Managed Care for Seniors

Posted: November 9, 2026

People who are 65 or older have two managed care programs available to them. They are Minnesota Senior Care Plus (MSC+) and Minnesota Senior Health Options (MSHO).

To be eligible to enroll in the health plan for these programs, the enrollee must:

· For MSC+:

· Be eligible for Medical Assistance (MA)

· Be the age of 65 or older

· For MSHO:

· Be eligible for Medical Assistance

· Be the age of 65 or older

· Have Medicare Part A and Medicare Part B

· Complete an enrollment form for MSHO

Page Contents

MSC+
MSHO
MSC+ and MSHO Enrollment Process
Senior Enrollment (MSC+ and MSHO) Packet Contents
MSHO Denial and Rejection Information
When to Call Minnesota Aging Pathways

MSC+

The following describes the MSC+ program:

· MSC+ is a non-integrated program which means the enrollee receives their MA benefits through a health plan. If they are enrolled in Medicare, they will receive their Medicare benefits separately.

· Enrollment in MSC+ is mandatory if an enrollee is not otherwise excluded from managed care.

· Health plan enrollment is handled by counties and Tribal health care workers.

· MSHO

The following describes the MSHO program:

· MSHO is an integrated program which means both their MA and Medicare benefits are administered by the same health plan.

· MSHO is a voluntary program. 

· To be eligible to enroll in MSHO, the enrollee must be enrolled in both Medicare Parts A and B.

· Some health plans offer other incentives for this population, such as fitness programs or discounts.

· Enrollees can contact each health plan directly if they want more information on incentives or discounts provided.

· MSHO enrollment is handled by the Minnesota Department of Human Services (DHS) and the health plans. 

The health plans available for enrollees to choose from are based on their county of residence as listed in MMIS.

MSC+ and MSHO Enrollment Process

The following outlines the heath plan enrollment process after county or Tribal health care workers have determined enrollee eligibility:

1. Eligibility information is entered into MMIS by county or Tribal health care worker or by interfacing via METS.

2. A county or Tribal health care worker determines if the enrollee meets criteria to be excluded from managed care and instead falls under fee for service (FFS):

a. If yes, the county or Tribal health care worker enters the appropriate exclusion code on the RPPH screen. MMIS does not generate an enrollment form and the process is complete.

b. If no, and the enrollee is eligible to be reenrolled in their previous health plan, refer to the Reinstatement and Reenrollment page of this manual. MMIS does not generate an enrollment form and the process is complete.

c. If no, and the enrollee is not eligible to be reenrolled in their previous health plan, the county or Tribal health care worker adds a “YY” exclusion for the next available month on the RPPH screen.

3. A county or Tribal health care worker or MMIS adds a tracking span on the RTRK screen to initiate the enrollment process. The section, Tracking System within MMIS in this manual, has more information on the enrollment and tracking process.

4. In an overnight batch job MMIS generates an enrollment form.

5. The county or Tribe prints the enrollment forms each day and assembles and mails the enrollment packet.

a. Contents of the packet are listed in the section Senior Enrollment (MSC+ and MSHO) Packet Contents.

6. A county or Tribal health care worker provides education to the enrollee about managed care and health plan selection.

7. The way the enrollee completes the enrollment form determines what program they will enroll in. The enrollee chooses a program and completes the form in one of the following ways:

a. How the enrollee completes an MSC+ enrollment form:

i. The enrollee returns the enrollment form by mail. The processing entity checks the form for completeness and accuracy. They review the enrollee’s name, health plan choice and responses to questions on the form. Then, they enter the information on the RPPH and REFM screens in MMIS. Finally, they add a case note in MMIS that includes the enrollee’s name and health plan choice.

ii. The enrollee contacts the processing entity by phone. The processing entity enters the enrollee’s health plan choice on the RPPH screen and adds a case note in MMIS that includes the enrollee’s name, health plan choice, and the date of the phone call.

b. How the enrollee completes an MSHO enrollment form:

i. The enrollee completes the enrollment form by checking the MSHO box as illustrated in the following image.

ii. Counties, Tribes or enrollees return completed forms to DHS using one of the following methods:

1. Counties and Tribes can submit forms to DHS via the Partner and Provider Portal (DHS-8147A) (eform). This method is not available to enrollees.

