Minnesota Managed Care Plans
Explains what managed care is under Minnesota Health Care Programs, the types of plans available, and how to help callers compare options.
Article 1: Understanding Minnesota Managed Care Plans
Purpose:
Help Hub staff explain what managed care is, who it applies to, and what types of plans exist under Minnesota Health Care Programs (MHCP).
Q&A:
Q: What does “managed care” mean for Medical Assistance (MA)?
A: Managed care means your MA coverage is through a health plan instead of directly through the state. The plan coordinates your care, pays your doctors, and offers member services.
Q: What are the different types of managed care plans in Minnesota?
A:
- PMAP (Prepaid Medical Assistance Program): For families, children, and adults without a disability.
- SNBC (Special Needs BasicCare): For adults 18–64 with a certified disability.
- I-SNBC (Integrated SNBC): For adults 18–64 with a disability and Medicare.
- MSC+ (Minnesota Senior Care Plus): For adults 65+ with or without Medicare.
- MSHO (Minnesota Senior Health Options): For adults 65+ with Medicare.
- PMCRE (Prepaid MinnesotaCare): For people enrolled in MinnesotaCare.
- Fee-for-Service (FFS): For people excluded from managed care or who opt out.
Q: How do people know which plan they qualify for?
A: It depends on age, disability status, and whether they have Medicare. DHS assigns the appropriate plan based on eligibility and county of residence.
Internal Notes:
- Managed care enrollment rules differ by program.
- Fee-for-Service is not managed care but may be chosen or automatic for some.
- Use DHS’s MHCP Managed Care Manual for details.
Article 2: PMAP – Prepaid Medical Assistance Program
Purpose:
Help staff explain who PMAP is for, how enrollment works, and who can help.
Q&A:
Q: Who can get PMAP?
A: MA-eligible adults, pregnant people, families, and children (program codes MA-CK, MA-AA, MA-AX, MA-PX, MA-FC).
Q: Do I have to be in PMAP?
A: Yes, PMAP is mandatory unless you qualify for an exclusion.
Q: How do I sign up for PMAP?
A: Enrollment happens through DHS — people can return the form by mail, apply in person at their county or tribal office, or call a Managed Care Advocate for help.
Q: Who helps with PMAP questions?
A: Managed Care Advocates can help with enrollment or issues. Each county has its own contact.
Internal Notes:
- MA-AA and MA-AX members with a disability certification can opt out of PMAP or enroll in SNBC (Choice Form required).
- PMAP plan availability by county: PMAP Map (DHS).
Tags: MHCP, PMAP, Families, Children, Managed Care, Enrollment
Article 3: SNBC – Special Needs BasicCare
Purpose:
Help staff explain SNBC eligibility, enrollment, and who can help compare options.
Q&A:
Q: What is SNBC?
A: SNBC is a voluntary managed care program for adults (18–64) with a certified disability.
Q: Do I have to join SNBC?
A: No, enrollment is voluntary — you can stay on Fee-for-Service or join SNBC.
Q: How do I sign up?
A:
- Complete the online Choice Form, or
- Contact your health plan’s Member Services, or
- Mail the paper form.
Internal Notes:
- SNBC plan map: SNBC Map (DHS).
- People with a spenddown are not eligible, unless it begins after enrollment and is paid monthly.
Tags: MHCP, SNBC, Disability, Managed Care, Options Counseling
Article 4: I-SNBC – Integrated Special Needs BasicCare
Purpose:
Help staff explain I-SNBC eligibility and how it differs from SNBC.
Q&A:
Q: What’s the difference between SNBC and I-SNBC?
A: I-SNBC is for adults (18–64) who have both a certified disability and Medicare Parts A & B. It integrates Medicare and MA services into one plan.
Q: Is I-SNBC required?
A: No, it’s voluntary.
Q: How do I enroll in I-SNBC?
A: Contact your health plan’s Member Services or get help from the Disability Hub MN for Options Counseling.
Internal Notes:
- Uses same plan map as SNBC: SNBC Map (DHS).
- Not eligible with a spenddown unless it begins after enrollment and is paid monthly.
Tags: MHCP, I-SNBC, Disability, Medicare, Integrated Plan, Managed Care
Article 5: MSC+ – Minnesota Senior Care Plus
Purpose:
Help staff explain MSC+ eligibility, enrollment, and coverage for people 65+.
