Medical Assistance (MA) enrollees who are elderly receive coverage for the standard MA covered services available to all other MA eligibility groups. MA benefits include federally mandated services and services provided at state option. In addition to covering standard medical services such as physician, inpatient hospital, dental, and therapy services, MA also covers many services used heavily by elderly persons. These include the following:
- Nursing facility services
- Home health care
- Personal care assistant services
- Home care nursing
- Prescription drugs
Medicare serves as the primary payor and MA as the secondary payor, for elderly (and disabled) MA enrollees who are also enrolled in Medicare. As secondary payor, MA pays only for those services not covered by Medicare and also for any Medicare cost-sharing oblige
Service Delivery Through Managed Care
MA enrollees who are elderly are required to receive health care services from prepaid health plans through Minnesota Senior Care Plus and have the option of receiving services through Minnesota Senior Health Options (MSHO).
Minnesota Senior Care Plus has provided services to elderly enrollees enrolled in county-based purchasing initiatives since June 1, 2005. Minnesota Senior Care Plus covers all MA state plan services, elderly waiver (EW) services, and 180 days of nursing home services for enrollees not residing in a nursing facility at the time of enrollment.
Elderly enrollees in Minnesota Senior Care Plus must enroll in a separate Medicare plan to obtain their prescription drug coverage under Medicare Part D. However, elderly enrollees also have the option of receiving managed care services through the MSHO, rather than Minnesota Senior Care Plus. MSHO includes all Medicare and MA prescription drug coverage under one plan. Since 1997, MSHO provided a combined Medicare and MA benefit as part of a federal demonstration project; the program now operates under federal Medicare Special Needs Plan (SNP) authority.1 DHS also contracts with SNPs to provide MA services. Enrollment in MSHO is voluntary. As is the case with Minnesota Senior Care Plus, MSHO also covers EW services and 180 days of nursing home services. Most elderly MA enrollees are enrolled in MSHO rather than Minnesota Senior Care Plus because of the integrated Medicare and MA prescription drug coverage. For state fiscal year 2016, average managed care enrollment of elderly enrollees was 49,200 and average monthly enrollment in EW fee-for-service was 2,403.
- A Medicare Special Needs Plan is a Medicare managed care plan that is allowed to serve only certain Medicare populations, such as institutionalized enrollees, dually eligible enrollees, and enrollees who are severely chronically ill and disabled. SNPs must provide all Medicare services, including prescription drug coverage.
The content of this and any related posts has been copied or adopted from the Minnesota House of Representatives Research Department’s Information Brief, Long-Term Care Services for the Elderly, written by legislative analyst Danyell Punelli.