2. Mail the completed paper form to:
Managed Care – Department of Human Services
PO Box 64984
St. Paul, MN 55164-0838

3. Fax the completed paper form to: 651-431-7548

iii. The enrollee can also contact the health plan directly to complete the enrollment process. County and Tribal health care workers cannot enter MSHO enrollment information into MMIS. DHS or some health plans enter MSHO enrollment information. Because this is a voluntary program, enrollees are not defaulted into an MSHO plan.

c. If the enrollee does not respond with a health plan choice by mail or by phone they will be defaulted into an MSC+ plan. The section, Default Health Plan Enrollment Process in this manual, has more information on this process.

1. DHS will mail:

a. A Notice of Health Plan Enrollment indicating what health plan each enrollee is enrolled in and the effective date.

b. A Minnesota Health Care Program (MHCP) ID card for each enrollee.

2. MSHO enrollees will receive additional enrollment confirmation notices.

3. The health plan will mail additional information and a health plan ID card to the enrollee.

Senior Enrollment (MSC+ and MSHO) Packet Contents

The enrollment packet for enrollees who are 65 years of age or older includes the following documents:

· Enrollment form. MMIS will generate enrollment forms based on Medicare information:

· MMIS will generate a Prepaid Health Plan (PPHP) enrollment form if the enrollee either doesn’t have any Medicare or only has Part A or Part B. These will be on the MW0448 (PPHP) report in Mobius. MSC+ is the only option on this form.

· MMIS will generate a senior enrollment form if the enrollee has both Medicare Part A and Part B. These will be on the MW0450 (MSHO) report in Mobius. Enrollees can select either MSC+ or MSHO using this form.

· Managed Care Enrollment Guide for Seniors (DHS-6892) (PDF) (can be printed from eDocs)

· County or Tribal informational documents (can vary and DHS must approve these)

· County or Tribal return envelope

· DHS-4200MA mailing envelope (can be ordered in bulk from DHS forms supply)

If an enrollee reports they have lost their enrollment form, processing entities create and mail the Health Plan Enrollment Form for People 65 and Older (DHS-4106C) (PDF). When printing the DHS-4106C form from eDocs, workers must indicate the default plan following the instructions on the form. Workers must also provide instruction to the enrollee on returning the form. Processing entities can also submit an HPEN ticket in SIR requesting a new form.

Enrollees using a DHS-4106C form to enroll in MSHO must check the box as illustrated in the following image and return it to DHS using the instructions outlined previously in the step titled How the enrollee completes an MSHO enrollment form.

MSHO Denial and Rejection Information

An enrollee’s enrollment into MSHO may be delayed if the enrollment form or DHS-4106C is incomplete. Examples of missing information include a missing signature, not having Medicare eligibility or a missing plan selection. The enrollee will be given a due date to provide the missing information on the enrollment form.

MSHO requires a complete enrollment form and final approval depends on the Centers for Medicare & Medicaid Services (CMS) guidelines. If CMS rejects the enrollment, the enrollee will receive a letter with further information and instructions. If CMS rejects an enrollee’s MSHO enrollment, the enrollee will be enrolled into MSC+ with the selected health plan.

Regardless of how many MSHO health plans are available in the enrollee’s county of residence, they must select a health plan by completing an enrollment form. If they do not, they will remain in MSC+.

When to Call Minnesota Aging Pathways

Processing entities can refer enrollees with questions to Minnesota Aging Pathways at 800-333-2433 (this call is free) for counseling on Medicare products or to their website at mn.gov/aging-pathways.

Enrollees may call Minnesota Aging Pathways to:

· Understand their Medicare benefits.

· Select a new Medicare Part D drug plan. This will disenroll the enrollee from their current MSHO plan and move them into MSC+.

For other questions, refer enrollees to contact their county or Tribe.