This bar chart shows how Medicare is financed nationally for year 2022. Medicare revenue sources = $988.6 billion.
General revenue=42.8%
Payroll taxes=35.7%
Premiums=15.5%
Taxation of benefits=3.3%
Transfers from States=1.4%
Other=0.8%
Interest=0.5%
- Source: 2023 Annual Report of The Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, Table II.B1, Medicare data for calendar year 2022.

Page 7 – Change in Medicare from Previous Year, Enrollment and Spending

This line graph shows the change from the previous years for Minnesota’s Medicare enrollment, spending, and spending per enrollee.
2013: Enrollment=3.3%, Spending=4.3%, Spending per Enrollee=0.9%
2014: Enrollment=2.9%, Spending=5.0%, Spending per Enrollee=2.1%
2015: Enrollment=2.8%, Spending=4.3%, Spending per Enrollee=1.5%
2016: Enrollment=3.0%, Spending=4.6%, Spending per Enrollee=1.6%
2017: Enrollment=2.8%, Spending=7.3%, Spending per Enrollee=4.4%
2018: Enrollment=3.0%, Spending=5.8%, Spending per Enrollee=2.7%
2019: Enrollment=2.6%, Spending=5.3%, Spending per Enrollee=2.7%
2020: Enrollment=2.4%, Spending=-0.9%, Spending per Enrollee=-3.2%
2021: Enrollment=2.1%, Spending=9.6%, Spending per Enrollee=7.3%
2022: Enrollment=2.3%, Spending=8.7%, Spending per Enrollee=6.3%
- Source: CMS Program Statistics; downloaded June 2023. Minnesota spending estimates are based on MDH annual spending report data for Medicare – public payer data and exclude out-of-pocket expenditures (updated through 2022). Enrollment estimates include dual-eligible Medicare and Medical Assistance enrollees.
- The COVID-19 Pandemic began in late 2019. A Public Health Emergency was declared on January 27, 2020.

Page 8 - Distribution of Minnesota Medicare Beneficiaries by Reason for Eligibility¹

This bar chart shows the percentage of Minnesota and United States Medicare beneficiaries who are Age 65 or older and People with Disabilities, for 2018 through 2022.
Minnesota:
- 2018: Age 65 or older=87.6%; People with Disabilities=12.4%
- 2019: Age 65 or older=88.2%; People with Disabilities=11.8%
- 2020: Age 65 or older=88.7%; People with Disabilities=11.3%
- 2021: Age 65 or older=89.2%; People with Disabilities=10.8%
- 2022: Age 65 or older=89.7%; People with Disabilities=10.3%
United States
- 2018: Age 65 or older=85.5%; People with Disabilities=14.5%
- 2019: Age 65 or older=86.1%; People with Disabilities=13.9%
- 2020: Age 65 or older=86.8%; People with Disabilities=13.2%
- 2021: Age 65 or older=87.4%; People with Disabilities=12.6%
- 2022: Age 65 or older=88.1%; People with Disabilities=11.9%
- Source: CMS Program Statistics; March 2024. U.S. population estimates are based on the United States and do not include territories, Puerto Rico, or other/outlying areas. Enrollment estimates include dual-eligible Medicare and Medical Assistance enrollees.

¹People with disabilities includes enrollees with disabilities that are under age 65 and those with End-Stage Renal Disease-only. Those aged 65 or older and with ESRD or disabilities are classified as Age 65 or Older.

Page 9 - Distribution of Minnesota Medicare Beneficiaries by Dual-Enrollment Coverage

This bar chart shows the percentage of people in Minnesota and the United States who are Medicare beneficiaries and are dually enrolled compared to those who are not dually enrolled for 2018 through 2022. Dual eligible are full-benefit MMEs (Medicare – Medicaid Enrollees) and Qualified Disabled working individuals.
Minnesota
- 2018: Dually Enrolled=12.2%; Not Dually Enrolled=87.8%
- 2019: Dually Enrolled=11.9%; Not Dually Enrolled=88.1%
- 2020: Dually Enrolled=11.7%; Not Dually Enrolled=88.3%
- 2021: Dually Enrolled=12.0%; Not Dually Enrolled=88.0%
- 2022: Dually Enrolled=12.4%; Not Dually Enrolled=87.6%
United States
- 2018: Dually Enrolled=13.1%; Not Dually Enrolled=86.9%
- 2019: Dually Enrolled=12.9%; Not Dually Enrolled=87.1%
- 2020: Dually Enrolled=12.9%; Not Dually Enrolled=87.1%
- 2021: Dually Enrolled=13.4%; Not Dually Enrolled=86.6%
- 2022: Dually Enrolled=14.0%; Not Dually Enrolled=86.0%
- Source: CMS Program Statistics; March 2024. U.S. population estimates are based on the United States and do not include territories, Puerto Rico, or other/outlying areas.

Page 10 - Medicare Enrollment as a Percent of Population, by County, 2022

This map shows Minnesota’s enrollment in Medicare as percent of the population for each county by five quintiles, for 2022. The quintiles are 0-18.9%, 19.0%-22.5%, 22.6%-24.5%, 24.6%-27.6%, 27.7% and greater. Minnesota’s Medicare enrollment as a percent of population is 19.1%. The following counties have enrollment in each quintile (by alphabetical order):

0-18.9% = Anoka, Benton, Blue Earth, Carver, Clay, Dakota, Dodge, Hennepin, Nicollet, Nobles, Olmsted, Ramsey, Rice, Scott, Sherburne, Stearns, Washington, Wright
19.0%-22.5%= Beltrami, Carlton, Chisago, Isanti, Le Sueur, Lyon, McLeod, Mower, Pennington, Polk, Roseau, Sibley, Steele, Stevens, Waseca, Watonwan, Winona
22.6%-24.5%= Chippewa, Clearwater, Fillmore, Goodhue, Jackson, Kandiyohi, Mahnomen, Meeker, Mille Lacs, Morrison, Pipestone, Red Lake, Redwood, Rock, St. Louis, Swift, Todd, Wilkin
24.6%-27.6%= Becker, Brown, Cottonwood, Crow Wing, Faribault, Freeborn, Grant, Houston, Kanabec, Marshall, Norman, Pine, Renville, Wabasha, Wadena, Yellow Medicine
27.7% and greater = Aitkin, Big Stone, Cass, Cook, Douglas, Hubbard, Itasca, Kittson, Koochiching, Lac qui Parle, Lake, Lake of the Woods, Lincoln, Martin, Murray, Otter Tail, Traverse
- Sources: CMS Program Statistics; March 2024; U.S. Census Bureau, Annual Estimates of the Resident Population for Counties in Minnesota: April 1, 2020 to July 1, 2022. Map shapefile from 2021 Mapbox @OpenStreetMap. Ranges are based on quintiles. Enrollment estimates include dual-eligible Medicare and Medical Assistance enrollees.

