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Minnesota Department of Human Services family experiences. Overview for J oint House Health and Human Services Finance and Health and Human Services Reform Committees January 14, 2015. Mary and her children. Mary just lost her job in retail sales.
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Minnesota Department of Human Services family experiences Overview for Joint House Health and Human Services Finance and Health and Human Services Reform Committees January 14, 2015
Mary and her children • Mary just lost her job in retail sales. • She has two children, Tony, 7, and Diane, 4, and is separated from her husband. • She is not eligible for unemployment insurance, and applies for the Minnesota Family Investment Program (MFIP) and Child Care Assistance Program (CCAP) while she looks for work.
MFIP and CCAP • With no other income, Mary will receive $532 in cash assistance (MFIP) and $459 in food assistance (Supplemental Nutrition Assistance Program or SNAP) per month for a total of $991. • Federal poverty level for a family of three is $1,649. • While looking for work, Mary also receives Child Care Assistance.
People who receive MFIP and CCAP services • Of the 90,804 individuals in an average month served by MFIP, 71 percent are children. • About one-third of these children are 5 years old or younger. • Child Care Assistance is provided for 31,219 children in an average month.
Food supports • In 2013, more than 533,000 Minnesotans in an average month received food via SNAP, and even more via food shelves. • Total value was over $750 million with an average monthly SNAP benefit of $118 per person. • Almost all food supports are federally funded.
Health Care • Mary claims both children as tax dependents and has no other income (MFIP, SNAP, and CCAP excluded). • Mary and both children are eligible for Medical Assistance (MA). • Eligibility for MA is based on 133% FPG ($2,193 per month) for a household size of three for a parent, and 275% FPG ($4,535 per month) for a household size of three for a child, age 2-18.
Medical Assistance for Families with Children • Medical Assistance (MA) is Minnesota’s Medicaid program. It is the largest of Minnesota’s publicly funded health care programs. • The average monthly enrollment of individuals enrolled in MA was 739,000 in FY 2015. 59% are families with children. • Most enrollees get their health care through health plans. The rest get care on a fee-for-service basis, with providers billing the state directly for services provided. • MA is funded jointly with federal, state and county funds. • There is no asset test for families with children and adults.
Melissa and Jenny • Melissa is a single mother of Jenny, age 14. • Jenny was diagnosed with a developmental disability shortly after birth. Melissa has been able to support her without other services, but as Jenny’s gotten older she’s found Jenny needs more help than she can provide.
Medical Assistance and DD Waiver • Melissa requests the Developmental Disabilities waiver for her daughter to receive case management, teaching and training services to help her be more independent, and respite for herself. • In order to receive the DD Waiver, her daughter needs to be eligible for Medical Assistance.
Medical Assistance • If the family’s income is too high for Medical Assistance, Melissa can apply through the TEFRA option for her daughter. • If the child is found to have a disability, and require institutional level of care, the TEFRA option will look at the child’s income alone to determine eligibility for Medical Assistance. • Once found eligible for Medical Assistance, Jenny can receive services she has a need for, including Personal Care Assistance to help with daily activities
Home and Community-Based Services Waivers • HCBS waivers provide community alternatives to institutionalization • There are 4 HCBS waivers in Minnesota for people with disabilities • Brain Injury waiver • Community Alternative Care for people who require hospital level of care • Community Alternatives for Individuals with Disabilities for people who require nursing facility level of care • Developmental Disabilities waiver
Robert and Justin • Robert is a single father who earns $27,000 a year at his job, but that’s not enough to pay for child care. • He doesn’t know much about child care, but wants the best for his son, Justin, age 4. • Child Care Assistance Program and Parent Aware can help.
Child Care Assistance – Basic Sliding Fee Program • The Child Care Assistance Program can help pay for the costs of child care. • Families who are not currently or recently receiving assistance through the Minnesota Family Investment Program are eligible for Child Care Assistance through the Basic Sliding Fee Program.
Parent Aware • Quality Rating Improvement System for child care and early education programs • Provides information to parents on quality • Technical assistance and training available for center-based child care providers, family child care providers, Head Start programs and school-based pre-kindergarten programs • Expansion statewide in progress
Health Care • Robert earns $2,250 per month from his job (172% FPG for household size of 2). • Robert is eligible for MinnesotaCare because his income is under the income limit of $2,621 per month (200% FPG for household of 2). • Robert’s coverage will begin the month following the month eligibility is approved. • He must pay a $38 monthly premium for his coverage. • Robert’s 3-year-old son Justin is eligible for MA. The income limit for MA for children is 275% FPG.
MinnesotaCare • MinnesotaCare covers people who do not have access to affordable health insurance and have higher income levels than those served on the MA program. • The average monthly MinnesotaCare enrollment in FY 2013 was 125,000. • Eligibility rules changed in 2014 to align with the Affordable Care Act. Under the new rules, primarily parents and adults without children are enrolled in MinnesotaCare. Most children and pregnant women are now eligible for MA.
