Minnesota Health Care Programs is an umbrella term for a variety of public health care programs for residents who are disabled, or who have incomes below certain levels. These include:
Read more about Minnesota Health Care Programs at the DHS website here:
Medical Assistance is the term for the federal program called Medicaid in Minnesota. Medical Assistance pays for medical care for very low-income Minnesotans. There are eligibility requirements for the program. Federal and state dollars pay for MA. (This program is different from Medicare, which is a federal health insurance program for people over 65 and for certain people with disabilities.) In 2011 Medical Assistance expanded its coverage to provide coverage to more low income adults.
What MA Covers
MA covers most of the services that we provide at Accend, although some may require prior-authorization and others may depend on where we have local contracts to provide specific services. Refer to the coverage chart below to understand what services are covered by MA in what service areas.
MinnesotaCare is a health care program for uninsured working Minnesotans. MinnesotaCare does not pay for past medical bills. MinnesotaCare is for Minnesota residents who meet income and other eligibility guidelines. MinnesotaCare is paid for with state and federal tax dollars, provider taxes and premiums paid by people who are enrolled.
It takes 30-45 days to process a MinnesotaCare application. Enrollees pay a monthly premium based on family size, income and the number of people in their family who are covered. Children under age 21 who meet a lower income guideline pay a fixed premium of $4 a month.
Coverage starts the first of the month after payment is received. Continued coverage depends on timely payment of premiums. MinnesotaCare enrollees must complete a renewal application every year.
What MinnesotaCare Covers
MinnesotaCare pays for all of the same services covered under Medical Assistance. Managed Care Organizations may have specific requirements for prior-authorization for some services.
In Minnesota all people who have MinnesotaCare, many who have Medical Assistance, and some who have Medicare receive their health care coverage through Managed Care Organizations, or MCOs. These MCOs are private, non-profit insurance companies who have contracted with the state Department of Human Services to manage the care for certain individuals with public health care coverage.
Everyone who has MinnesotaCare and many people who have Medical Assistance (MA) must enroll in a health plan. Persons eligible for Managed Care Programs may select which MCO they want, from among those available in the region of the state where they live.
What MHCP Managed Care Covers
Managed Care for Medical Assistance/Minnesota Care pays for all of the same services covered under Medical Assistance. Managed Care Organizations may have specific requirements for prior-authorization for some services
Read FAQs about Managed Care programs on the DHS website here:
Medicare is the federally-administered program that provides insurance coverage to persons who are elderly or disabled.
Medicare covers only a limited set of the services we provide at Accend. This includes only Diagnostic Assessment and Psychotherapy, and it pays only for services provided by a Licensed Psychotherapist. Clinical Trainees may not provide either DAs or Psychotherapy for persons who have only Medicare.
Some people who recieve Medicare may also enroll in Medical Assistance.
The link below provides a good general overview of Medicare.
Medicare Savings Programs (MSP) help people who have low income pay the cost of their Medicare coverage. There are four different programs with specific rules for qualifying. Details about each program can be found at this link:
We accept private insurance for the services we provide. However, private insurance is very limited. In almost all cases, private insurance pays only for Diagnostic Assessments and Psychotherapy. Services like Case Management, ARMHS, and CTSS are not covered.
When people have private insurance, they also almost always have co-pays and deductibles. They must pay these copays and deductibles, or apply for Sliding Fee Scale Services. These are described below.
Rarely, but occassionally, people ask to pay privately for services, or an organzation (like a County) asks us to provide a service to an individual and pays for it. When we get these requests, we follow all of the same rules for the service we provide, and we charge the same rate as we do to insurance providers.
Your Obligation
Navigating the public health care system and maintaining health insurance is a daunting task for anyone, and presents exceptional difficulty for many of the people we serve. Your obligation is to provide help to individuals who need it. TabsTM provides you with the information you need. What follows is guidance for meeting this obligation.
Insurance Alerts
Insurance alerts for individuals assigned to you appear on your home page as displayed below, or in a link with a customizable search for for certain users.
You will notices that there are three different colors in the alerts.
Overwhelmed By Your List?
What you're seeing as of early November 2019 is a list of all clients assigned to you. By the end of this month, expect the list to shrink down to just those indivdiuals for whom you are assigned as Primary or Secondary for a service.
While that will make it easier to use this tool, don't fail to peruse the list for the names you recognize right now, and inquire with the folks you serve about whether or not they have received and need help with the redetermination paperwork.
- RED means that the individual no longer has active insurance for the listed service.
- ORANGE means that the individual's redetermination date is approaching within one month and they should have already received a Renewal Notice in the mail. They will lose insurance for the covered service on the date shown if they do not complete the paperwork and all other requirements within 45 days of receiving the Renewal Notice. When a alert has turned orange, the individual has probably already received the Renewal Notice up to one month ago.
- YELLOW means that the individual's redetermination date is approaching within two months and they will be receiving (most likely have already received) a Renewal Notice in the mail. They will lose insurance for the covered service on the date shown if they do not complete the paperwork and all other requirements within 45 days of receiving the Renewal Notice.
Why Do People Lose Insurance?