Page 11 - Share of Medicare Population Compared to Share of Minnesota Population, by Region

This bar chart shows the share of Minnesotans within the Medicare program, by region, compared to the share of all Minnesotans, by region, for 2022.

Twin Cities Metro= Medicare 48.4%; State Population 55.1%
Central= Medicare 14.6%; State Population 14.0%
Southeast= Medicare 9.8%; State Population 9.1%
Northeast= Medicare 7.8%; State Population 5.7%
South Central= Medicare 5.9%; State Population 5.2%
Southwest= Medicare 4.7%; State Population 3.8%
Northwest=Medicare 4.4%; State Population 3.6%
West Central= Medicare 4.4%; State Population 3.5%
- For the regional boundaries, see slide 44 at the end of this chartbook.
- Sources: CMS Program Statistics; March 2024; U.S. Census Bureau, Annual Estimates of the Resident Population for Counties in Minnesota: April 1, 2020 to July 1, 2022. Blue bar chart percentages are calculated by taking the Medicare enrollment in each region by the total Medicare population. Green bar chart percentages are calculated by taking the Minnesota residents in each region by the total state population. Medicare enrollment estimates include dual-eligible Medicare and Medical Assistance enrollees.

Page 13 – Medicare Enrollment, as of December 2022

These bar charts show Minnesota’s distribution of Medicare enrollment between original Medicare plans and Private Medicare Plans (Medicare Cost and Medicare Advantage plans).
Original Medicare=44.1%
Private Medicare=55.9%
- Medicare Cost=5.7%
- Medicare Advantage=50.2%
- Source: CMS, Medicare Advantage Monthly Enrollment by State/County/Contract as of December 2022. Total Medicare enrollment is based off CMS Enrollment Dashboard 2022, calendar year.
- Private Medicare is representative of Medicare Advantage and Medicare Cost Plans. Medicare Advantage and Medicare Cost Plans cover Medicare hospital and provider benefits (Part A and Part B) and may cover Part D (drug). Original Medicare is the traditional fee-for-service Medicare health care system. Private Medicare enrollment estimates include dual-eligible Medicare and Medical Assistance enrollees. These do not include stand-alone Medicare Part D (drug) plans, or other Medicare supplement plans. As this is a point in time estimate, results may differ from data reported on a calendar year basis.

Page 14 - Total Medicare Private Plan Enrollment as a Percent of Population, Minnesota and the United States

This line graph shows the share of Medicare enrollees in private plans in Minnesota and the United States.

2013: Minnesota=50.6%, United States=28.3%
2014: Minnesota=52.7%, United States=30.2%
2015: Minnesota=54.7%, United States=31.5%
2016: Minnesota=56.5%, United States=32.3%
2017: Minnesota=58.3%, United States=34.0%
2018: Minnesota=58.4%, United States=35.7%
2019: Minnesota=46.2%, United States=37.6%
2020: Minnesota=49.2%, United States=40.3%
2021: Minnesota=53.2%, United States=43.6%
2022: Minnesota=55.9%, United States=46.3%
- Source: CMS, Medicare Advantage Monthly Enrollment by State/County/Contract as of December of each year. Total Medicare enrollment is based off CMS Enrollment Dashboard 2022, calendar year.
- CMS Medicare private plans include Medicare Advantage and Medicare Cost Plans that cover Medicare hospital and provider benefits (Part A and Part B) and may cover Part D (drug). These estimates include dual-eligible Medicare and Medical Assistance enrollees. It does not include stand-alone Medicare Part D (drug) plans, or other Medicare supplement plans. U.S. population estimates are based on the United States and do not include territories, Puerto Rico, or other/outlying areas.

Page 15 - Medicare Private Plan Enrollment as a Percent of Total Enrollment in Minnesota

This line graph shows the share of Medicare enrollees by private Medicare plan type in Minnesota.
2013: Medicare Cost=29.5%, Medicare Advantage=21.1%
2014: Medicare Cost=32.8%, Medicare Advantage=19.9%
2015: Medicare Cost=37.1%, Medicare Advantage=17.6%
2016: Medicare Cost=39.6%, Medicare Advantage=16.9%
2017: Medicare Cost=41.1%, Medicare Advantage=17.2%
2018: Medicare Cost=40.1%, Medicare Advantage=18.3%
2019: Medicare Cost=6.1%, Medicare Advantage=40.2%
2020: Medicare Cost=5.8%, Medicare Advantage=43.4%
2021: Medicare Cost=5.8%, Medicare Advantage=47.4%
2022: Medicare Cost=5.7%, Medicare Advantage=50.2%
- Source: CMS, Medicare Advantage Monthly Enrollment by State/County/Contract as of December as of each year. Total Medicare enrollment is based off CMS Enrollment Dashboard 2022, calendar year. Medicare private plans include Medicare Advantage and Medicare Cost Plans that cover Medicare hospital and provider benefits (Part A and Part B) and may cover Part D (drug). These estimates include dual-eligible Medicare and Medical Assistance enrollees. It does not include stand-alone Medicare Part D (drug) plans, or other Medicare supplement plans.

