*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: April 1, 2013 |
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30.10 - Medical Needs |
Archived: June 1, 2016 (Previous Versions) |
This section provides information on programs to assist people who are not eligible for Minnesota Health Care Programs (MHCP) with their medical needs.
The Primary Care Resources form (DHS-4741) is also available as a resource for clients not eligible for an MHCP. It provides a listing of medical, dental and mental health care providers who may see clients who do not have insurance.
Child and Teen Checkups (C&TC).
Minnesota Children with Special Health Needs (MCSHN).
Alternative Care (AC) provides funding for home and community-based services for people who would otherwise need nursing facility care. It is an optional and voluntary program intended to allow a specific population to access a limited set of certain services.
AC cannot overlap with MinnesotaCare.
AC and MA programs may or may not overlap, depending on the specific situation:
l People enrolled in or potentially eligible for MA are not eligible for AC if they are eligible for MA without a spenddown or an Elderly Waiver obligation, and are within the MA asset.
l People who would be eligible for SIS-EW but choose AC are not eligible for MA at the same time.
Exception: A client requesting retroactive eligibility or while MA is pending may receive AC with MA eligibility.
l People whose income exceeds the SIS may be eligible for AC and MA with a spenddown.
l People can receive AC and QMB, SLMB and/or QI at the same time.
Covered services include:
l Adult day care.
l Respite care.
l Homemaker services.
l Home health aide.
l Case management.
l Equipment and supplies.
l Nutrition service.
l Chore service (lawn mowing, grocery delivery, snow shoveling, etc.).
l Home health nursing.
l Transportation.
l Home-delivered meals.
l Companion services.
l Caregiver training and education.
l Environment modifications.
l Private duty nursing.
l AC cash grant.
l AC discretionary services.
l Personal care services.
To receive AC funding for home and community-based services, a person must meet all eligibility criteria including:
l Complete a Long-Term Care Consultation (LTCC).
l Require a nursing facility level of care as determined by the LTCC team.
l Be age 65 or older.
l Be able to remain in the community rather than a nursing facility, as determined by the LTCC team.
For more information on the Alternative Care Program, clients may:
l See the DHS website.
l Contact their local county social services office.
Child and Teen Checkups (C&TC)
The Child and Teen Checkups (C&TC) Program is Minnesota's name for the federal Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. C&TC promotes early and preventive health care for children through comprehensive screening for health problems at an early stage. This allows treatment before the problem becomes more serious and expensive to treat.
l Children from birth to age 21 who are eligible for MinnesotaCare or MA are eligible for the C&TC Program.
l Participation on the part of the children/families is voluntary.
l C&TC includes an administrative services component (outreach and follow up). The agency that provides administrative services is the county C&TC agency.
l Federal regulations require the state to have an 80% participation rate for children eligible for C&TC screening. County C&TC agencies must:
n Make the initial contact with eligible children and their families to provide information about the purpose and benefits of the program.
n Inform families that support services such as transportation, interpreter services, and appointment scheduling assistance are available.
n Workers who have contact with families during the application process are encouraged to inform families that C&TC is a benefit of the MA and MinnesotaCare programs and that the county C&TC agency will contact them with more information.
For more information on C&TC, clients may:
l Contact their local county social services agency.
l See the DHS website.
The Minnesota Comprehensive Health Association (MCHA) provides health insurance to people who have been turned down for individual coverage in the private market. MCHA has high premiums as well as deductibles and co-pays. People most likely to benefit from MCHA are those:
l Who are ineligible for any of the Minnesota Health Care Programs because of income or assets.
l Who have pre-existing medical conditions that prevent private coverage.
l Some people with large spenddowns may benefit from MCHA.
Some people may have a six-month waiting period before MCHA will cover certain pre-existing conditions.
To qualify for MCHA, people must:
l Have been Minnesota residents for at least six months before making application.
l Provide proof of denial of private coverage within the past six months unless they have been treated for certain presumptive conditions within the past three years.
Refer people who are interested in applying or receiving more information to:
l MCHA's customer service line at (866) 894-8053, or (651) 456-8700 for TTY.
l the MCHA Web site: www.mchamn.com.
Congress passed the Hill-Burton Act in 1964. This Act gives hospitals and other health facilities money to build and remodel.
l Facilities which receive these funds agree to provide a limited amount of services to people who cannot pay for health care.
l Services provided vary among facilities because Hill-Burton facilities, annually, choose the type of services to provide at no or reduced charge.
l The facility where people apply for the program will tell them what types of free or reduced charge services it provides, and what income levels qualify for the program.
l People may apply for Hill-Burton funds before or after they receive care (including bills for care already sent to a collection agency).
l People may apply at any Hill-Burton assisted facility, including hospitals, nursing homes, and clinics.
Tell the following people about the Hill-Burton program:
l People who are not eligible for MA, MCRE, or EMA.
l People who are eligible for MA with a spenddown. These people may be eligible for Hill-Burton funds for all or part of the spenddown amount.
Note: Any expenses covered by Hill-Burton funds before MA is approved may not be used to meet a spenddown.
DHS has several programs to help people with HIV gain access to medical care.
l The HIV/AIDS insurance program pays medical insurance premiums for eligible people. This includes but is not limited to COBRA continuation, individually purchased cost-effective policies (but not COBRA conversion policies), MCHA-Medica policies and employer-sponsored insurance policies if the enrollee pays 50% or more of the premium. People are not eligible if they have insurance for which an employer pays more than 50% of the premium.
l The HIV/AIDS drug reimbursement program pays the patient’s portion of the cost of many major drugs used to treat HIV or prevent HIV-related conditions. People must be uninsured, underinsured or insured with a drug co-payment. Drug reimbursement for Medicare-eligible individuals depends on the individual’s income. People enrolled in other Minnesota Health Care Programs (MA and MinnesotaCare) are not eligible.
l The HIV/AIDS dental program pays for routine diagnostic, preventive and corrective procedures. Providers must contact Program HH at (651) 431-2414 for prior authorization for certain procedures. Some people enrolled in other MHCPs may be eligible for this program if they have exhausted their dental benefits.
l The HIV/AIDS nutrition program pays up to $100 per month for enteral nutritional supplements when prescribed by a physician, nutritionist or by a registered dietitian. Some people enrolled in other MHCPs may be eligible for this program if they have exhausted their nutritional benefits.
l The mental health program pays for limited outpatient counseling from providers who accept MHCP for people who do not have mental health insurance coverage or who have exhausted their mental health benefits.
The HIV/AIDS programs are open to people living with HIV/AIDS in Minnesota. To be eligible, a person must:
l Be a Minnesota resident.
l Be HIV positive.
l Have annual income less than or equal to 300 percent of FPG.
l Have total cash assets of $25,000 or less. One car and a home are excluded.
Applications are available through DHS or at many community and clinic-based sites serving people with HIVAIDS. People can also download the HIV/AIDS Programs (Program HH) Annual Application (DHS-3539) from the DHS website.
For more information clients may:
l Call DHS at (651) 582-1980 or (800) 657-3761.
l See the DHS website.
Minnesota Children with Special Health Needs (MCSHN)
MCSHN provides an information and referral telephone line for families, teachers, social workers, and others to help identify and locate resources and services for children with special health needs and their families. The program is administered by the Minnesota Department of Health.
Refer interested families to MCSHN at (651) 201-3650 or (800) 728-5420.
For information on Veterans’ Benefits and/or Workers’ Compensation, see Other Needs.