Health Care & Insurance

Medical Assistance (MA) is Minnesota's Medicaid insurance program for people with very low income (for individuals, under $1,699 per month as of 2024).  Some working people with disabilities who earn a higher income are also eligible to use Medicaid through MA-EPD.

To Enroll:  visit the MNSure website.  For assistance, contact a MNSure Assister.

Medical Assistance recipients have a choice between several health plans administered by various Managed Care Organizations (MCOs).  While they all cover the same essential services, each plan may have different networks of providers and special perks.  Most MA recipients are on one of the following Prepaid Medical Assistance Plans (PMAP):

• Hennepin Health (612-596-1036, provider directory)

• Health Partners (952-967-7998, provider directory)

• Medica ChoiceCare (1-800-373-8335, provider directory)

• UCare  (612-676-3200, provider directory-for Plan select "Prepaid Medical Assistance PMAP")

• Blue Advantage (1-800-711-9862, provider directory)

• South County Health Alliance (1-866-567-7242, provider directory)

• PrimeWest Health (1-866-431-0801, provider directory)

• Occasionally, some people may receive Medical Assistance benefits without being assigned to a specific insurance company.  This is known as "Straight MA" (651-431-2670).

If you are unsure of your insurance information, have a provider look up your case in the MN-ITS database or call the MHCP Provider Call Center (651-431-2700; option 7).   

Medical Assistance plans need to be renewed annually.  You will receive a notice by mail but can also look up your renewal month here.

Medical Assistance Waivers provide funding for services that help people with disabilities or age 65+ live in community settings rather than in an institution.  Waiver services may be provided in people's homes, or in places like Group Homes, Assisted Living or Adult Foster Care.

TYPES OF WAIVERS

There are four disability-based Waivers:

• The Community Alternative Care (CAC) Waiver serves people with disabilities who need a hospital level-of-care.

• The Community Access for Disability Inclusion (CADI) Waiver serves people with disabilities who need a nursing facility level-of-care.

• The Developmental Disabilities (DD) Waiver serves people with developmental disabilities or related conditions who needs the level-of-care provided at an Intermediate care facility for persons with developmental disabilities (ICF/DD).

• The Brain Injury (BI) Waiver provides services to people with a brain injury who need neurobehavioral hospital or nursing facility level-of-care.

Additionally, there is one age-based Waiver:

• The Elderly Waiver serves people age 65 and older who need the a nursing home level-of-care.

Finally, the Alternative Care Program is similar to the Elderly Waiver, but open to low income people who don't qualify for Medical Assistance.

HOW TO APPLY

"It couldn't get any simpler..."  🙄🤨😝

STEP 1 - Referral:  Request a MnCHOICES Assessment by contacting your county or tribal human services office - if you have a Case Manager ask for their help.  A scheduler will reach out to plan a date for an in-person interview.

• In Hennepin County, referrals can be submitted online or by phone.  By phone, call Front Door (612-348-4111); choose option 1 (English), then option 0 (Speak to Representative) and a brief pre-screening will be conducted to verify eligibility.  1+ month wait for assessments

• For seniors, a Long-Term Care Consultation (LTCC) may be recommended to evaluate what medical care may be necessary. 

STEP 2 - Assessment:  At your MnCHOICES interview, an Assessor will discuss your needs for services.  They will request that your Case Manager and other members of your support team be present.

If you are under 65 and not already on SSI or SSDI you will need to be certified disabled by the State Medical Review Team (SMRT) before receiving a Waiver.  Your MNChoice Assessor or Long-Term Care Consultant will help you with this step.   4+ month wait for SMRT determinations

STEP 3 - Approval:  Following your interview (and, if necessary, SMRT determination), you will be notified whether you are approved for a Medical Assistance Waiver.  You will receive a summary of your assessed needs and options for services and supports.  

Once approved, you have 60 days to "activate" the Waiver by initiating Waiver-funded services.  After 60 days the Waiver authorization will expire.

STEP 4 - Enroll With a Provider:  The next step is to enroll for services with a Waiver service provider of your choice.  If you have a Case Manager or Care Coordinator, they can help you with this.

If requesting Skilled Nursing (an "Essential Service") have your MNChoice Assessor make the referral.

If requesting Community First Services and Supports (CFSS) - formerly called PCA services, and also considered an "Essential Service" - you will need to contact a CFSS Consultation Provider.  That provider will then refer you to a CFSS service provider.   1+ month wait for CFSS Consultations in Hennepin currently; ask your MNChoice Assessor to be put on a "priority waiting list" if eligible

STEP 5 - Reconciliation: Next, the Waiver service provider is responsible for reaching out to your MNChoice Assessor and initiating the "Reconciliation" process in which service hours and rates are negotiated with the county or your MCO.   Reconciliation process may take ~1 week

STEP 6 - Activation:  Following "Reconciliation," a start-date for services will be determined.  Your Waiver will be "activated" on that start date.  If moving to a Waiver-dependent residential setting, this will be the day you move in.

STEP 7 - Waiver Case Management:  Once activated, a Waiver Case Manager (not your behavioral health Case Manager) will be assigned to help you manage your Waiver benefits moving forward.  You may have to wait to set up some services until your Waiver Case Manager is assigned.   In Hennepin County, currently "several weeks" until a Waiver Case Manager is assigned; notification is by mail.

STEP 8 - Rejoice

If ineligible for a Waiver:

If you are 65+, not eligible for MA, not eligible for nursing home level-of-care, live independently and need services beyond those of a PCA, you may be eligible for Essential Community Supports (ECS) which pays for services similar those available through a Waiver.

