This article is a section taken from MA for People Who Are Age 65 or Older or People Who Are Blind or Have a Disability (MA-ABD), a part of the revisions and additions to the Minnesota Health Care Program Eligibility Policy Manual.
Health Care Delivery
Fee for Service
Fee-for-service is a method of payment for health care services used for enrollees, not in a managed care plan. See MHCP Health Care Delivery for more information.
Managed care is a health care delivery system under which enrollees receive most medical services through a health plan or network of providers, which coordinates the services provided.
People who are Aged 65 and Older
Most Medical Assistance (MA) enrollees aged 65 and older must enroll in a managed care plan. Enrollees aged 65 and older have two managed care programs to choose from.
- Minnesota SeniorCare Plus (MSC+) provides medical services through the health plan of the enrollee’s choice, and enrollees must choose a separate plan for Medicare Part D drug coverage.
- Minnesota Senior Health Options (MSHO) is for enrollees who have Medical Assistance and Medicare Parts A and B. MA medical services, Medicare services and drug coverage are all provided through the MSHO health plan.
People who are Blind or Disabled
Enrollees who are certified blind or disabled are exempt from enrolling in a managed care plan. However, enrollees aged 18-64, who are certified blind or disabled, may voluntarily enroll in Special Needs Basic Care (SNBC). Some SNBC health plans coordinate health care coverage with Medicare.
Detailed information on managed care is found in the Prepaid Minnesota Health Care Programs (PMHCP) Manual.
The benefit set for people using an aged, blind or disabled basis of eligibility includes a wide range of healthcare services, from preventive care to hospitalization. Some benefits have limitations on services or level of coverage. This means there may be a limit or maximum dollar amount on specific types of services, like eyeglasses, or on all services in a category, like dental.
Services in a long-term care facility can be covered by MA if the person has a pre-admission screening that indicates the person needs a nursing facility level of care and meets the other requirements to be eligible for MA for Long-Term Care Services.
- The Minnesota Health Care Programs (MHCP) Summary of Coverage, Cost Sharing and Limits (DHS-3860) explains covered services and cost-sharing requirements.
- Minnesota Senior Health Options (MSHO) explains services included in the MSHO managed care plan.
- SNBC covered services explains services included in the SNBC managed care plan.
Code of Federal Regulations, title 42, section 435.1000
Code of Federal Regulations, title 42, section 438.1
Minnesota Statutes, section 256B.035
Minnesota Statutes, section 256B.0625
CREDIT: The content of this post has been copied or adopted from the Minnesota Healthcare Programs Eligibility Policy Manual, originally published by the Minnesota Department of Human Services.
This is also part of a series of posts on Minnesota Healthcare Eligibility Policies.