Managed care products

Page posted: 8/3/26

Most people who have Medical Assistance (MA) get their health care through managed care organizations (MCOs), which are also called “health plans.” Enrollment in managed care is mandatory for some MA-eligible populations.

This page describes the managed care products referenced throughout this manual.

People age 65 and older: Minnesota Senior Health Options (MSHO) and Minnesota Senior Care Plus (MSC+)

Approximately 94% of all people age 65 and older who are eligible for MA enroll in MSHO or MSC+ for their health care and other services.

MSHO is a voluntary managed care program that provides eligible people age 65 and older with all Medicaid services, including home care, all Medicare services under parts A, B and D, EW services and 180 cumulative days of care in a nursing facility.

MSC+ is a managed care program that provides eligible people age 65 and older with acute and preventive care, home care, Elderly Waiver (EW) services and 180 cumulative days of care in a nursing facility.

For people enrolled in MSHO or MSC+:

· The MCO is the lead agency.

· Only MSHO and MSC+ certified assessors can complete the eligibility determination for EW and state plan home care services, including personal care assistance (PCA)/Community First Services and Supports (CFSS).

· Only MSHO and MSC+ staff can enter long-term care (LTC) screening documents for assessments completed, including those for people on EW.

· The MCO assigns a care coordinator. For people on EW, the care coordinator also assumes waiver case management responsibility.

· The MCO completes a preadmission screening (PAS) and enters PAS screening documents in MMIS if they are admitted to a nursing facility. For more information, refer to Minnesota Aging Pathways – PAS and CBSM – Temporary waiver exits and restarts: MMIS actions.

People younger than age 65: Special Needs BasicCare (SNBC)

SNBC is a voluntary managed care plan for people who meet all of the following criteria:

· Age 18 to 64.

· Have a certified disability as determined by the Social Security Administration (SSA) or the State Medical Review Team (SMRT).

· Eligible for MA.

· If eligible for Medicare, have both Medicare Part A and Medicare Part B.

There are two SNBC products available for people with a certified disability:

· Non-integrated SNBC (SNBC-NI): When enrolled in a non-integrated SNBC program, the person receives their MA health care benefits through an MCO. If the person is enrolled in Medicare, they will receive their MA and Medicare benefits separately. Eligible people are automatically enrolled in a non-integrated MCO unless they opt out.

· Integrated SNBC (I-SNBC): When enrolled in an integrated SNBC program, the person’s MA and Medicare health care benefits are both administered by the same MCO.

People who receive home and community-based services (HCBS) waivers or state plan PCA, CFSS or home care nursing (HCN) services are eligible to enroll in either SNBC product (i.e., integrated or non-integrated). People enrolled in SNBC will continue to get these services authorized and paid for in FFS.

For people enrolled in SNBC:

· The MCO is not the lead agency for HCBS, PCA, CFSS or HCN.

· The county or Tribal Nation completes HCBS and PCA/CFSS eligibility determination, service authorization and service agreements. For information about HCN authorization, refer to CBSM – HCN and MHCP Provider Manual – HCN.

· The county or Tribal Nation enters screening documents and service agreements, except for PAS documents (refer to nursing facility services section below).

· The MCO is responsible to authorize and pay for all basic state plan health care services. For information about how state plan home health services are included on FFS service agreements for people on SNBC and Brain Injury (BI), Community Alternative Care (CAC) and Community Access for Disability Inclusion (CADI) waivers, refer to MCO, County Agency and Tribal Nation Communication Form, DHS-5841 (PDF).

· The MCO assigns a care coordinator. For people on BI, CAC or CADI waivers, the county or Tribal Nation is responsible to provide waiver case management. The SNBC care coordinator and the waiver case manager coordinate the SNBC care plan and the waiver support plan.

Nursing facility services

SNBC includes 100 cumulative days of nursing facility services. The MCO completes the PAS if the person is admitted to a nursing facility. If the person is on the BI, CAC or CADI waiver, the county or Tribal Nation is responsible to close the waiver program according to policy related to institutional admission. For more information, refer to Minnesota Aging Pathways – PAS and CBSM – Temporary waiver exits and restarts: MMIS actions.

Additional resources

MMIS LTSS Manual – Managed care enrollment and disenrollment
MMIS LTSS Manual – Managed care use of the LTC screening document
MMIS LTSS Manual – EW case management transfers
DHS – FAQs about health plans and managed care
SNBC MA Health Plan Coverage, DHS-6301 (PDF)