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Effective: December 1, 2006 |
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28.15ar1 - Managed Care Enrollment (Archive) |
Archived: June 1, 2009 |
Many Minnesota Health Care Program (MHCP) enrollees receive their services through a managed care delivery system. The primary resource for managed care policy and procedures is the Prepaid Minnesota Health Care Programs (PMHCP) Manual. However, a number of topics that most workers may need to be familiar with are included in this manual as well.
All people with MinnesotaCare coverage are enrolled in managed care.
Exception: Some enrollees may have MinnesotaCare coverage on a fee-for-service basis for a limited period in certain circumstances.
Most people with Medical Assistance (MA) and General Assistance Medical Care (GAMC) coverage are also enrolled in managed care, unless:
l They live in Beltrami, Clearwater, Hubbard, or Lake of the Woods counties (which still use a fee-for-service delivery system for their MA and GAMC clients).
l They live in a managed care county but are part of a group that is excluded from managed care enrollment.
MHCP households must choose the same health plan, or managed care organization (MCO) , for all eligible household members. However, a household may choose different primary care clinics within the MCO for different household members.
Exception: Until June 1, 2004, MA and GAMC households had the option of choosing different health plans for household members. Households that selected multiple health plans before June 1, 2004 were grandfathered in and not required to change.
People who will receive their health care services through managed care are educated about their enrollment choices in one of two ways:
l By mail.
n All MinnesotaCare enrollees are educated by mail.
n MA and GAMC enrollees are educated by mail if they do not apply in person or otherwise attend a presentation at the county agency.
l In a presentation.
All managed care enrollees have the right to appeal. The appeal issues and procedures may differ between MinnesotaCare and MA or GAMC. See Managed Care Appeals for further information.
For more information, see