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Minnesota Health Care Programs
1.6 Health Care Delivery (Archive)
Minnesota Health Care Program (MHCP) enrollees must follow guidelines for receiving medically necessary services.
Managed Care
Most MHCP enrollees receive services from a managed care health plan or network of providers. The health plan coordinates the services provided. The Minnesota Department of Human Services (DHS) pays a fixed rate in advance for each enrollee.
New enrollees receive information and enrollment forms from presentations at the county or tribal servicing agency or in the mail. People must choose a health plan based on what plans are available in their county of residence.
Detailed information on managed care and managed care exemptions is in the Prepaid Minnesota Health Care Programs (PMHCP) Manual.
Fee for Service
Fee-for-service is a method of payment where the medical provider bills MHCP for specific, individual services. Enrollees must use a medical provider enrolled with MHCP, except in special circumstances. A directory of enrolled providers is available online.
Covered Services
The MHCP Summary of Coverage, Cost Sharing and Limits (DHS-3860) explains covered services and cost-sharing requirements.
Out of State Services
Enrollees who are temporarily absent from the state may receive MHCP services when they are out of the state in a medical emergency.
A person who is temporarily living out of the country usually cannot receive MHCP services.
Membership Card
Each enrollee has a Person Master Index Number (PMI). The PMI is a unique number that verifies MHCP eligibility when obtaining health care services. MHCP enrollees receive a MHCP member card from the Minnesota Department of Human Services. People enrolled in a managed care plan receive a managed care organization membership card.
Legal Citations
Minnesota Statutes, section 256B