MinnesotaCare Funding and Service Delivery • MinnesotaCare is paid for by enrollee premiums and draws on appropriations from the Health Care Access Fund and federal Basic Health Program funds (beginning in 2015). • MinnesotaCare expenditures were $571 million in FY 2013. This represented 4.7% of DHS overall budget. The average medical payment per enrollee was $4,571 a month. • All MinnesotaCare enrollees are served through health plans.
Jacob • Teachers notice that 7th-grade Jacob is more withdrawn than usual. Harsh outbursts intersperse with his silence. • His guidance counselor calls in the school’s contracted mental health clinic for an assessment.
Mental health services in school • The licensed psychologist gives a preliminary diagnosis and Jacob’s Individual Education Program (IEP) Team adds treatment sessions to his IEP. • Since Jacob’s family has Medical Assistance coverage, the school bills MA for the community psychologists' services. • Lacking MA, the School-Linked Grant could be used.
Marcus • Marcus is a veteran who has been in and out of work due to difficulties with depression and chemical dependency. • He is homeless and living on the streets. He may qualify for benefits to get shelter. • He is likely eligible for chemical dependency treatment.
Housing benefits • Marcus is eligible to stay at a shelter where his room and board is covered by Group Residential Housing. He receives $97 a month for personal needs through the General Assistance (GA) program. • Marcus is assisted with getting on Supplemental Security Income (SSI, $733/month), Minnesota Supplemental Aid (MSA, $81/month), SNAP ($16/month) and Medical Assistance for a total of $830 in benefits. Federal poverty level for one person is $972.50 monthly. • Due to the tight rental market and lack of available Section 8 vouchers, Marcus will need some assistance paying for stable housing – either a state rental subsidy program or income supplement program, or a program funded through HUD McKinney-Vento.
Housing programs • Group Residential Housing, pays for room-and-board for adults living in licensed or registered settings who are elderly or have disabilities and who have low incomes • Minnesota Supplemental Aid Shelter Needy, provides assistance to adults with disabilities who have low incomes, high housing costs and live in their own home • State and federal grants to local service providers for shelter, transitional housing, and permanent supportive housing
People who receive housing services • Families with children, youth, single adults. Most of the adults served have disabilities (developmental and physical/mobility disabilities, mental illness and chemical dependency) • Children and youth make up 46 percent of Minnesota’s homeless population, per 2012 Wilder report.
General Assistance and Minnesota Supplemental Aid • General Assistance helps individuals with little or no income meet their basic needs. • Minnesota Supplemental Aid is an income supplement for people who receive federal Supplemental Security Income (SSI), or who are just over the SSI income limit
People who receive GA and MSA General Assistance • 23,216 people received GA in an average month in 2013. • Typical monthly benefit is $203 for an individual and $260 for a couple. Minnesota Supplemental Aid • 30,344 people received MSA in an average month in 2013. • Typical monthly benefit is $81 for an individual and $111 for a couple.
Chemical dependency treatment • Marcus wants to get help with his chemical dependency. • He is eligible to get a “Rule 25” assessment at his county office to determine whether he needs a referral to chemical dependency treatment.
Health Care • While Marcus is waiting for his SSI determination he is eligible for MA as an adult without children. • Marcus does not have an asset test and the income limit is 133% FPG ($1,293 per month). • Marcus will continue to be eligible for MA if he is approved for SSI.
Marcus and Bill • Marcus’ father Bill is 88 years old, has multiple chronic conditions and limitations in daily activities but strongly desires to remain in his own apartment. • Bill and Marcus both wish to reconnect with one another.
Elderly Waiver (EW) • Bill is on Medicare and is financially eligible for Medical Assistance. • He has a care coordinator through his health plan. His care coordinator assesses his need for assistance and determines he is eligible for Elderly Waiver, which will pay for services to help him remain in his apartment. • Through EW, Bill chooses to receive home delivered meals, homemaking, assistance with bathing, and a weekly nurse visit to set up medications and monitor his health conditions. • Bill’s goal is to reconnect with his son Marcus. EW pays for transportation for Bill to visit Marcus in his new apartment.
Elderly Waiver and Alternative Care for older adults • Provide community alternatives to nursing homes for people age 65 and older. • Elderly Waiver (EW) is for people who are financially eligible for long term care under Medical Assistance, and who meet level of care (need) requirements • Alternative Care (AC) is for people with low income and assets who are not eligible for Medical Assistance and who meet level of care requirements.
Medical Assistance (MA) for Persons Over Age 65, Blind, or Disabled • Elderly and people with disabilities made up only 31% of total enrollment, but 66% of total MA expenditures in FY 2013. • People with disabilities who work and earn more than $65 a month may be eligible for MA for Employed Persons with Disabilities (MA-EPD). There is no income test for MA-EPD. There is a $20,000 asset limit and eligible people must pay a monthly premium for coverage.
