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Minnesota Department of Human Services Community-Based Services Manual (CBSM)
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Minnesota Medical Assistance Managed Care Programs

Page posted: 4/18/14

Page reviewed:

Page updated:

Legal Authority

Title XIX of the Social Security Act; Medicaid State Plan Options of the Social Security Act: SSA §1915, SSA §1915(b), SSA §1915(c) and SSA chapter 1115; 42 CFR parts 434 and 42 CFR parts 438, Minn.Stat chapter 256L, Minn. Stat. §256B.69 subd.23 and 28 and Minn.Stat. §256B.692

Definition

Managed care: Term used to describe a health care delivery system that coordinates a wide range of health services and support systems into one health care package. Enrollment may either be on a voluntary or mandatory basis.

Programs

DHS contracts with managed care organizations (MCOs) to provide health care to eligible people and provides programs to specific populations and specific Minnesota counties.

Through these contracts, DHS pays the MCO a monthly fee to provide services covered by these contracts.

Minnesota offers three main managed health care programs under Medical Assistance for special populations:

Minnesota Senior Care Plus (MSC+): A mandatory prepaid Medical Assistance program for people age 65 years and older. (Page is under construction).

Minnesota Senior Health Options (MSHO): A voluntary Minnesota health care program (MHCP) for people age 65 years and older who are enrolled in Medical Assistance (MA) and Medicare Parts A and B.

Special Needs BasicCare (SNBC): A voluntary managed care program for people with a certified disability, ages 18 through 64, who are enrolled in Medical Assistance (MA).Please note: Certain Home and community-based services remain covered by DHS fee-for-service and are not covered by the managed care organization.

Assistance to managed care enrollees

Health plan member services phone numbers
Managed Care County Contacts DHS-6666A (PDF)
Office of the Ombudsman for State Managed Health Care Programs

Model Contracts

Managed care model contracts:

  • • MSHO/MSC+ Model Contract (PDF)
  • • SNBC Model Contract (PDF)
  • Additional Resources

    Lead agencies

    DHS Program Resources: Comparison of SNBC Health Plans 5567A (PDF)
    Lead Agency Case Manager / Worker Communication Form DHS-5181 (PDF)
    MSHO and MSC+ Service Authorization Process (PDF)

    Recommendation for State Plan Home Care Services DHS-5841 (PDF)

    SNBC Service Authorization Process

    Enrollees

    Guide to Special Needs BasicCare Enrollment DHS-5667 (PDF)
    Managed Care Guide to Health Plan Enrollment DHS-3354 (PDF)
    Medical Assistance for: Adults and Children who are Blind or have a Disability, and People Age 65 or Older DHS-2087C (PDF)

    MSC+ service areas DHS-5025 (PDF)

    MinnesotaHelp.Info

    MSHO service areas DHS-4840 (PDF)

    SNBC service areas DHS-5218 (PDF)

    Providers

    Managed Care Organization Contacts DHS-6581A (PDF)

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