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MHCP Eligible Children

Revised: 04-24-2018

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Individualized Education Program (IEP) health-related services provided by the schools are eligible for Minnesota Health Care Program (MHCP) reimbursement when the services meet criteria for federal financial participation and the child or youth meets the MHCP eligibility requirements.

Eligible Children

  • • Must be under 21 years old
  • • Have a current IEP or Individualized Family Service Plan (IFSP) that identifies the covered IEP health-related service to be provided
  • • Are actively enrolled in one of the following MHCP major program codes:
  • • MA (Medical Assistance)
  • • NM (covered services mirrors MA) for certain non-citizens and children with CHIP eligibility types CB (infants from birth to 2 years old) or PC (pregnant women)
  • • RM (Refugee Medical Assistance)
  • When a youth reaches 21 years old, MHCP will no longer pay for IEP health-related services, but the youth may receive special education services until he or she turns 22 years old.

    Note: All other Minnesota Health Care Programs have specific medically necessary criteria or are not federally funded. MHCP will not pay for IEP health-related services provided under those programs.

    Verifying Eligibility

    Districts can check eligibility for one child or multiple children using MN–ITS Interactive. Refer to the MN–ITS User Guide Verify Eligibility for MHCP Recipients for step-by-step instructions.

    To avoid denied claims, it is the provider’s (school districts) responsibility to verify eligibility before submitting claims to MHCP. It is important to verify a child’s eligibility at least monthly. In most cases, MHCP coverage is determined on a month-to-month basis.

    Schools will be responsible for 100 percent of the cost of IEP health-related services provided to children who do not meet the MHCP eligibility requirements.

    Understanding the Eligibility Response (271)

    On the eligibility response:

  • • Confirm that the child has health care coverage with MHCP for one of the major program codes MA, NM or RM
  • • Verify if other health insurance information (child’s private health care plan) is available
  • Note: Ignore references to special transportation, pharmacy and waiver services. Although they may be reported on the eligibility response, they are not IEP related.

    Managed Care “Carve Out”

    Children eligible for MHCP may have their health care covered by a managed care organization (MCO) – a prepaid Medical Assistance plan. IEP services are “carved out” (not covered) by the MCO. Bill IEP services directly to MHCP.

    Protections for Families and Children for Other MHCP Health Care Services

    Note how IEP services coordinate with other MHCPs:

  • • MHCP payments for IEP health-related services do not count against prior authorization caps for home care services, do not affect waiver (CADI, CAC, TBI or DD) caps or the amount of services available under the waiver, and do not count against service limits or thresholds.
  • • CADI, CAC, TBI and DD waivers provide home and community-based services to certain children with disabilities. These waiver programs have limits on the amount of services a child can use in a year.
  • • The TEFRA parental fee is a sliding fee based on income, family size and whether the child lives at home. The parental fee cannot exceed the cost of the child's MA and county expenditures. IEP-related services are not included in calculating parental fees. The DHS contact number for TEFRA is 651-431-3806.
  • • MHCP payments for IEP services do not affect MinnesotaCare premiums.
  • Minnesota Health Care Programs (MHCP)

    Families may apply for MHCP online at or by completing a paper version of the application. A link to print the application is available at How to apply for Minnesota Health Care Programs. Refer to the MNsure and MHCP Member Help Desk contact information for hours and phone numbers, as well as county and tribal offices contacts.

    Parent Consent on MHCP Applications

    DHS refers questions about parental consent to the Minnesota Department of Education (MDE), the state education authority on education law. Issues deal with the Family Educational Rights and Privacy Act (FERPA) and the Individuals with Disabilities Education Act (IDEA). Review MDE’s Third-party Billing webpage for more information.

    Both the initial MHCP application and the renewal application that the parent completes contain the language that is required under FERPA and IDEA about permission for school districts to access the child’s health information and to bill for services. Check the signature page of the most current version of the application to see the parent agreements and rights. Refer to the appendix for the Notice of Privacy Practices. The section on release and sharing of medical information contains information about how records may be released to several parties including schools.

    Note: A parent must sign the MHCP application consent statement for Medical Assistance to cover heath care costs. However, a parent has the right under FERPA to deny consent to school districts to access information and to bill MHCP. A parent may stop consent for sharing records with school districts at any time. These two rights are covered in the MDE Notice of Procedural Safeguards.

    Parent Notification, Release and Consent

    Notification, consent and release forms are available only from MDE. Contact MDE with questions about notification, consent and release documents related to billing for IEP services and other consents required by education laws.

    Locating a District IEP Services Provider

    MHCP maintains an MHCP Provider Directory for families to locate enrolled IEP providers in their area. From Select drop down, choose Individual Education Plan/School District. Type district ISD #0000 in the name field or select the county from drop down in MN county field. Check the list periodically to assure district information is accurate.

    MHCP IEP Services Information for Families Brochures

    Minnesota Health Care Programs (MHCP) Individualized Education Program (IEP) Services – Information for Families brochures are available in eleven languages:, under Quick Links for IEP Providers.

    Legal Reference

    34CFR 300.154 (Title 34: Education Part 300 - Assistance to States for the Education of Children with Disabilities - Methods of ensuring services
    Minnesota Statues 256B.0625, subd. 26
    (Covered Services – Special Education)

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