Committee discusses report related to alleged improper MNsure payments

A report released last week showed that not everyone who enrolled in public health insurance through MNsure was qualified to receive state assistance.

The report, from the Office of the Legislative Auditor, indicated the state spent between $115 million and $271 million on improper payments during a five-month period in early 2015.

"Thousands were wrongfully kicked off health care, while others believed they had insurance only to find they were uninsured. While middle class Minnesota struggles to pay for health insurance, hundreds of millions of dollars are being wasted,” Rep. Matt Dean (R-Dellwood) said in a statement.

The House Health and Human Services Finance Committee, which Dean chairs, met Wednesday to review the report and hear responses from officials with MNsure, the Department of Human Services, MN.IT and the Association of Minnesota Counties.

MNsure started in 2013 as a way to implement the federal Affordable Care Act.

According to its website, “MNsure is a marketplace where Minnesotans can shop, compare and choose health insurance coverage that meets their needs. MNsure is the only place where consumers can qualify for financial help either through federal tax credits or through MinnesotaCare and Medical Assistance.”

The Department of Human Services is responsible for determining benefit eligibility. 

“The findings in this report are serious, and the need for improvement is critical. Accurate eligibility determinations are a basic function that we must get right to ensure the integrity of our public health care programs.” Commissioner Emily Johnson Piper said in a response included with the report.

However, the department questioned the audit methodology, which differs from that required by state and federal law.

“We conduct Payment Error Rate Measurement (PERM) audits of Medicaid eligibility under the federally directed PERM rules. Our most recent PERM audit found much lower error rates than the findings of this audit,” Johnson Piper wrote. “The PERM audit also found only one case in the sample of 128 cases – less than one percent – that was not eligible for any public program, a marked difference from the 28% reported in Finding 1 in this audit.”