MHCP Eligible Children

Revised: September 24, 2024

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· Overview

· Eligible Children

· Verifying Eligibility

· Understanding the Eligibility Response (271)

· Managed Care “Carve Out”

· Protections for Families and Children for other MHCP Health Care Services

· Minnesota Health Care Programs (MHCP)

· Parent Consent on MHCP Applications

· Locating a District IEP Service Provider

· MHCP IEP Services Information for Families Brochures

· Legal References

Overview

Individualized Education Program (IEP) health-related services provided by the schools are eligible for Minnesota Health Care Programs (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 22 years old or have not graduated from the 12th grade

· Must have a current IEP or Individualized Family Service Plan (IFSP) that identifies the covered IEP health-related service to be provided

· Must be actively enrolled in one of the following MHCP major program codes:

· Medical Assistance (MA)

· NM – These covered services are similar to MA services for certain non-citizens and children with Children’s Health Insurance Program eligibility types CB (infants from birth to 2 years old) or PC (pregnant women)

· Refugee Medical Assistance (RM)

Verifying Eligibility

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

To avoid denied claims, it’s the school district’s 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.

School districts 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, indicate the following:

· 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. They are not IEP related although they may be reported on the eligibility response.

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

IEP services coordinate with other MHCP major programs in the following ways:

· MHCP payments for IEP health-related services do not count against prior authorization caps for home care services; do not affect waiver [Brain Injury (BI), Community Alternative Care (CAC), Community Access for Disability Inclusion (CADI) and Developmental Disabilities (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.

· IEP-related services are not included in calculating Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) parental fees. 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. The Minnesota Department of Human Services (DHS) contact number for TEFRA is 651-431-3806.

· MHCP payments for IEP services do not affect MinnesotaCare premiums.

Parent Consent on MHCP Applications

DHS refers questions about parental or guardian 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 Medicaid in Education - What is Third Party Reimbursement? webpage for more information.

Both the initial MHCP application and renewal application that the parent or guardian completes contain the language required under FERPA and IDEA about permission for a school district 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 review the parent or guardian 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 or guardian must sign the MHCP application consent statement for MA to cover heath care costs. However, a parent or guardian has the right under FERPA to deny consent to a school district to access information and to bill MHCP. A parent or guardian may stop consent for sharing records with a school district at any time. These two rights are covered in the MDE Notice of Procedural Safeguards.

Locating a District IEP Services Provider

MHCP maintains an MHCP Provider Directory for Medicaid members to locate MHCP participating providers. Select drop down, choose Individual Education Plan/School Districts. follow the search prompts to locate an IEP Provider in your area. The MHCP Provider Directory is updated daily.

MHCP IEP Services Information for Families Brochures

MHCP IEP Services – Information for Families brochures are available in English and five additional languages on the Individualized Education Program (IEP) resources webpage, under Brochures for Parents.

Legal References

Minnesota Statues, 256B.0625, subdivision 26 (Covered Services – Special Education)