*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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. ***
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Effective: December 1, 2011 |
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03.45.30.10 - Presumptive Eligibility Providers for MA-BC |
Archived: June 1, 2016 (Previous Versions) |
Providers who participate in the Sage Screening Program may choose to register with DHS to become presumptive eligibility providers for Medical Assistance for Breast and Cervical Cancer (MA-BC) . These health care providers have signed agreements (see DHS-4786) with DHS to conduct presumptive eligibility determinations for women who are screened through the program and who need treatment for breast cancer or cervical cancer, including precancerous conditions.
Authorized providers will approve presumptive MA-BC eligibility for a minimum of 30 days from the application date for Minnesota women who meet all of the following:
l Have been screened through the Sage Screening Program and need treatment for breast or cervical cancer, including precancerous conditions and early stage cancer.
l Have had one of the following Sage Screening Program forms completed by their provider:
n Enrollment Form.
n Return Visit Form.
n Colposcopy Program.
Note: These Minnesota Department of Health forms (completed by Sage providers' staff) do not have DHS form numbers.
l Are under age 65.
l Have no health coverage.
The following is a list of providers who are currently authorized by DHS to grant presumptive eligibility for MA-BC. If you receive an application from a provider who is not on the list, follow your agency's procedures to submit a policy question to HealthQuest.
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Presumptive Eligibility Providers |
City |
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Altru Clinic |
Crookston |
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Avera Medical Group Robin Funk |
Worthington |
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Bloomington Public Health/Sage Women's Clinic |
Bloomington |
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Broadway Medical Center |
Alexandria |
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CentraCare OB/GYN Michelle Lauer, Roxanne Roehl, Mary Daniel |
St. Cloud |
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CentraCare Family Health Center Pam Siewert, Shar Wallack |
St. Cloud |
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Central Avenue Clinic Ali Palacios |
Minneapolis |
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East Side Family Clinic Laura Randall |
St Paul |
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Essentia Health Walker |
Walker |
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Family Tree Clinic |
St. Paul |
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Glacial Ridge Health System |
Glenwood |
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Glencoe Regional Health Services |
Glencoe |
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Gundersen Clinic, Ltd. |
LaCrosse, WI |
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HCMC Whittier Clinic Hennepin County Medical Center |
Minneapolis |
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Lake City Medical Center |
Wabasha |
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Lake Superior Community Health Center |
Duluth |
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Lakewood Clinic/Greater Staples Hospital |
Staples |
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Madelia Parkview Clinic |
Madelia |
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Mayo Clinic |
Rochester |
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Migrant Health Services Willmar Sandra Rangel, Bonnie Raddatz, Thare Iliff, Lorie Borke, Mary Stetzel |
Willmar |
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Northpoint Health and Wellness Center |
Minneapolis |
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Olmsted Medical Center |
Rochester |
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Open Door Health Center |
Mankato |
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Owatonna Clinic/MHS |
Owatonna |
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Sanford Health |
Jackson |
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Sanford Worthington Clinic Heather Bennett |
Worthington |
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Scenic Rivers Health Services Jeffery Scrivner |
Big Fork |
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St. Cloud Hospital |
St. Cloud |
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St. Croix Family Medical Clinic Leon Mesracil, Milan Za |
Stillwater |
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St. Luke's OB/GYN Associates Nancy Rubin |
Duluth |
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St. Paul-Ramsey County Department of Public Health |
St. Paul |
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Stevens Community Medical Center |
Morris |
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United Family Medicine |
St. Paul |
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United Breast Center Ali Cain |
St. Paul |
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West Side Community Health Services |
St. Paul |
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Western OB/GYN |
Waconia |
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White Earth Health Center |
Ogema |