Medical Assistance for Families with Children and Adults

2.2.4.1 Health Care Delivery

Health care services are provided by the Prepaid Medical Assistance Program (PMAP) for Medical Assistance for Families with Children and Adults (MA-FCA) enrollees. PMAP is delivered in Minnesota by managed care organizations and county based purchasing groups.

The enrollee’s county must educate them about managed care and the need to select a plan.

MA-FCA enrollees have 30 days to choose a PMAP plan. After 30 days, a default plan is assigned.
Enrollees choose a health plan based on what plans are available in their county of residence.
Enrollees may receive services via fee-for-service providers before they are enrolled in a health plan.
Enrollees must get services from the health plan's network of providers except in special circumstances.
Some enrollees are not allowed to enroll in managed care.
Enrollees who are temporarily absent from the state for more than 30 consecutive days are disenrolled from their health plan and receive health care services via fee-for-service for the period of their temporary absence. See EPM 1.4.4 for information about temporary absence.

Detailed information on all of these topics is found in the Prepaid Minnesota Health Care Programs (PMHCP) Manual.

Covered Services

The benefit set for people enrolled in MA-FCA includes a wide range of health care services, from preventive care to hospitalization. Some benefits have limitations on services or level of coverage. This means there may be a limit or maximum dollar amount on specific types of services, like eyeglasses, or on all services in a category, like dental.

Services in a long-term care facility can be covered by MA if the person has a pre-admission screening that indicates the person needs a nursing facility level of care and meets the other requirements to be eligible for MA for Long-Term Care Services.

The Minnesota Health Care Programs (MHCP) Summary of Coverage, Cost Sharing and Limits (DHS-3860) explains covered services and cost-sharing requirements.

Legal Citations

Minnesota Rules, parts 9500.1450 to 9500.1464

Minnesota Rules, part 9505.0285

Minnesota Statues, section 256B.056, subdivision 1

Minnesota Statutes, section 256B.69