Page 17 - Medicare Private Plan Enrollment as a Percent of Population, by County, as of December 2022

This map shows Minnesota’s Medicare private plan enrollment for each county by five quintiles, for 2022.
The quintiles are: 0.0%-40.1%, 40.2%-46.2%, 46.3%-51.8%, 51.9%-61.1%, 61.2% and greater. Statewide Medicare Private enrollment as a percent of total Medicare enrollment: 55.9%. The following counties have enrollment in each quintile (by alphabetical order):
0.0%-40.1%= Big Stone, Brown, Chippewa, Cottonwood, Jackson, Kittson, Lincoln, Lyon, Mahnomen, Martin, Murray, Nobles, Norman, Olmsted, Polk, Pope, Swift, Watonwan
40.2%-46.2%= Beltrami, Blue Earth, Clay, Dodge, Faribault, Fillmore, Freeborn, Grant, Hubbard, Lac qui Parle, Marshall, Mower, Nicollet, Redwood, Renville, Roseau, Stevens, Wilkin
46.3%-51.8%=Becker, Cass, Clearwater, Douglas, Houston, Kandiyohi, Lake of the Woods, Otter Tail, Pennington, Pipestone, Stearns, Steele, Traverse, Wabasha, Wadena, Waseca, Winona
51.9%-61.1%= Benton, Carver, Crow Wing, Dakota, Hennepin, Isanti, Koochiching, Morrison, Ramsey, Red Lake, Rock, Scott, Sherburne, Todd, Wright, Yellow Medicine
61.2% and greater = Aitkin, Anoka, Carlton, Chisago, Cook, Goodhue, Itasca, Kanabec, Lake, Le Sueur, McLeod, Meeker, Mille Lacs, Pine, Rice, Sibley, St. Louis, Washington
- Sources: CMS, CMS Enrollment Dashboard 2022, calendar year; U.S. Census Bureau, Annual Estimates of the Resident Population for Counties in Minnesota: April 1, 2020 to July 1, 2022. Map shapefile from 2022 Mapbox @OpenStreetMap. Ranges are based on quintiles.
- Medicare private plans include Medicare Advantage and Medicare Cost Plans that cover Medicare hospital and provider benefits (Part A and Part B) and may cover Part D (drug). It does not include stand-alone Medicare Part D (drug) plans, or other Medicare supplement plans. These estimates include dual-eligible Medicare and Medical Assistance enrollees. Ranges are based on quintiles. Distribution is based on Private Medicare Plan Enrollees as a percent of total Medicare enrollees.

Page 18 - Distribution of Minnesota Medicare Private Plan Enrollees, by Region & Type of Plan, December 2022

This bar graph shows the distribution of Minnesota Medicare private plan enrollees by region and type of plan for 2022.
Rural: Medicare Cost=22.3%, Medicare Advantage=77.7%
Urban: Medicare Cost=6.0%, Medicare Advantage=94.0%
Statewide: Medicare Cost=10.3%, Medicare Advantage =89.7%
- Source: CMS, Medicare Advantage Monthly Enrollment by State/County/Contract Report as of December 2022.These plans cover Medicare hospital and provider benefits (Part A and Part B) and may cover Part D benefits (prescription drugs). These do not include stand-alone Medicare Part D (drug) plans, or other Medicare supplement plans. Medicare Cost plans represented are 1876 Cost Plans; Medicare Advantage plans represented are local Coordinated Care Plans (CCPs). Due to low populations, Private Fee For Service Plans and Medicare MSA plans are including within Medicare Advantage; each have less than 0.1% of Medicare enrollees enrolled. These estimates include dual-eligible Medicare and Medical Assistance enrollees.

Page 20 - Distribution of Prescription Drug Coverage for Medicare Enrollees, by Type, 2022

This bar graph shows the types of prescription drug coverage for Medicare enrollees in Minnesota and the United States for 2022.
Stand-alone Prescription Drug Plan: Minnesota=31.8%, United States=36.7%
Medicare Advantage: Minnesota=48.4%, United States=41.2%
No Part D Plan: Minnesota=19.8%, United States=22.2%
- Source: MDH analysis of CMS Program Statistics; March 2024. MDH has calculated “No Part D Plan” to be based off subtracting Medicare Advantage Drug Plan Enrollment and Medicare Part D enrollment from Total Medicare enrollment. “No Part D Plan” may include participants enrolled in a Retiree Drug Subsidy (RDS) plan, other prescription drug coverage not included in the other categories, or participants without drug coverage. Medicare Advantage CMS definition does not implicitly indicate this includes Medicare Cost plans. U.S. population estimates are based on the United States and do not include territories, Puerto Rico, or other/outlying areas.

Page 21 – Change in Annual Prescription Drug Coverage, by Type

This bar graph shows the annual change in enrollment for Medicare prescription drug coverage enrollees in Minnesota and the United States for years 2018 through 2022.
Minnesota:
- Stand Alone Prescription Drug Plan (2022 enrollment: 347,623): 2018: 2.5%; 2019: -9.2%; 2020: -3.2%; 2021: -6.5%; 2022: -3.2%
- Medicare Advantage (2022 enrollment: 528,515): 2018: 4.9%; 2019: 21.4%; 2020: 10.0%; 2021: 11.6%; 2022: 8.7%
- No Part D Plan (2022 enrollment: 216,938): 2018: 1.2%; 2019: -1.8%; 2020: -1.1%; 2021: -1.6%; 2022: -2.8%
United States:
- Stand Alone Prescription Drug Plan (2022 enrollment: 23,377,512): 2018: 1.3%; 2019: 0.1%; 2020: -1.6%; 2021: -4.0%; 2022: -3.1%
- Medicare Advantage (2022 enrollment: 26,258,763): 2018: 7.0%; 2019: 8.5%; 2020: 10.1%; 2021: 11.1%; 2022: 9.3%
- No Part D Plan (2022 enrollment: 14,146,603): 2018: 0.0%; 2019: -0.4%; 2020: -1.8%; 2021: -2.4%; 2022: -1.9%
- Source: MDH analysis of CMS Program Statistics; March 2024. MDH has calculated “No Part D Plan” to be based off subtracting Medicare Advantage Drug Plan Enrollment and Medicare Part D enrollment from Total Medicare enrollment. MDH believes that “No Part D Plan” includes Medicare participants enrolled in a Retiree Drug Subsidy (RDS) and may include Medicare beneficiaries who have other prescription drug coverage, including creditable coverage (defined as coverage that meets or exceeds the actuarial value of the standard Medicare Part D benefit) based on comparing this data with historical data provided by CMS Medicare Part D enrollment files (MDCR Enroll 3); the 2022 MDCR file was not yet available as of July 30, 2024. Creditable coverage data is no longer published by CMS. Medicare Advantage CMS definition does not implicitly indicate this includes Medicare Cost plans. U.S. population estimates are based on the United States and do not include territories, Puerto Rico, or other/outlying areas.

