*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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: March 1, 2013 |
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02.05 - Hierarchy of Health Care Programs |
Archived: June 1, 2016 (Previous Versions) |
The primary Minnesota Health Care Programs are MinnesotaCare and Medical Assistance (MA). When people submit an application for Minnesota Health Care Program coverage, they may meet the eligibility criteria one or both of these primary programs.
There may be a hierarchy to consider in determining which health care program is best for each applicant. In addition, applicants may request a specific health care program. The HCAPP allows applicants to choose to apply for all health care programs or for MinnesotaCare only. This is called ”informed choice”. Their choice dictates which of the primary health care programs should be considered, and in what order. See Informed Choice for more information.
People may be enrolled in only one of the two primary health care programs (MA or MinnesotaCare) at a time, with a few exceptions. For further information, see Programs Overlap.
People who qualify for Medicare may also qualify for the Medicare Savings Programs. See that section of the manual for further information about those programs.
There are five major programs within MinnesotaCare. Each major program has a system code used to identify the correct benefit set for the applicant or enrollee, and whether DHS will receive Federal Financial Participation (FFP). See MinnesotaCare Major Program Eligibility Type (MPET) for more information.
There are several different Medical Assistance (MA) major programs. These major programs also use system codes to identify the correct benefit set and whether DHS will receive FFP.
l Medical Assistance (MA) (major program MA) is funded by both federal and state dollars, and is the Minnesota Health Care Program that provides the most covered services.
l Emergency Medical Assistance (EMA) (major program EH) is funded by both federal and state dollars. However, it is available only for some noncitizens that have a medical emergency, and does not cover all of the services otherwise covered by MA.
l Refugee Medical Assistance (RMA) (major program RM) is funded entirely by federal dollars, and provides up to eight months of MA coverage for some refugees who are otherwise ineligible for MA.
l State-funded Medical Assistance (major program NM/GS) is funded entirely by state dollars and provides all MA-covered services for people who receive services from the Center for Victims of Torture.
l CHIP-funded Medical Assistance for Pregnant Women (major program NM/PC) is funded by both state and federal dollars and provides all MA-covered services for pregnant women who are ineligible for federally funded MA due solely to immigration status.
l Some people with an MA basis of eligibility are ineligible for MA when they are admitted to an Institution for Mental Diseases (IMD). These people may be eligible for major program IM, which is a state-funded MA program that does not include nursing home coverage.
Consider the following factors when determining the best health care program for an applicant or enrollee:
l Which program will provide the most covered medical services with the minimal amount of cost-sharing or lowest spenddown obligation? See Medical Assistance (MA) Copays and Family Deductible (DHS-3723) for information on the five-percent cap on cost-sharing.
l Will the state of Minnesota receive FFP for the applicant's or enrollee's health care costs under a given program?
l What agency received the application for health care coverage? If an applicant applies for health care on a form that does not contain the informed choice question, county agencies will generally determine eligibility for MA first; MinnesotaCare Operations at DHS will generally determine eligibility for MinnesotaCare first. See Where to Apply for further information. Follow the processing instructions in Informed Choice if the applicant applies for health care on a HCAPP that contains the informed choice question.
l Does the client have a choice between programs or bases of eligibility within one of the primary health care programs? Some people may qualify for more than one MA basis of eligibility. See Multiple Bases of Eligibility for further information.
The usual major program hierarchy for MA should be:
1. Medical Assistance (MA).
2. Emergency Medical Assistance (EH).
3. Refugee Medical Assistance (RM).
4. State-funded Medical Assistance (NM, IM).
5. Minnesota Family Planning Program (MFPP).
For MinnesotaCare (major programs BB, FF, JJ, KK, LL), no hierarchy is needed. People will fit into only one of the five major programs due to the income and other eligibility criteria.
For more information about the specific eligibility criteria for each program, see Eligibility Groups and Bases of Eligibility.