Moose Lake Star Gazette - Serving Carlton and Pine Counties Since 1895

By C.M. Swanson
Moose Lake Star Gazette 

Making sense of MNsure

Couples are 'trapped' in state's recovery process for fees paid on their behalf


C.M. Swanson

The farm of Ellen and Scott Killerud. The Killeruds were enrolled in Medical Assistance through the MNsure website, only to later find the state had been paying premiums on their behalf accumulating to over $11,000, leaving a lien in that amount on their estate.

C.M. Swanson

Part Two of a three article series

This is the continuing story of three married couples, all in or nearing retirement age, each pondering their next moves in their search for mandatory health care coverage.

When Minnesota residents Scott and Ellen Killerud, Rick and Rose Rayburn, and Robert and Julie Gelle closed their Medical Assistance (MA) accounts, they were left with state claims upon their demise for (respectively) $11,000, $30,000 and $16,000.

Primary concerns of the couples include what they term a confusing and time consuming enrollment process through the MNsure exchange and the feeling of being trapped in the state's recovery process for premiums and services paid on their behalf. (

Doctors, patients, chickens, and pie

There was a time when doctors' services were paid with a couple of chickens and a homemade pie. It was generally understood, due to various income levels, some folks operated on the barter system, others on cash.

Over many years, with the advent of specialty medical fields, community and urban hospitals systems, health care insurance, pharmaceutical companies, research and development entities and vast medical related networks, the way medical services are paid has changed. Simplicity in paying the doctor bill is now extinct.

Today's medical bills are met through an intricate maze of agencies and systems, including state funding for those families and individuals unable to meet its perpetually rising costs.

Medicaid, established with Medicare in 1965, is a joint federal and state program to assist those with limited income and resources to cover medical costs. Traditionally, its primary recipients were people with disabilities or those in need of long-term care.

The Affordable Care Act (ACA) signed into law in October 2010 expanded eligibility qualifications for Medicaid, which significantly increased the number of people covered, particularly those in the 55 and older category. The ACA has been in an evolving process of implementation since its signing.

Clearing confusion about the MNsure exchange

The ACA requires states to determine Medicaid eligibility for the expansion population. MA is Minnesota's name for Medicaid. MNsure, the agency, was formed in response to the signing of the ACA.

However, some Minnesota residents, including the Killeruds, Rayburns and Gelles, have found MNsure to be confusing. Part of the confusion lies in the definition of the word MNsure.

"I think where the confusion lies is that people are confusing MNsure the IT (Information Technology) system with MNsure the agency," said Minnesota State Department of Human Services (DHS) Assistant Commissioner Nathan Moracco. "Where MNsure, the agency and DHS, the agency get involved is that we share a single IT platform. That IT platform is referred to as METS, the Minnesota Eligibility Technology System. That IT system is accessed through a website called"

Moracco further explained that programs available through were designed primarily for people in the zero to 400 percent range of federal poverty guidelines.

(See chart for 2016 federal poverty guidelines at

Dropping Asset Test expands eligibility for Medicaid

Another aspect of the ACA was dropping the asset test for eligibility for Medicaid. This expanded the number of people eligible for Minnesota's MA program, particularly for those in the 55- to 65-year-old bracket.

Prior to the ACA, while annual income may qualify a person for MA, having personal assets like a house, car, motorcycle, boat, savings account, or retirement plan would likely have disqualified them. Since January 2014, if income is within the MA guidelines, having assets does not disqualify them.

"So if you think of someone who is retired, maybe they're living alone, do we want them to have to sell their house, sell their land, their cars, whatever it might be, to dwindle their bank account?" said Moracco. "If that puts them in a position of having to no longer live in their house, to move away from their community, to go into assisted living, that's not necessarily the goal here. What we're saying is, it's OK to have assets. You don't have to be resource poor in order to need health care coverage."

While retaining assets is comforting, it also adds to the confusion regarding the difference between paying up front for health insurance premiums through a broker versus receiving MA through DHS. At times, people aren't even aware they are enrolling in a MA program, as in the case of the Rayburns who enrolled through MNsure via their insurance agent. They were subsequently notified by mail of their enrollment in MA. Neither Rick nor Rose Rayburn were familiar with MA.

"That doesn't mean anything to me," said Rick Rayburn. "We know MA, Medical Assistance, but as far as we know, that's just the bottom tier of the insurance plan."

MA's recovery provision

When Medicaid was established in the 1960s, a provision was also put in place to recover federal funds paid for medical services on an individual's behalf. That policy remains intact today, affecting everyone on MA, including those in the 55- to 65-year-old bracket.

"On one hand we want people to hold on to assets so that they don't have to spend themselves poor in order to qualify for health care programs," said Moracco, "but that said, upon death it's reasonable that if there are assets remaining, since a lot of that support was funded through public programs, i.e. tax dollars, that some of that money then would be returned back to the taxpayer."

The rub for recent enrollees of MA is not having been made aware of the state's recovery provision at the time of enrollment.

As MA programs available through MNsure rolled out via the website, with navigators, certified assisters and brokers, information gaps began to surface. Moracco said while MNsure, the agency, works well in terms of getting people in the door and establishing their eligibility, DHS has become aware of the confusion being experienced by some enrollees.

He went on to say the original vision of sharing logos on communications is "turning out to be more confusing than the value that it provides." Currently the focus is to differentiate notices to clearly delineate when an enrollee is dealing with DHS and public programs vs. working with other programs available through MNsure.

Changes in the making

Due to people including the Killeruds, Rayburns and Gelles voicing their concerns, MNsure and DHS are making changes. Moracco said the online application now reflects the asset recovery process for DHS MA enrollees more clearly.

"We did hear concerns from people that they didn't understand that or they weren't reading it," said Moracco. "We then changed the online application to actually require them to check a box that says, 'I have read this information.'

"It's one small step we can take to ensure people understand that the information about assets and what it means to be on Medicaid is very important. We'll continue to try to find ways to improve it."

As for people like the Killeruds, Rayburns and Gelles who are experiencing potential liens on their assets upon their demise after having been enrolled in MA via MNsure, a fix is yet to come.

"I really hope this (information) will get out and save some other people from going through this," said Rick Rayburn. "You know that right now, it's like getting a punch in the gut."

This is Part Two of a three-part series. See next week's Moose lake Star-Gazette to learn what the Killeruds, Rayburns and Gelles are doing, including appealing to legislators to resolve their challenges with the state recovery process in which they find themselves after having enrolled in MA via MNsure.


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