Page 24 – Change in Medical Assistance from Previous Year, Enrollment and Spending^1-3

This line graph shows the changes in enrollment, total spending, and spending per enrollee, for Medical Assistance.^1-3
2014: Enrollment=13.4%, Total Spending=15.2%, Spending per Enrollee=1.5%
2015: Enrollment=25.2%, Total Spending=14.2%, Spending per Enrollee=-8.8%
2016: Enrollment=2.8%, Total Spending=6.1%, Spending per Enrollee=3.1%
2017: Enrollment=0.3%, Total Spending=-3.0%, Spending per Enrollee=-3.3%
2018: Enrollment=1.8%, Total Spending=15.2%, Spending per Enrollee=13.2%
2019: Enrollment=-1.2%, Total Spending=-2.1%, Spending per Enrollee=-0.9%
2020: Enrollment=-1.3%, Total Spending=8.9%, Spending per Enrollee=10.3%
2021: Enrollment=10.6%, Total Spending=3.0%, Spending per Enrollee=-6.9%
2022: Enrollment=9.1%, Total Spending=19.8%, Spending per Enrollee=9.8%
2023: Enrollment=7.6%, Total Spending=10.0%, Spending per Enrollee=2.3%
- Source: Minnesota Department of Human Services, February 2024 Expenditure Forecast, data for state fiscal years. Lower enrollment in SFY 2020 is a result of lower enrollment for the first three quarters of 2020, making the average monthly enrollment in SFY2020 lower than the average in SFY2019.

¹Some MinnesotaCare enrollees qualified for Medical Assistance (MA) following the March 2011 MA eligibility expansion to include childless adults with incomes at or below 75% of the Federal Poverty Guidelines (FPG).

³The Public Health Emergency related to the COVID-19 pandemic began on January 27, 2020 (ASPE: https://aspr.hhs.gov/legal/PHE/Pages/2019-nCoV.aspx) and allowed for continuous enrollment for anyone enrolled on or after March 31, 2020. The continuous enrollment provision ended on March 31, 2023.

Page 25 - Medical Assistance Enrollment as a Percent of Population, by County, Calendar Year 2023

This map shows Minnesota’s enrollment in Medical Assistance as percent of the population for each county by five quintiles, for 2023. The quintiles are 0.0%-21.3%, 21.4%-24.6%, 24.7%-27.6%, 27.7%-30.7%, 30.8% and greater. Minnesota’s Medical Assistance gross enrollment as a percent of population is 24.5%. The following counties have enrollment in each quintile (by alphabetical order):
0.0%-21.3%=Brown, Carver, Chisago, Dakota, Douglas, Goodhue, Houston, Le Sueur, Nicollet, Pennington, Scott, Sherburne, Stevens, Wabasha, Washington, Winona, Wright
21.4%-24.6%=Anoka, Blue Earth, Carlton, Cook, Fillmore, Isanti, Jackson, Lake, Lincoln, Marshall, McLeod, Meeker, Murray, Olmsted, Rice, Rock, Roseau, St. Louis
24.7%-27.6%=Benton, Clay, Crow Wing, Hennepin, Kittson, Koochiching, Lac qui Parle, Morrison, Otter Tail, Red Lake, Sibley, Stearns, Todd, Wilkin, Yellow Medicine
27.7%-30.7%=Aitkin, Becker, Big Stone, Freeborn, Hubbard, Itasca, Kanabec, Lake of the Woods, Lyon, Martin, Pine, Pipestone, Polk, Redwood, Renville, Swift, Watonwan
30.8% and greater=Beltrami, Cass, Chippewa, Clearwater, Cottonwood, Faribault, Kandiyohi, Mahnomen, Mille Lacs, Mower, Nobles, Norman, Pope¹, Ramsey, Steele¹, Traverse, Wadena
- Source: Minnesota Department of Human Services, enrollment data for calendar year 2023; County estimates from U.S. Census Bureau, Annual Estimates of the Resident Population for Counties: April 1, 2020 to July 1, 2023; map shapefile from 2022 Mapbox @OpenStreetMap. Ranges are based on quintiles. Enrollment excludes “other” with no known category. Includes all enrollees, even those with dual-coverage (Medicare or private coverage) during the year.

¹DHS does not separate out Grant county enrollment and it is instead included in Pope county; Dodge and Waseca counties enrollment is combined into enrollment for Steele county.

Page 26 – Share of Medical Assistance Enrollees Compared to Share of Minnesota Population, by Region

This bar chart shows the share of enrollees within the Medical Assistance Program, by region, compared to the share of all Minnesotans, by region, for 2023.
Twin Cities Metro= Medical Assistance 54.5%; State Population 55.1%
Central= Medical Assistance 13.8%; State Population 14.0%
Southeast= Medical Assistance 8.8%; State Population 9.1%
Northeast= Medical Assistance 5.8%; State Population 5.7%
South Central= Medical Assistance 4.6%; State Population 5.2%
Southwest= Medical Assistance 4.5%; State Population 3.8%
Northwest=Medical Assistance 4.4%; State Population 3.6%
West Central= Medical Assistance 3.6%; State Population 3.5%
- For the regional boundaries, see slide 44 at the end of this chartbook.
- Source: Minnesota Department of Human Services, enrollment data for calendar year 2023; County estimates from U.S. Census Bureau, Annual Estimates of the Resident Population for Counties: April 1, 2020 to July 1, 2023. Enrollment excludes “other” with no known category. Blue bar chart percentages are calculated by taking the Medical Assistance enrollment in each region by the total Medical Assistance population. Green bar chart percentages are calculated by taking the Minnesota residents in each region by the total state population.

