related to reimbursement of premiums for employer sponsored health insurance
and for Long Term Care supplemental health insurance policies to individuals
enrolled in both Medicare and Medicaid. This resulted in an end to
reimbursement for at least tens of thousands of individuals enrolled in Medical
Assistance.
Soon after I received a notice from Hennepin County that reimbursement of
premiums for health insurance through an employer would be discontinued, I
filed a petition for an administrative appeal on the grounds that the new state
agency policy was enacted in violation of sections of the Untied States Code
and Code of Federal Regulations.
MN DHS claims to has authority to exclude individuals enrolled in both Medical
Assistance and Medicare from getting premium assistance on the basis of
language in 42 USC 1396e-1 which says that a state "may elect to" offer premium
assistance to all individuals enrolled in Medical Assistance.
However, the language cited by DHS ceased to be in force effective January 1,
2014. At that time the words "may elect to" were stricken and replaced with the
word "shall."
The significance of the change in language is that the evaluation of employer
sponsored health insurance was an optional activity for states prior to January
1, 2014. When "may elect to" was stricken and replaced with "shall," the
evaluation of employer sponsored health insurance became a required activity.
Discontinuation of a required activity on grounds that it is not cost effective
is allowed only after Centers for Medicare and Medicaid Services approve a
petition for a waiver of requirements, accompanied by documentation in this
case to show that it is not cost effective for the state agency to provide
premium reimbursement compared to enrolling people into managed care
organizations that contract with the state.
After administrative appeals were exhausted, I filed an appeal in the state
district court of Hennepin County in June 2020. Attached is the rebuttal to the
joint memorandum in opposition to the memorandum filed by lawyers working for
the Attorney General of MN and Hennepin County Attorney's office. Oral
arguments were heard via telephone conference on December 28, 2020.
Regardless of the outcome of this legal process at the district court level, I
suspect that it is very likely going to be appealed by the losing side.No
ruling from the judge at this point.
-Doug Mann, Minneapolis, MN