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Medical Assistance

Page posted: 10/01/03

Page reviewed: 6/2/10

Page updated:

Definition

Medical Assistance: Minnesota’s name for the federal Medicaid program that provides medical care for low-income persons.

Health Care Program Descriptions

MA is one of the Minnesota Health Care Programs (MHCP). Within federal rules, each state decides the types of health care services the MA program will cover. State and federal dollars jointly fund MA. Counties administer MA.

There are several different ways a person could access health care coverage through MA.

Eligibility for MA

The local county human services agency determines MA eligibility. MA eligibility is dependent upon a number of factors.

Basis of eligibility

Each applicant must meet a basis of eligibility for MA. The basis of eligibility is a federally established set of characteristics such as age, income, disability or family status. Minnesota MA provides health care coverage for the following eligible groups:

  • • Children under age 21
  • • Parents or relative caretakers of dependent children
  • • People age 65 or older
  • • People who have a certified disability
  • • Pregnant women
  • Disability determination

    A person must meet the disability definition from the Social Security Administration (SSA) to be eligible for MA as a disabled person. A person may also be certified disabled by the SSA or State Medical Review Team (SMRT). See disability determinations for more information.

    Deeming

    To deem means to count the income or assets of one person when determining the eligibility of another. For example, a:

  • • Parent when determining the eligibility for a child
  • • Spouse when determining eligibility for a spouse
  • If a person has a waiver of deeming, family income and assets are not included when eligibility is determined for the person. The income and assets of the applicant determine eligibility and not the income and assets of the household. For example, in TEFRA cases, the child's income determines eligibility, not the parents.

    Other health care coverage

    People may have other health care coverage in addition to Medical Assistance.

    However, MA is generally the payer of last resort. Therefore, vendors must bill the other health care provider prior to billing MA.

    MA Eligibility Renewal

    The local county human services agency must renew MA eligibility on an annual basis.

    Covered Services

    Certain prevailing community standards or customary practices are required in order for Medical Assistance to cover a health service. See Covered Service Requirements for Medical Assistance for more information.

    See page 2 of Minnesota Health Care Programs DHS-3860 (PDF) for an overview of MA covered services.

    Authorization of MA Services

    Certain MA covered services require authorization. Authorization requirement safeguards against inappropriate and unnecessary use of health care services.

    Providers should obtain authorization prior to providing a service, or in some circumstances, after the provision of service. Receiving approval for an authorization request does not guarantee payment. Providers must follow MA billing policy guidelines and the MA recipient must be eligible when receiving services.

    List of MHCP Enrolled Providers

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    Updated: 9/29/11 12:46 PM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 9/29/11 12:46 PM