 2020, Prepaid Medical Assistance Plus and Minnesota SeniorCare Plus.
• Minnesota's Medicaid and CHIP state plan amendments, which are agreements between the state and federal governments describing how Minnesota administers its Medicaid and CHIP programs. The state plan sets out groups of individuals covered, services provided and methodologies for provider reimbursement.

There are several types of case management services in Minnesota, each with its own provider requirements and funding arrangements. The Minnesota Legislature has directed the Department of Human Services (DHS) to redesign Medical Assistance-funded case management to:

• Increase consumer choice
• Specify and standardize the delivery of services
• Improve quality and accountability
• Streamline funding arrangements.

Learn more about the case management redesign project.

The Uniform Service Standards (USS) project is a multi-phase reform of the regulatory structure and requirements of state-funded mental health services in Minnesota. The USS project will: 

• simplify and clarify the regulation of state-funded mental health services, eliminating requirements that fail to add value or enhance quality; and 
• transition the regulatory structure of state-funded mental health services to a unified licensing structure, incorporating all licensed and certified mental health services.

Learn more about the USS project.

• How prevalent are family risk factors among Minnesota children who receive Medical Assistance (MA) or MinnesotaCare? 2015, DHS-7079 (PDF)
• Comparison of Low Birth Weight (LBW) Outcomes among Medicaid and Non-Medicaid Funded Births in Minnesota - full report 2010, DHS-6270 (PDF)
  • Comparing LBW and LBW Risk Factors between Medicaid and non-Medicaid births - brief 2010, DHS-6270A (PDF) 
  • Prenatal Care, Tobacco Use, and Teen Pregnancy: Modifiable Risk Factors for Low Birth Weight - brief 2010, DHS-6270B (PDF)
  • Populations of Color and the Life Course Perspective: A Comparison of LBW Outcomes - brief 2010, DHS-6270C (PDF)
• Infant Mortality among Births Covered by Minnesota Health Care Programs 2010, DHS-6263 (PDF)
  • Key findings from the Infant Mortality report 2010, DHS-6263A (PDF)
• Where do Minnesota youth stand on Healthy Youth 2010 targets? DHS-5632A (PDF) 
• Lead poisoning in Minnesota Medicaid Children 1999-2003, DHS-4626 (PDF)

Also see:

• Child and Teen Checkups reports
• Minnesota Student Survey reports

• Evaluation of Minnesota Health Care Programs 2010 Dental Utilization 2011, DHS-6512 (PDF)

• Cybersavvy, old school, and everyone in between, March 2024 (PDF)
• Improving the health of people living in deep poverty 2020, DHS-8061 (PDF)
• Building Racial Equity into the Walls of Minnesota Medicaid: A focus on U.S.-born Black Minnesotans 2022, DHS-8209a (PDF)
• MHCP Racial Disparities in Healthcare Utilization Monitoring 2010, DHS-7134 (PDF)
• Disparities and Barriers to Utilization among Minnesota Health Care Program Enrollees 2008, DHS-5852 (PDF) 
• Analysis of Race-Ethnic Group Disparities in Minnesota Health Care Programs 2001-2007, DHS-4762 (PDF) 
• Accounting for Social Risk Factors in Minnesota Health Care Program Payments, December 2018, DHS-7834 (PDF)

Quarterly and annual reports submitted to the federal Centers for Medicare & Medicaid Services are available on the health care federal Medicaid waiver pages.

Please see the Managed care reporting pages for reports on enrollment, quality, consumer satisfaction and costs.

Medicaid Matters: The Impact of Minnesota’s Medicaid Program report DHS-7659 (PDF), provides a history of Medicaid in the state, a detailed snapshot of its current eligibility and services, and an in-depth look at the program’s impact.

Federal law requires state Medicaid programs to ensure that Medicaid beneficiaries can access services to at least the same extent as the general population in the same area. The Centers for Medicare & Medicaid Services (CMS) recently issued a final rule implementing this equal access provision. The rule sets new requirements for states to create a data-driven process and plan to monitor and review access to services for fee-for-service enrollees in Medical Assistance, as compared to the general population.

The most recent MHCP Provider Participation List is available. The Provider Participation List is a compilation of health care providers who are in compliance with Rule 101 (Minnesota Statutes, 256B.044 and Minnesota Rules, 9505.5200 – 9505.5240). If a provider name is not on the list, DHS considers the provider noncompliant with Rule 101. DHS will post an updated list each quarter.

A subcommittee of the Health Services Advisory Council (HSAC), this 13-member group consists of a variety of dental providers, representatives from health plans and public health, health researchers and a health care consumer. The committee provides clinical guidance to enhance the department's ability to design dental care benefit and coverage policies for Minnesota Health Care Programs. Like HSAC, DSAC uses evidence-based research to inform recommendations used to advise the DHS Commissioner on pertinent dental policy topics. Appointing authority: Commissioner of Human Services. Compensation: $200 honorarium plus reimbursement for mileage and parking. (Minnesota Statutes 256B.0625, subd.3c(b) Committee web page.

Minnesota Department of Human Services
PO Box 64984
St. Paul, MN 55164-0984

Dental Home Advisory Committee

The Dental Home Advisory Committee (DHAC) is a subcommittee of the Dental Services Advisory Committee (DSAC). This group consists of specific representatives designated by the Minnesota Legislature. This group is charged with designing a dental home demonstration project and presenting recommendations by Feb. 1, 2022, to the DHS commissioner, the chairs and ranking minority members of the legislative committees with jurisdiction over health finance and policy. (Article 1, Section 33 of the 2021 Health and Human Services Omnibus Bill)

Minnesota Department of Human Services
PO Box 64984
St. Paul, MN 55164-0984

The Medicaid Services Advisory Committee, mandated by federal Medicaid law and regulation, advises the state Medicaid agency (the Department of Human Services is Minnesota's Medicaid agency) on issues affecting populations served by Medicaid, as well as those enrolled in MinnesotaCare. This includes eligibility, health care services covered in each program, and payment for services. The committee evaluates policies, makes specific recommendations, and contributes to the formulation of agency policy and standards. Appointing authority: Assistant commissioner of Health Care. Compensation: None. (42 CFR 431.12) 

Minnesota Department of Human Services
P.O. Box 64983
St. Paul, MN 55164-0983
651-431-2298 

The Opioid Prescribing Work Group (OPWG) is an advisory body of experts convened to forward DHS’ Opioid Prescribing Improvement Program (OPIP). The OPIP plays a crucial role in Minnesota’s response to the crisis of prescription opioid misuse and abuse, namely addressing inappropriate prescribing behavior among Minnesota health care providers.

The work group will help shape the program by recommending statewide opioid prescribing protocols for various pain scenarios, such as acute, post-acute, and chronic pain. They will also recommend a quality improvement program within the Minnesota Health Care Programs. The OPIP was created in 2015 at the direction of the governor and the Legislature, and the OPWG is convened through 2017.

Appointing authority: Commissioner of Human Services. Compensation: $200 honorarium plus reimbursement for mileage and parking. (Minnesota Statutes, section 256B.0638). OPWG web page

Minnesota Department of Human Services
PO Box 64983
St. Paul, MN 55164-0983
dhs.opioid@state.mn.us

An advisory committee on managed care for seniors and people with disabilities called Special Needs Purchasing meets at various times during the year. Materials presented at the previous meetings are available.