Page 27 - Medical Assistance Enrollment, by Eligibility Category

These bar graphs show the distribution of Medical Assistance enrollment by eligibility category for the years 2019 through 2023.
Families with Children: 2019: 710,062; 2020:703,038; 2021: 772,776; 2022: 830,701; 2023: 883,449
People with Disabilities / Elderly: 2019: 177,427; 2020: 176,678; 2021: 179,665; 2022: 187,182; 2023: 196,745
Adults no Children: 2019: 201,203; 2020: 194,849; 2021: 235,844; 2022: 278,707; 2023: 314,341
- Source: Minnesota Department of Human Services, February 2024 Expenditure Forecast.

Page 28 - Distribution of Medical Assistance Enrollment and Spending, by Eligibility Category, Calendar Year 2023

These bar graphs show the distribution of Medical Assistance spending compared to eligibility, by eligibility category, for 2023.
Families with Children: Eligibility=62.2%, Spending=24.3%; population: 873,523
Adults no Children: Eligibility=23.1%, Spending=19.9%; population: 324,567
People with Disabilities: Eligibility=8.8%, Spending=39.2%; population: 124,131
Elderly: Eligibility=5.8%, Spending=16.7%; population: 81,171
- Source: Minnesota Department of Human Services, data for calendar year 2023. Data source is different than prior slide, which data is based on state fiscal years. Enrollment within eligibility labels is rounded.

Page 29 - Proportion of Fee-for-Service Medical Assistance Enrollment, as of December

This bar graph shows the estimated annual distribution of Medical Assistance enrollees enrolled in fee-for-service Medical Assistance. Data are based on a point of time (December) for each calendar year.
- 2019: 21.9%
- 2020: 16.0%
- 2021: 14.8%
- 2022: 14.1%
- 2023: 14.6%
- Source: Minnesota Department of Human Services monthly enrollment files and December Managed Care Enrollment files. Data are based on a point of time (December) for each calendar year.

Page 30 - Medical Assistance Spending, per Recipient, State Fiscal Year

These bar and line graphs show the monthly average payments and annual enrollment by various Medical Assistance eligibility and spending categories over the past 10 years.
- Families Basic Care
  - State fiscal year 2014: Monthly Average Payments: $386, Enrollment: 532,952
  - State fiscal year 2015: Monthly Average Payments: $351, Enrollment: 677,188
  - State fiscal year 2016: Monthly Average Payments: $367, Enrollment: 698,257
  - State fiscal year 2017: Monthly Average Payments: $302, Enrollment: 705,441
  - State fiscal year 2018: Monthly Average Payments: $390, Enrollment: 714,083
  - State fiscal year 2019: Monthly Average Payments: $351, Enrollment: 710,062
  - State fiscal year 2020: Monthly Average Payments: $391, Enrollment: 703,038
  - State fiscal year 2021: Monthly Average Payments: $353, Enrollment: 772,776
  - State fiscal year 2022: Monthly Average Payments: $419, Enrollment: 830,701
  - State fiscal year 2023: Monthly Average Payments: $412, Enrollment: 883,449
- Adults with No Kids Basic Care
  - State fiscal year 2014: Monthly Average Payments: $730, Enrollment: 121,353
  - State fiscal year 2015: Monthly Average Payments: $731, Enrollment: 193,302
  - State fiscal year 2016: Monthly Average Payments: $677, Enrollment: 204,138
  - State fiscal year 2017: Monthly Average Payments: $732, Enrollment: 199,951
  - State fiscal year 2018: Monthly Average Payments: $778, Enrollment: 211,009
  - State fiscal year 2019: Monthly Average Payments: $755, Enrollment: 201,203
  - State fiscal year 2020: Monthly Average Payments: $881, Enrollment: 194,849
  - State fiscal year 2021: Monthly Average Payments: $785, Enrollment: 235,844
  - State fiscal year 2022: Monthly Average Payments: $978, Enrollment: 278,707
  - State fiscal year 2023: Monthly Average Payments: $986, Enrollment: 314,341
- Aged and Disabled Basic Care¹
  - State fiscal year 2014: Monthly Average Payments: $989, Enrollment: 183,951
  - State fiscal year 2015: Monthly Average Payments: $948, Enrollment: 179,329
  - State fiscal year 2016: Monthly Average Payments: $1,047, Enrollment: 177,005
  - State fiscal year 2017: Monthly Average Payments: $1,032, Enrollment: 177,262
  - State fiscal year 2018: Monthly Average Payments: $1,174, Enrollment: 176,995
  - State fiscal year 2019: Monthly Average Payments: $1,138, Enrollment: 177,427
  - State fiscal year 2020: Monthly Average Payments: $1,220, Enrollment: 176,678
  - State fiscal year 2021: Monthly Average Payments: $1,172, Enrollment: 179,665
  - State fiscal year 2022: Monthly Average Payments: $1,310, Enrollment: 187,182
  - State fiscal year 2023: Monthly Average Payments: $1,359, Enrollment: 196,745
- Elderly Waiver Managed Care
  - State fiscal year 2014: Monthly Average Payments: $1,266, Enrollment: 20,899
  - State fiscal year 2015: Monthly Average Payments: $1,208, Enrollment: 20,960
  - State fiscal year 2016: Monthly Average Payments: $1,419, Enrollment: 20,935
  - State fiscal year 2017: Monthly Average Payments: $1,262, Enrollment: 21,794
  - State fiscal year 2018: Monthly Average Payments: $1,472, Enrollment: 22,763
  - State fiscal year 2019: Monthly Average Payments: $1,260, Enrollment: 23,564
  - State fiscal year 2020: Monthly Average Payments: $1,448, Enrollment: 24,419
  - State fiscal year 2021: Monthly Average Payments: $1,279, Enrollment: 24,496
  - State fiscal year 2022: Monthly Average Payments: $1,571, Enrollment: 24,625
  - State fiscal year 2023: Monthly Average Payments: $1,560, Enrollment: 25,226
- LTC Facilities
  - State fiscal year 2014: Monthly Average Payments: $4,472, Enrollment: 17,300
  - State fiscal year 2015: Monthly Average Payments: $4,594, Enrollment: 16,761
  - State fiscal year 2016: Monthly Average Payments: $4,986, Enrollment: 16,289
  - State fiscal year 2017: Monthly Average Payments: $5,596, Enrollment: 16,067
  - State fiscal year 2018: Monthly Average Payments: $5,770, Enrollment: 15,714
  - State fiscal year 2019: Monthly Average Payments: $6,241, Enrollment: 15,412
  - State fiscal year 2020: Monthly Average Payments: $6,647, Enrollment: 14,926
  - State fiscal year 2021: Monthly Average Payments: $7,027, Enrollment: 13,163
  - State fiscal year 2022: Monthly Average Payments: $7,318, Enrollment: 12,442
  - State fiscal year 2023: Monthly Average Payments: $8,076, Enrollment: 12,018
- LTC Waivers Home Care
  - State fiscal year 2014: Monthly Average Payments: $3,641, Enrollment: 56,010
  - State fiscal year 2015: Monthly Average Payments: $4,047, Enrollment: 57,602
  - State fiscal year 2016: Monthly Average Payments: $4,093, Enrollment: 58,598
  - State fiscal year 2017: Monthly Average Payments: $4,166, Enrollment: 60,827
  - State fiscal year 2018: Monthly Average Payments: $4,309, Enrollment: 63,254
  - State fiscal year 2019: Monthly Average Payments: $4,358, Enrollment: 68,046
  - State fiscal year 2020: Monthly Average Payments: $4,542, Enrollment: 73,570
  - State fiscal year 2021: Monthly Average Payments: $4,890, Enrollment: 77,003
  - State fiscal year 2022: Monthly Average Payments: $5,195, Enrollment: 80,141
  - State fiscal year 2023: Monthly Average Payments: $5,589, Enrollment: 83,846
- Source: Minnesota Department of Human Services, February 2024 Expenditure Forecast – State Fiscal Years. This excludes several categories of service that do not have “monthly average spending” data within the forecast; these include categories such as: breast and cervical cancer coverage, family planning services, pharmacy rebates, adjustments, and special funding items.

