Managed care enrollment and disenrollment

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. For more information, refer to MMIS LTSS Manual – Managed care and MMIS.

How to find enrollment information

If you are a county or Tribal Nation staff member with MMIS access to screening documents, you can find information about a person’s enrollment in a managed care product in the recipient subsystem.

Press F4 from anywhere on a screening document to navigate to the recipient subsystem and view managed care enrollment information.

You can also view this information starting at the MMIS main menu using these steps:

1. Type X next to the recipient subsystem on the MMIS main menu screen.

2. Use inquiry mode on the recipient key panel screen.

3. Search for the person using their name or person master index (PMI) number. For instructions, refer to MMIS LTSS Manual – Instructions to look up a person.

4. Type RELG or RPPH in the upper left corner and press the transmit key.

5. Review information on the RELG or RPPH screen about managed care enrollment, including:

· The product in which the person is enrolled, if any.

· The dates of enrollment.

· The provider ID for the MCO associated with that enrollment period.

For additional information, refer to MMIS LTSS Manual – Recipient screen descriptions.

Product ID

Each managed care product has a product ID:

· Minnesota Senior Health Options (MSHO): MA02

· Minnesota Senior Care Plus (MSC+) with Elderly Waiver (EW): MA35

· MSC+ without EW: MA30

· Special Needs BasicCare (SNBC) with Medicare: MA17 and IM17 (integrated)

· SNBC without Medicare: MA37 and IM 37 (non-integrated)

Provider ID

The MCO provider ID is the ID associated with a particular MCO.

The following table shows the name of the MCO, the LTCC CTY field code used by the MCO on the ALT1 screen in the screening document and the MCO provider ID number.

MCO name	LTCC CTY field code	MCO provider ID number
UCare MN	UCM	A5658136 00
Medica	MED	A4057139 00
Metropolitan Health Plan (no longer operating; replaced by HHP)	MHP	A9657134 00
Blue Plus	BPH	A0658138 00
Health Partners	HPH	A5857139 00
Itasca Medical Care	IMC	A1060139 00
First Plan Blue (no longer operating)	FPB	A8855137 00
PrimeWest Health System	PWH	A1551183 00
South Country Health Alliance	SCH	A0137073 00
Hennepin Health for SNBC only	HHP	A8366182 00
United Health Care	UHC	A1684074 00

Disenrollment

A person may disenroll from managed care for several reasons:

· The person moved to a county where their current MCO is not available. In this situation, the person will be served under the fee-for-service (FFS) model until they enroll in another MCO.

· The person was enrolled in a voluntary product (e.g., SNBC) and wishes to disenroll.

· The person’s circumstances change, and they are no longer eligible for enrollment.

· The person enrolled in a different MCO. Enrollment in a new MCO automatically disenrolls the person from the previous MCO.

A person who remains eligible for MA at disenrollment will be served under the FFS model during any period of time between disenrollment and reenrollment in managed care, if applicable. A person on EW may need to transfer from the MCO as their lead agency to a county or Tribal Nation. This is completed through a case management transfer, described on MMIS LTSS Manual – EW case management transfers.

Additional resources

MMIS LTSS Manual – EW case management transfers
MMIS LTSS Manual – Instructions to look up a person
MMIS LTSS Manual – Managed care and MMIS
MMIS LTSS Manual – Recipient screen descriptions