Q&A:
Q: Who can get MSC+?
A: Adults age 65 or older, with or without Medicare.
Q: Is MSC+ required?
A: Yes, it’s mandatory unless an exclusion applies.
Q: How do I enroll?
A: Enrollment happens automatically through DHS; people can also return the form by mail or in person at their county or tribal office.
Q: What services are included?
A: All MA services, plus Elderly Waiver (EW) services.
Q: Who can help with questions about Medicare?
A: The Senior LinkAge Line provides free Medicare counseling.
Internal Notes:
- MSC+ plan map: MSC+ Map (DHS).
- Not available to people with a spenddown unless it begins after enrollment and is paid monthly.
Tags: MHCP, MSC+, Seniors, Medicare, EW, Managed Care
Article 6: MSHO – Minnesota Senior Health Options
Purpose:
Help staff explain MSHO eligibility and enrollment for seniors with Medicare.
Q&A:
Q: What is MSHO?
A: MSHO is a voluntary managed care plan for people age 65+ who have Medicare Parts A and B. It combines Medicare and MA services under one health plan.
Q: How do I join MSHO?
A: Contact your health plan’s Member Services or call the Senior LinkAge Line for help comparing plans.
Q: What does MSHO cover?
A: All MA and Medicare services, including Elderly Waiver (EW) services.
Internal Notes:
- MSHO plan map: MSHO Map (DHS).
- Not available to people with a spenddown unless it begins after enrollment and is paid monthly.
Tags: MHCP, MSHO, Seniors, Medicare, EW, Managed Care
Article 7: PMCRE – Prepaid MinnesotaCare
Purpose:
Help staff explain managed care for MinnesotaCare enrollees.
Q&A:
Q: What is PMCRE?
A: PMCRE stands for Prepaid MinnesotaCare. It’s a managed care program for MinnesotaCare-eligible adults, families, and children.
Q: Is PMCRE required?
A: Yes, enrollment in a health plan is mandatory for MinnesotaCare.
Q: How do people enroll or pick a plan?
A: During their MNsure application or renewal. Plan selection happens in the MNsure process.
Q: Who can help with MinnesotaCare questions?
A: Call DHS Health Care Consumer Support at 1-800-657-3672, or visit MNsure.
Internal Notes:
- PMCRE is not Medical Assistance—it’s for MinnesotaCare only.
- Enrollment and plan selection are handled entirely through MNsure.
Tags: MinnesotaCare, PMCRE, Managed Care, MNsure, Enrollment
Article 8: Fee-for-Service (FFS) Medical Assistance
Purpose:
Help staff explain when people are in Fee-for-Service instead of managed care.
Q&A:
Q: What does Fee-for-Service mean?
A: It means you don’t have a managed care plan. DHS pays your doctors directly for each covered service.
Q: Who is in Fee-for-Service?
A:
- People excluded from managed care (for example, living in certain facilities).
- People under 65 with a disability certification who choose to opt out of managed care.
Q: How do I opt out of managed care?
A: People under 65 with a certified disability can request this through their county or tribal worker.
Q: Who can I contact if I have questions about my FFS coverage?
A:
- For general FFS questions: DHS Health Care Consumer Support at 1-800-657-3672.
- For case-specific help: your County or Tribal Human Services Office.
Internal Notes:
- Automatically applies to people excluded from managed care.
- MHCP County & Tribal Directory lists local contacts.
Tags: MHCP, FFS, Fee-for-Service, Managed Care Exclusion
Article 9: Managed Care Help and Resources
Purpose:
Provide Hub staff with resources for helping callers resolve managed care issues or find assistance.
Q&A:
Q: Who can help with managed care enrollment or plan issues?
A: Managed Care Advocates through local lead agencies. Their roles vary by county.
Q: What if the contact I have is outdated?
A: Ask to be connected to someone at the lead agency who handles managed care enrollment.
Q: What other resources can I share with callers?
A:
Internal Notes:
- Managed Care Advocate contact lists are maintained by counties, not DHS.
- Refer complex issues (appeals, plan changes) to the Ombudsman or Senior LinkAge Line.
Tags: MHCP, Managed Care, Resources, Advocacy, Ombudsman, Appeals
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