¹The “Aged and Disabled Basic Care” has had the “Elderly Waiver Managed Care” expenditures removed; instead “Elderly Waiver Managed Care” expenditures are included in its own category and based on taking the total annual payments by the average monthly service recipients by 12 months.

Page 31 - Medical Assistance Spending, by Eligibility Category

This line graph shows the state fiscal year Medical Assistance spending by eligibility category, in addition to the total state fiscal year spending for Medical Assistance over the past 10 years.
- Total
  - State fiscal year 2014: $9.3B
  - State fiscal year 2015: $10.6B
  - State fiscal year 2016: $11.2B
  - State fiscal year 2017: $10.9B
  - State fiscal year 2018: $12.5B
  - State fiscal year 2019: $12.3B
  - State fiscal year 2020: $13.4B
  - State fiscal year 2021: $13.8B
  - State fiscal year 2022: $16.5B
  - State fiscal year 2023: $18.1B
- Long-term care (LTC)
  - State fiscal year 2014: $3.7B
  - State fiscal year 2015: $4.0B
  - State fiscal year 2016: $4.2B
  - State fiscal year 2017: $4.4B
  - State fiscal year 2018: $4.8B
  - State fiscal year 2019: $5.1B
  - State fiscal year 2020: $5.6B
  - State fiscal year 2021: $6.0B
  - State fiscal year 2022: $6.6B
  - State fiscal year 2023: $7.3B
- Families Basic Care
  - State fiscal year 2014: $2.5B
  - State fiscal year 2015: $2.9B
  - State fiscal year 2016: $3.1B
  - State fiscal year 2017: $2.6B
  - State fiscal year 2018: $3.3B
  - State fiscal year 2019: $3.0B
  - State fiscal year 2020: $3.3B
  - State fiscal year 2021: $3.3B
  - State fiscal year 2022: $4.2B
  - State fiscal year 2023: $4.4B
- Aged and Disabled Basic Care¹
  - State fiscal year 2014: $2.2B
  - State fiscal year 2015: $2.0B
  - State fiscal year 2016: $2.2B
  - State fiscal year 2017: $2.2B
  - State fiscal year 2018: $2.5B
  - State fiscal year 2019: $2.4B
  - State fiscal year 2020: $2.6B
  - State fiscal year 2021: $2.5B
  - State fiscal year 2022: $2.9B
  - State fiscal year 2023: $3.2B
- Adults with No Kids Basic Care
  - State fiscal year 2014: $1.1B
  - State fiscal year 2015: $1.7B
  - State fiscal year 2016: $1.7B
  - State fiscal year 2017: $1.8B
  - State fiscal year 2018: $2.0B
  - State fiscal year 2019: $1.8B
  - State fiscal year 2020: $2.1B
  - State fiscal year 2021: $2.2B
  - State fiscal year 2022: $3.3B
  - State fiscal year 2023: $3.7B
- Other²
  - State fiscal year 2014: -$0.1B
  - State fiscal year 2015: $0.0B
  - State fiscal year 2016: $0.1B
  - State fiscal year 2017: -$0.1B
  - State fiscal year 2018: $0.0B
  - State fiscal year 2019: $0.0B
  - State fiscal year 2020: -$0.2B
  - State fiscal year 2021: -$0.3B
  - State fiscal year 2022: -$0.5B
  - State fiscal year 2023: -$0.4B
- Source: Minnesota Department of Human Services, February 2024 Expenditure Forecast. Data source is different than prior slide, which data is based on calendar years.

¹The “Aged and Disabled Basic Care” has had the “Elderly Waiver Managed Care” expenditures removed; instead “Elderly Waiver Managed Care” expenditures are included in the LTC category.

