Managed Care Education and Enrollment Overview
Posted: November 9, 2026
The Managed Care Education and Enrollment Overview explains what managed care is, who enrolls in managed care and how county and Tribal workers educate enrollees about managed care.
Page Contents
What is Managed Care?
Who Enrolls in Managed Care?
Managed Care Education
What is Managed Care?
Managed care is a service delivery model in which the health plan is paid directly by the Department of Human Services (DHS) to provide health care services to enrollees of that health plan. This is different than the service delivery model of fee for service (FFS) in which the health care provider receives payment directly from DHS to provide health care services. Not all health care services are covered by managed care. Services that are not covered by managed care are “carved out” services and may be covered through another program.
Within managed care, there are different programs that are designed for specific populations based on their needs. These are listed here, referred to throughout this manual, and determine the processes involved and the information sent to the enrollee.
Who Enrolls in Managed Care?
Most enrollees who are eligible for Minnesota Health Care Programs (MHCP) must enroll in a health plan to receive their health care services. Once processing entities (county, Tribal, or DHS staff) determine eligibility for MHCP they must verify whether an enrollee meets criteria to be excluded from managed care and they enter the information into the Medicaid Management and Information System (MMIS).
Participation in managed care is mandatory for enrollees meeting criteria according to Minnesota Statutes, 256B.69, subdivision 4 and Minnesota Rules, 9500.1450 to 9500.1464. Enrollees who do not meet managed care exclusion criteria must enroll in a health plan.
Exclusions
If the processing entity determines that an enrollee is exempt from enrolling in managed care, they must enter the appropriate exclusion code into the MMIS system. The exclusion code indicates that someone is excluded from managed care enrollment and is then considered to be eligible for FFS. All MinnesotaCare enrollees must receive health care services through a managed care organization (MCO). There may be fee-for-service coverage for a limited period in certain circumstances per Minnesota Statutes, 256L.12, subdivision 3.
Refer to the Exclusions page of this manual for more detailed information on managed care exclusions. For additional information regarding managed care exclusion codes, refer to the RPPH screen of the MMIS User Manual. If the processing entity encounters system errors or edits related to managed care enrollment, they can review the HPEN Ticket Guide and submit an HPEN (Health Plan Enrollment) ticket in SIR. These tickets are routed to DHS.
Managed Care Education
Managed care education, also called choice counseling, begins once the enrollee has been determined eligible for MHCP. Per the Code of Federal Regulations, title 42, section 438.2 , choice counseling “means the provision of information and services designed to assist beneficiaries in making enrollment decisions; it includes answering questions and identifying factors to consider when choosing among managed care plans and primary care providers. Choice counseling does not include making recommendations for or against enrollment into a specific MCO, Prepaid Inpatient Health Plan (PIHP), or Prepaid Ambulatory Health Plan (PAHP).”
It is the responsibility of the county or Tribal health care worker to educate enrollees about the managed care enrollment process or to exclude them from managed care.
Processing entities notify enrollees who must enroll in managed care via a managed care enrollment packet. Enrollment packets contain information about the requirements to enroll in a health plan and the deadline for enrolling. The enrollment packets are designed to meet the criteria outlined in the Code of Federal Regulations, title 42, section 438.10(e) and Minnesota Statutes, 256B.69.
All enrollees are encouraged to make a health plan choice. If the managed care enrollment forms are not received by the deadline, the enrollee will be systematically enrolled into the default health plan listed on the RTRK screen in MMIS.
Throughout the managed care enrollment process, processing entity staff who assist with managed care enrollment are responsible for assisting enrollees with questions related to health plan selection. Processing entity staff must let the enrollee choose the health plan that best fits their needs and not recommend one health plan over another.
Managed care enrollment guides and envelopes listed in this manual can be ordered in bulk from DHS forms supply. All other managed care materials listed in this manual can be printed from eDocs.
County and Tribal health care workers can refer enrollees with questions for counseling on Medicare products to Minnesota Aging Pathways at 800-333-2433 (this call is free). When to call Minnesota Aging Pathways is explained in the Managed Care for Seniors page of this manual.
County and Tribal health care workers can refer SNBC enrollees with questions beyond choice counseling to the Disability Hub MN™ at 866-333-2466 (this call is free). When to call the Disability Hub™ is explained in the Managed Care for People with Disabilities page of this manual.
Provider Network
Not all providers are considered in-network for the available health plans. The enrollee needs to verify if their preferred providers are covered by their chosen health plan. If they want to go to the same health care providers they currently go to, they can review the online provider directories for each of the available health plans. Enrollees can ask if the health plans contract with their provider or they can call their provider’s office to find out which health plans they accept. Providers that have contracts with the health plans are considered in-network providers.
Education for Non-English-Speaking Enrollees
The Managed Care Enrollment Guide (DHS-8041) (PDF), Guide to SNBC Enrollment (DHS-5567) (PDF), and Managed Care Guide to Health Plan Enrollment for Seniors (DHS-6892) (PDF) include a language block for non-English-speaking enrollees. The language block explains in multiple languages, including: English, Amharic, Arabic, Burmese, Cantonese, French, Hmong, Karen, Khmer, Korean, Lao, Oromo, Russian, Somali, Spanish and Vietnamese, that interpreter services are available and provides instruction on how to request them.
The following forms are available on DHS eDocs (our electronic document library) in Spanish, Hmong, Russian, Somali or Vietnamese:
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