People we serve lose insurance for many reasons. Some of the most common are:
- They have moved or become homeless and do not receive the renewal notice in the mail because it is sent to a previous address.
- They receive a Renewal Notice that requires a response (Need to Renew), but fail to complete it accurately or completely, or return it in time.
- They are required to provide additional proofs of eligibility, but fail to do so.
- They have a change in income and no longer qualify for the program they were previously insured under, and fail to apply for an alternative in time.
- They fail to pay premiums (MinnesotaCare) or spenddowns (Medical Assistance).
Renewal Notices
About six weeks before mailing renewal forms, DHS will mail a letter explaining how to get ready and to watch for the renewal notice in the mail. Individuals with MA can expect to get renewal forms about two months before the month they originally applied for health insurance. For example, if they applied in July, your MA renewal forms will be mailed to them in May. Do not worry if you don’t remember when you applied. DHS will mail renewal forms when it is time to renew.
Individuals with MinnesotaCare can expect to get renewal forms in October.
The renewal form has been modified in April 2023:
Services When Insurance Lapses
We do not, as a rule, suspend services when insurance lapses. However, you must contact your supervisor for guidance when insurance lapses for anyone you serve.
Case Managers must immediately respond to insurance lapses by investigating the problem and offering help to individuals to remedy it. Avoid this problem with proactivity, using the steps above.
What You Will Learn
Advocate from an informed on behalf of the people you serve for waiver and home health care services
Seek permssion from your supervisor to pursue advocacy on behalf of a person you serve for additional health care services
What are Waiver Services?
Waiver services are developed through special agreements by the state with the Center for Medicare and Medicaid Services that allow states to design services and programs that provide home- and community-based services as alternatives to hospital or facility placement. Minnesota has several Waiver Services programs, supporting adults and chilren with developmental disabilities, brain injuries, physical and cognitive disabilities, and the elderly.
For more information about Waiver Services, follow the link to Waiver Services in the Health Care Programs and Insurance section of this guides.
Service of Last Resort
Finally, Waiver services is considered a service of last resort. This means that all other support options have been tried, and have not been successful. This includes natural supports such as family members, other paid services such as PCA or Home Health Aides, and skill development services such as ARMHS.
You can also read about all of the Waiver programs available in Minnesota in the
Minnesota CBSM Manual: Waiver Programs Overview.
Minnesota Health Care Programs also offer a variety of Home Care Services. You can read about them at this link: Minnesota CBSM Manual: Home Care Services. What follows is an explanation in more detail of PCA (Personal Care Attendant services), as this is an often sought service and, like the CADI waiver, also has very specific eligibility requirements.
PCA Services
Eligibillity for PCA services requires dependency in at least two activities of daily living. Folllow the links below for more inforamtion about PCA services.
Try Everything Else First
Having identified needs, perhaps during a Functional or Health and Wellness Assessment, first look at whether or not current services can meet needs. When the need is related to a skill deficit, can the individual learn the skills he or she lacks? What supports and resources does he or she have right now that could be tapped to meet the need? Is the environment in which the individual lives the best, most optimal to accomodate for a lack of skills or abilities? Can ARMHS help the individual to learn skills or use existing resources more effectively?
These and other questions are the first you must ask, and the options you must try. Put forth your best efforts to help individuals learn and use skills, and use existing resources and supports. Having documented these efforts with diligent data collection, progress reporting, review and re-assessment, then and only then might it be time to request additional services.
Be Informed and Prepared
Being informed and prepared to request services for the people you serve is essential. Review this guide, seek assistance from your Team or Clinical Lead, or the Program Director if you have questions. Understand eligibility requirements, and work with the people you serve to make sure they are also prepared to participate in screening for services, and teach them self-advocacy skills.
Do not promise services to the people you serve. Promise to investigate resources and options, and to support and advocate for them to get the services they need.
Identify Needs Rather Than Request Specific Services
If you have read this guide and believe someone with whom you work needs the services described in this guide, understand that requesting specific services is putting the cart before the horse. Requesting a screening, and preparing with the people you serve to identify their needs during the screening is the starting point.
Request a Screening
MnChoices Assessment
MnChoices Assessment is a person-centered assessment to help people with long-term or chronic-care needs make care decisions and select support and service options. If you have determined that someone you serve needs additional MHCP supports, this is the screening you will request. Follow this link to learn more about: MnChoices Assessment.
Understand Appeals
The right to appeal a decision about eligbility and health care services is fundamental. Anyone who has been screened for MHCP services and who disagrees with the decision - whether it is about eligibility or the units/hours of services authorized - has a right to appeal this decision/finding.
Follow this link to read about: appeals regarding MHCP services.
This guide is a living document. We want to improve it with your help. Do you have questions? Found a typo? Find yourself wanting more information? Please send us your thoughts about anything in this chapter by tapping on the link below.
April 18, 2023
Additional information on renewal notices added and link to the revised renewal form that will be mailed to particants added.
Link to Sliding Fee Scale removed as we no longer offer this.
November 14, 2023
Advocacy Guidance for Waiver Programs, Home Care Services, Home- and Community-Based Health Care Services moved here from general Effective Advocacy guide.
