MinnesotaCare expands eligibility to Minnesotans with undocumented status

Thousands of Minnesotans with an undocumented status will soon be able to get coverage through the state's low-income health insurance marketplace, MinnesotaCare. Gov. Tim Walz signed the legislation into law at the end of this session and it will take effect in January 2025.

All Things Considered host Tom Crann spoke last week with the Deputy Assistant Commissioner of the Department of Human Services, Julie Marquardt, about the expansion to MinnesotaCare and how it’ll work.

For the full conversation, click play on the audio player above or read the transcript below. The transcript has been lightly edited for clarity.

Who will now be eligible for MinnesotaCare who hasn't been?

Starting in 2025, we will be covering individuals who have incomes at or below 200 percent of the federal poverty level, that are undocumented who previously had not been eligible for that coverage.

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Tell us what was the argument? Why did some say this was needed?

We have families who are working, going to school, paying taxes and yet, do not have access to the same basic health care coverage that other Minnesotans do. So, they're missing work, they're missing school for things that could have been prevented.

Right now, we are paying for the most expensive coverage, waiting for people to get far too sick when we could be providing much cheaper, more effective health care coverage to people much earlier on — accessing in the same way that every other Minnesotan does.

The other place this helps is when someone who is low income presents to a hospital a clinic, they often will not have the means to pay the bill so that bill is written off as charity care or it remains unpaid. So, [for] health care providers, this is a big issue for them in ensuring that they have sufficient revenue to continue to operate and provide services to all Minnesotans.

For those who will now be eligible in 2025, will they have to pay a premium? How will it work?

Coverage for undocumented people will be just the same as it is for someone who is on the program today. They will be required to pay premiums, they will be required to pay any caution including deductibles or copays.

One difference I should say for this population is we will actually be operating the program under our fee-for-service programs. So, people on MinnesotaCare today, they actually receive their services through a managed care plan. This program will run with DHS directly paying the claim so it will not affect the risk pool or any of the rates that are paid for people who are on MinnesotaCare through managed care.

Opponents of this were concerned, among other things, about the costs. What are the projections on how much this will cost to expand eligibility to potentially 40,000 or more people?

We were looking at approximately — and this is our best estimate — a little over $7,000 per year, per individual. That would be an average per person. We assume that it will take some time for people to become aware of this to enroll. But when the full amount [has signed up], and the number we were estimating was somewhere between 7,000 and 8,000 people, it would be about $59 million per year.

Where will that additional money come from?

This is coming from our state funds so we don't have any federal funding attached to this.

What should people who may be eligible for this know as it moves from law into implementation? Especially if people are perhaps reluctant to sign up because they feel they will be tracked that they're not documented?

That's part of the importance of working with community members so that people understand that their information is not going to be shared with immigration agencies — that it is safe for them to come forward and ask for health care coverage and apply for health care coverage.

But we really want to work within communities that are trusted so that people can have confidence that that they can get the coverage and that it is safe for them to do so.