This bill amends Minnesota Statutes 2024, section 256B.69, subdivision 5a, to establish a new medical assistance capitation payment withhold related to the verification of coverage for managed care plans and county-based purchasing plans. Effective January 1, 2026, the commissioner will withhold two percent of the capitation payment for each medical assistance enrollee until a verification of coverage form, developed by the commissioner, is submitted and signed by the enrollee. The form must include the enrollee's name, address, and the name of their managed care or county-based purchasing plan. Plans are required to request that all enrollees complete this form and submit it to the commissioner by February 27, 2026.

If a completed verification form is not received by the deadline, the commissioner will not return the withheld funds for that enrollee, will stop capitation payments effective April 2026, and will disenroll the enrollee from medical assistance, allowing for an appeal process. This new provision aims to ensure that managed care plans maintain accurate records of enrollee coverage, thereby enhancing accountability and oversight in the medical assistance program.

Statutes affected:
Introduction: 256B.69