HF2955 Summary (Minnesota 2025-2026)
Overview
- Bill: HF 2955
- Session/Jurisdiction: Minnesota, 2025-2026
- Topic: Establishes a county-administered rural medical assistance program (CARMA) as an alternative to PMAP and related programs, with details on governance, enrollment, payments, benefits, data integration, and federal waivers
- Status: Introduced April 2025; referred to Health Finance and Policy
Purpose and intent
- Create CARMA: A county-owned and county-administered alternative to state medical assistance and related programs for rural areas.
- Improve integration: Align health care with public health and social services to address health-related social needs (HRSN) in rural communities.
- Increase local control and accountability: Leverage county input on networks, procurement, and program performance while ensuring compliance with broader state and federal requirements.
- Seek federal waivers: Directs the commissioner of human services to apply for federal waivers necessary to implement CARMA.
Key provisions and changes
1) CARMA establishment and structure (Sec. 2; new statute 256B.695)
- Definitions:
- CARMA: County-administered rural medical assistance program
- Eligible individual: Residents in counties administering CARMA who are eligible for medical assistance, MinnesotaCare, MSHO, MSC+, or SNBC
- Enrollee: CARMA participant
- PMAP: Prepaid Medical Assistance Program
- Rural county: Based on rural area definitions in federal regulation
- Program purpose (Subd. 2)
- Provide a county-owned/administrated alternative to PMAP
- Integrate health care, public health, and social services
- Acknowledge smaller enrollments and local provider networks in rural areas
- Promote accountability for health outcomes, equity, customer service, outreach, and cost
- County participation (Subd. 3)
- Counties or groups of counties may administer CARMA for eligible individuals as an alternative to PMAP, MinnesotaCare, MSHO, MSC+, SNBC
- Counties administering CARMA are exempt from the standard procurement process under 256B.69
- Oversight and procurement (Subd. 4)
- CARMA governed by existing sections (256B.69, 256B.692) unless stated otherwise
- DHS must develop a procurement process for county-based plans to apply to offer CARMA
- Applications reviewed for regulatory compliance and ability to meet program goals
- Enrollment and elections (Subd. 5)
- Automatic enrollment of eligible individuals into CARMA, with option to decline
- Annual election period; changes allowed within year for certain circumstances
- If other plans are required by federal law, or counties terminate contracts for cause, DHS may offer alternative/ replacement plans
- If counties must offer a second plan, and individuals don’t select, they may be automatically enrolled in CARMA
- Second plan options may be offered for Medicare dual-eligibles where necessary
- This subdivision supersedes some existing CARMA-related sections
- Benefits and services (Subd. 6)
- CARMA-covered benefits must include all requirements of medical assistance under 256B.0625
- HRSN benefits may be included starting January 1, 2030, addressing housing, food, transportation, utilities, interpersonal safety
- Enrollees may be reimbursed for out-of-pocket costs for HRSN services from nontraditional providers (not for providers already eligible to enroll)
- Payment and financing (Subd. 7)
- A DHS-county collaboration must establish a payment mechanism with:
- Contract-based terms including adjustable rates
- Full-risk monthly capitation for CARMA services and administration
- Risk corridors (minimum loss ratio, total cost of care, or other metrics)
- Settle-up process tied to risk corridors; potential reinvestment of savings after at least year 3
- Collaborative rate-setting considering CARMA, regional, and DHS FFS experience
- Exemption from certain DHS payment provisions for at least three years post-CARMA implementation
- Payments for CARMA benefits must not exceed prior PA payments; HRSN payments in addition to benefits payments
- Quality measures (Subd. 8)
- Develop CARMA quality measures aligned with 256B.69 and 256B.692
- Focus areas: Enrollee experience/outcomes, population health, health equity, and value of spending
- Create a county-specific quality improvement model, defined before contracts with counties
- Data, systems, and integration (Subd. 9)
- Improve eligibility reviews, enrollment navigation, and transitions to other programs
- Develop a universal public assistance application form
- Remove barriers to interagency collaboration and enhance interoperability
- Streamline data exchange and reduce manual processes
- Maintain an updated electronic inventory of community resources with closed-loop referrals
2) Administrative and timing provisions
- Effective date: Provisions in Sec. 2 and 4 are effective January 1, 2027
- Sec. 3: Federal waivers
- The commissioner must seek all federal waivers and authorities needed to implement CARMA
- Any parts not requiring federal approval have state-law effective dates; revisor notified when waivers are obtained
- Relationship to existing programs
- CARMA serves as an alternative to PMAP and related programs for participating counties
- County-based purchasing provisions and contract management are adjusted to accommodate CARMA
Potential impact and considerations
- Access and convenience for rural residents: CARMA aims to tailor coverage to rural needs, potentially improving access to care and coordination with social services.
- Local control: Counties gain procurement influence, network design, and performance oversight for CARMA, potentially increasing responsiveness to local needs.
- Costs and risk management: Full-risk capitation and risk corridors shift financial risk to county entities, with mechanisms to reinvest savings—requiring careful financial governance.
- HRSN expansion: Introducing coverage for nonclinical supports (housing, food, transportation, utilities, safety) starting in 2030 could address social determinants of health in rural areas.
- Data and interoperability: Emphasis on universal applications and data sharing may improve program navigation but requires robust IT investments and privacy safeguards.
- Federal waivers: Success depends on obtaining necessary waivers; timeline and scope hinge on federal approvals.
Effective date note
- While core CARMA provisions are slated to take effect January 1, 2027, some adjustments could occur earlier if related federal approvals or state actions are completed.
End of summary.