²Other includes categories of service that include pharmacy rebates and adjustments, resulting in some years having negative values.

Page 32 - Actual and Projected Cumulative Changes in Medical Assistance Spending and Enrollment

This line graph shows the actual and projected cumulative changes in Medical Assistance spending enrollment.
2014 is the starting point, both enrollment and spending have no growth.¹
2014: Enrollment=0.0%, Spending=0.0%
2015: Enrollment=25.2%, Spending=14.2%
2016: Enrollment=28.8%, Spending=21.2%
2017: Enrollment=29.2%, Spending=17.5%
2018: Enrollment=31.5%, Spending=35.4%
2019: Enrollment=29.9%, Spending=32.5%
2020: Enrollment=28.2%, Spending=44.3%
2021: Enrollment=41.8%, Spending=48.5%
2022: Enrollment=54.7%, Spending=78.0%
2023: Enrollment=66.4%, Spending=95.8%
2024: Enrollment=60.1%, Spending=105.5%
2025: Enrollment=49.7%, Spending=118.1%
2026: Enrollment=44.5%, Spending=133.2%
2027: Enrollment=45.4%, Spending=141.5%
- Sources: Minnesota Department of Human Services, February 2024 Expenditure Forecast, data for state fiscal years.
- Actual spending for fiscal years 2014 through 2023. Projected spending for 2024 through 2027.
- In 2014, Medical Assistance was expanded to include childless adults, parents and caretakers, and children (aged 19 to 20) with incomes up to 133% of the Federal Poverty Guidelines (FPG), and children (aged 2 to 18) up to 275% of the FPG, in accordance with the Medicaid Expansion in the Affordable Care Act.

¹The Public Health Emergency related to the COVID-19 pandemic began on January 27, 2020 (ASPE: https://aspr.hhs.gov/legal/PHE/Pages/2019-nCoV.aspx) and allowed for continuous enrollment for anyone enrolled on or after March 31, 2020. The continuous enrollment provision ended on March 31, 2023.

Page 33 - Medical Assistance Funding by Source of Funds

This line graph shows Medical Assistance funding by source of funds. Funding sources are federal, state, and county. Under the Affordable Care Act, the Federal Government will cover 100% of the costs of newly eligible enrollees from the Medicaid Expansion for calendar years 2014-2016, and 90% after 2016.^1-3
2014: Federal=52.9%, State=45.4%, County=1.7%
2015: Federal=57.3%, State=41.2%, County=1.5%
2016: Federal=57.7% State=40.4%, County=2.0%
2017: Federal=58.2%, State=40.4%, County=1.5%
2018: Federal=57.4%, State=40.9%, County=1.6%
2019: Federal=56.6%, State=41.9%, County=1.5%
2020: Federal=59.1%, State=39.7%, County=1.3%
2021: Federal=61.5%, State=37.5 %, County=1.1%
2022: Federal=66.2%, State=32.9%, County=0.9%
2023: Federal=64.5%, State=34.5%, County=1.0%
- Sources: Minnesota Department of Human Services, February 2024 Expenditure Forecast, data for state fiscal years. Includes state Chemical Dependency (CD) fund share, state medical education share, state chemical dependency fund, state medical education share, and CHIP enhanced.

²In 2014, under the ACA, eligibility was increased to all childless adults, parents and caretakers, and children (aged 19 to 20) with incomes at or below 133% FPG, and children (aged 2 to 18) with incomes at or below 275% FPG. Under the Affordable Care Act, the Federal Government will cover 100% of the costs of newly eligible enrollees from the Medicaid Expansion for calendar years 2014-2016, and 90% after 2016.

Page 36- Change in MinnesotaCare from Previous Year, Enrollment and Spending^1-3

This line graph shows the annual changes in enrollment, total spending and spending per enrollee, for MinnesotaCare.^1-3
2014: Enrollment=-18.5%, Total Spending=-8.8%, Spending per Enrollee=11.9%
2015: Enrollment=-10.4%, Total Spending=-2.0%, Spending per Enrollee=9.4%
2016: Enrollment=27.1%, Total Spending=-5.8%, Spending per Enrollee=-25.9%
2017: Enrollment=-23.0%, Total Spending=-17.2%, Spending per Enrollee=7.6%
2018: Enrollment=-6.4%, Total Spending=7.4%, Spending per Enrollee=14.8%
2019: Enrollment=-3.1%, Total Spending=2.8%, Spending per Enrollee=6.1%
2020: Enrollment=-3.9%, Total Spending=3.3%, Spending per Enrollee=7.5%
2021: Enrollment=19.7%, Total Spending=18.4%, Spending per Enrollee=-1.1%
2022: Enrollment=13.9%, Total Spending=18.7%, Spending per Enrollee=4.2%
2023: Enrollment=-2.1%, Total Spending=6.3%, Spending per Enrollee=8.5%
- Source: Minnesota Department of Human Services, February 2024 Expenditure Forecast, data for state fiscal years. Lower enrollment in SFY 2020 is a result of lower enrollment for the first three quarters of 2020, making the average monthly enrollment in SFY2020 lower than the average in SFY2019.

¹Enrollment and spending declines after 2010 reflect that some MinnesotaCare enrollees qualified for Medical Assistance (MA) following the March 2011 MA eligibility expansion to include childless adults with incomes at or below 75% of the Federal Poverty Guidelines (FPG).

²In 2014, under the ACA, Medical Assistance (MA) eligibility expanded and as a result some MinnesotaCare enrollees qualified for MA.

