This article is a section taken from Minnesota Health Care Programs (MHCP), a part of the revisions and additions to the Minnesota Health Care Program Eligibility Policy Manual.

Health Care Delivery

Minnesota Health Care Program (MHCP) enrollees must follow guidelines for receiving medically necessary services.

Managed Care

Most MHCP enrollees receive services from a managed care health plan. The health plan coordinates the services provided. The Minnesota Department of Human Services (DHS) pays a fixed rate in advance for each enrollee.

New enrollees receive information and enrollment forms from the county or tribal servicing agency or MinnesotaCare. People must choose a health plan based on what plans are available in their county of residence.

Detailed information on managed care and managed care exemptions is in the Prepaid Minnesota Health Care Programs (PMHCP) Manual.

Fee for Service

Fee-for-service is a method of payment where the medical provider bills MHCP for specific, individual services. Enrollees must use a medical provider enrolled with MHCP, except in special circumstances. A directory of enrolled providers is available online.

Covered Services

The MHCP Summary of Coverage, Cost Sharing, and Limits (DHS-3860) explains covered services and cost-sharing requirements.

Out of State Services

Enrollees who are temporarily absent from the state may receive MHCP services in a medical emergency. For managed care, enrollees should contact the managed care health plan for these services.

A person who is temporarily living out of the country usually cannot receive MHCP services.

Membership Card

Each enrollee has a Person Master Index Number (PMI). The PMI is a unique number that verifies MHCP eligibility when obtaining health care services. MHCP enrollees receive an MHCP member card from the Minnesota Department of Human Services. People enrolled in a managed care plan receive a managed care organization membership card in addition to the MHCP member card.

Legal Citations

Minnesota Statutes, section 256B

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.