If you use Housing Support, you may be eligible for a Housing Support Supplemental Rate to pay for services similar to those available through a Waiver.

MinnesotaCare extends most Medical Assistance benefits to low income individuals who make too much to be eligible for Medical Assistance (for individuals, between $20,029 and $29,160 as of 2024).  MinnesotaCare members pay a monthly premium.  

To enroll, visit the MNSure website.  For assistance, contact a MNSure Assister.

The MNSure Marketplace is where Minnesotans can purchase private insurance plans which are eligible for tax credits to offset the cost of premiums.  Individuals making over $29,160 annually (as of 2024) may be eligible for these tax subsidies.   Enroll through the MNSure website.  For assistance, contact a MNSure Broker.

Adults 65 and over - and some younger people with disabilities - qualify for federal Medicare insurance.

Enrollment:  Medicare eligibility and enrollment and handled by the Social Security Administration.  Enrollment is often automatic at age 65 if the person is receiving Social Security benefits.

Medicare is divided into four parts:

• Part A: Covers hospital insurance, including inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.

• Part B: Covers medical insurance, including outpatient care, doctor's visits, preventive services, and some home health care.

• Part C (Medicare Advantage): Offers an alternative way to receive Medicare benefits through private insurance companies that provide all Part A and Part B services, often with additional benefits like prescription drug coverage, dental, and vision.

• Part D: Provides prescription drug coverage, also through private insurers.

Many Medicare beneficiaries purchase supplemental insurance, or enroll in Medicare Advantage plans, to cover costs that Medicare Part A, B and D do not.

Medicare & Medical Assistance Dual Eligibility:   In Minnesota, when someone has both Medicare and Medical Assistance (MA), they are considered "dual eligible."  In this scenario Medicare is considered the "primary payer," paying first for covered services and Medical Assistance is the "secondary payer,"  covering costs and services that Medicare does not.  Some "dual eligible" people use health care plans that combine Medicare and MA benefits into a single plan, like Minnesota Senior Health Options (MSHO) and Special Needs BasicCare (SNBC).

Primary Care Physicians help you stay healthy, treat injuries, diagnose illnesses and prescribe medication (including mental health meds).  Yearly check-ups are recommended.

Online directories like ZocDoc or HealthGrades can help you find a highly-rated doctor.

Or you can search your insurance providers network:

• Medical Assistance ie: "Straight MA" (1-800-657-3739)

• Hennepin Health (612-596-1036, provider directory)

• Health Partners (952-967-7998, provider directory)

• Medica ChoiceCare (1-800-373-8335, provider directory)

• UCare (612-676-3200, provider directory-for Plan select "Prepaid Medical Assistance PMAP")

• Blue Advantage (1-800-711-9862, provider directory)

• South County Health Alliance (1-866-567-7242, provider directory)

• PrimeWest Health (1-866-431-0801, provider directory)

Your Primary Doctor will sometimes make referrals to Psychiatric Providers or other Medical Specialists (see below).

Very few dentists accept Medical Assistance plans.  Many are not currently accepting new patients.  Lately, many have had luck with Clear Lake Dental (make sure to reply to text appointment confirmations or they will cancel!).

You can find an eye doctor (optometrist) in your insurance companies network (below), or you can go to a nearby walk-in clinic like Pearl Vision.

You can also contact your insurance provider and ask for dentists/eye doctors taking new patients:

• Medical Assistance ie: "Straight MA" (1-800-657-3739)

• Hennepin Health (612-596-1036, provider directory)

• Health Partners (952-967-7998, provider directory)

• Medica ChoiceCare (1-800-373-8335, provider directory)

• UCare (612-676-3200, provider directory-for Plan select "Prepaid Medical Assistance PMAP")

• Blue Advantage (1-800-711-9862, provider directory)

• South County Health Alliance (1-866-567-7242, provider directory)

• PrimeWest Health (1-866-431-0801, provider directory)

Your doctor may refer you to a medical specialist to treat specific conditions.  For instance...

Psychiatrists and Advanced Practice Registered Nurses (APRN) specialize in mental health and prescribe psychiatric meds

Ophthalmologists are eye doctors

Neurologists treat disorders of the central nervous system

Dermatologists treat skin, hair and nail problems

Orthopedists treat the musculoskeletal system

OB/GYNs focus on women's reproductive health

For a more comprehensive guide to medical specialists, click here.

Usually your Primary Care Physician will give you a referral to a specialist.  Often they will recommend a clinic that is part of the same medical network as their own, which makes it easier for them to coordinate care.  

If you want to seek out a provider on your own, websites like ZocDoc or HealthGrades can help.  Or you can reach out directly to your insurance provider to see who they cover (call the number on the back of your insurance card).

For details on Minneapolis & Saint Paul community clinics, see Section 3 of Handbook of the Streets.

If you have questions about your medications, ask a pharmacist!  They are knowledgeable and offer free consultation.

You may wish to consider using an online, mail order pharmacy for convenience.  PillPack is helpful because they can pack your meds together by dose time.   Express Scripts is another well-regarded mail-order option.

Most clinics have "patient portal" websites (MyChart, etc) for accessing medical records and communicating with providers.   Call your clinic for help setting up a patient account. 

Frequently used patient portals in MN:

• MHealth Fairview

• Health Partners

• Allina Health

• HCMC

• Essentia Health

• Mayo

Some people may be assigned a Care Coordinator by the Managed Care Organization (MCO) that administers their health insurance plan.  Their job is to help patients with more complex needs navigate the health care system.  They may conduct assessments of needs, help with health care planning, help coordinate services, advocate for patients, monitor progress and provide education and support to patients and their families.  They may provide similar services as case managers, but are usually more limited in their role.