Page 37- MinnesotaCare’s Enrollment as a Percent of Population, by County, Calendar Year 2023

This map shows Minnesota’s enrollment in MinnesotaCare as percent of the population for each county by five quintiles, for 2023. The quintiles are 0.0%-1.42%, 1.43%-1.56%, 1.57%-1.70%, 1.71%-1.95%, 1.96% and greater. Minnesota’s MinnesotaCare gross enrollment as a percent of population is 1.8%. The following counties have enrollment in each quintile (by alphabetical order):
0.0%-1.42%=Brown, Carlton, Carver, Dodge, Goodhue, Houston, Le Sueur, McLeod, Nicollet, Nobles, Pipestone, Pope, Rice, Rock, Sherburne, Steele, Swift, Winona
1.43%-1.56%= Blue Earth, Clay, Fillmore, Jackson, Lyon, Murray, Pennington, Polk, Red Lake, Sibley, Stevens, Traverse, Wabasha, Washington, Wilkin, Wright
1.57%-1.70%=Becker, Benton, Chisago, Clearwater, Cottonwood, Douglas, Isanti, Lac qui Parle, Meeker, Morrison, Mower, Olmsted, Otter Tail, Roseau, St. Louis, Stearns, Waseca
1.71%-1.95%=Beltrami, Dakota, Freeborn, Itasca, Kandiyohi, Lake, Lincoln, Marshall, Martin, Mille Lacs, Norman, Pine, Redwood, Renville, Scott, Todd, Watonwan
1.96% and greater=Aitkin, Anoka, Big Stone, Cass, Chippewa, Cook, Crow Wing, Faribault, Grant, Hennepin, Hubbard, Kanabec, Kittson, Koochiching, Lake of the Woods, Mahnomen, Ramsey, Wadena, Yellow Medicine
- Source: Minnesota Department of Human Services, enrollment data for calendar year 2023; County estimates from U.S. Census Bureau, Annual Estimates of the Resident Population for Counties: April 1, 2020 to July 1, 2023; map shapefile from 2022 Mapbox @OpenStreetMap. Enrollment excludes “other” with no known category. Includes all enrollees, even those with dual-coverage (Medicare or private coverage) during the year. Ranges are based on quintiles.

Page 38- Share of MinnesotaCare Enrollees Compared to Share of Minnesota Population, by Region

This bar chart shows the share of enrollees within the MinnesotaCare program, by region, compared to the share of all Minnesotans, by region, for 2023.
Twin Cities Metro=61.1%; State Population 55.1%
Central=12.8%; State Population 14.0%
Southeast=7.2%; State Population 9.1%
Northeast=5.1%; State Population 5.7%
South Central=4.1%; State Population 5.2%
Southwest=3.4%; State Population 3.8%
Northwest=3.3%; State Population 3.6%
West Central=3.0%; State Population 3.5%
For the regional boundaries, see slide 44 at the end of this chartbook.
- Sources: Minnesota Department of Human Services, enrollment data for calendar year 2023; County estimates from U.S. Census Bureau, Annual Estimates of the Resident Population for Counties: April 1, 2021 to July 1, 2023. Enrollment excludes “other” with no known category. Blue bar chart percentages are calculated by taking the MinnesotaCare enrollment in each region by the total MinnesotaCare population. Green bar chart percentages are calculated by taking the Minnesota residents in each region by the total state population.

Page 39 - Proportion of Fee-for-Service MinnesotaCare Enrollment, as of December

This bar graph shows the estimated annual distribution of MinnesotaCare enrollees enrolled in fee-for-service MinnesotaCare. Data are based on a point of time (December) for each calendar year.
- 2019: 2.9%
- 2020: 1.4%
- 2021: 2.1%
- 2022: 1.5%
- 2023: 1.6%
- Source: Minnesota Department of Human Services monthly enrollment files. Data are based on a point of time (December) for each calendar year.

Page 41 - Distribution of MinnesotaCare Enrollment, by Eligibility Category

This line graph shows MinnesotaCare enrollment by Parents and Children compared to Childless Adults.^1-2
20141: Parents and Children=61.4%, Childless Adults=38.6%
2015: Parents and Children=42.9%, Childless Adults=57.1%
2016: Parents and Children=46.7%, Childless Adults=53.3%
2017: Parents and Children=48.9%, Childless Adults=51.1%
2018: Parents and Children=50.4%, Childless Adults=49.6%
2019: Parents and Children=46.7%, Childless Adults=53.3%
2020: Parents and Children=46.3%, Childless Adults=53.7%
2021: Parents and Children=47.5%, Childless Adults=52.5%
2022: Parents and Children=39.6%, Childless Adults=60.4%
2023: Parents and Children=38.2%, Childless Adults=61.8%
- Source: Minnesota Department of Human Services, February 2024 Expenditure Forecast, data for state fiscal years. Adults No Kids and Parents and Children include older adults and Deferred Action for Childhood Arrivals.

¹In 2014, under the ACA, Medical Assistance (MA) eligibility expanded and as a result some MinnesotaCare enrollees qualified for MA.

²The Public Health Emergency related to the COVID-19 pandemic began on January 27, 2020 (ASPE: https://aspr.hhs.gov/legal/PHE/Pages/2019-nCoV.aspx) and allowed for continuous enrollment for anyone enrolled on or after March 31, 2020. The continuous enrollment provision ended on March 31, 2023.

Page 42 - MinnesotaCare Funding by Source

This line graph shows the funding of MinnesotaCare, by source. Funding sources are state appropriations, federal appropriations, and premiums.^1-2
2014: State Appropriations=47.5%, Federal Appropriations=46.6%, Premiums=5.9%
2015: State Appropriations=54.0%, Federal Appropriations=43.0%, Premiums=3.1%
2016: State Appropriations=23.9%, Federal Appropriations=69.8%, Premiums=6.2%
2017: State Appropriations=2.9%, Federal Appropriations=88.0%, Premiums=9.1%
2018: State Appropriations=4.9%, Federal Appropriations=86.5%, Premiums=8.6%
2019: State Appropriations=5.0%, Federal Appropriations=86.9%, Premiums=8.1%
2020: State Appropriations=5.8%, Federal Appropriations=87.4%, Premiums=6.8%
2021: State Appropriations=6.1%, Federal Appropriations=87.7%, Premiums=6.2%
2022: State Appropriations=8.7%, Federal Appropriations=90.4%, Premiums=1.0%
2023: State Appropriations=8.6%, Federal Appropriations=91.3%, Premiums=0.1%
- Source: Minnesota Department of Human Services, February 2024 Expenditure Forecast, data for state fiscal years. Federal Appropriations includes Federal Basic Health Program (BHP) Funding.