Presumptive Eligibility Providers for MA-BC (Archive)

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 or cervical cancer or a precancerous condition.

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.

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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.

Presumptive Eligibility Providers

City

Affiliated Medical Center
Jerrie Dodge

Willmar

Allina Medical Clinic
Mary Olmscheid

Buffalo

Altru Clinic
Carrie Bergquist

Crookston

Austin Medical Center

Austin

Bloomington Public Health/Sage Women's Clinic
Patricia A. Heil, Karen Stanley, Janet Watchman

Bloomington

Broadway Medical Center
Karen L. Koski

Alexandria

Central Ave. Clinic
Shannon Culver

Minneapolis

CommonHealth Clinic
Joan F. Oien, Mary Sandgren

Stillwater

Dakota Clinic
Marsha Krisko

Walker

ELEAH Medical Center
Lydia Carlson, Billie J. Smith

Elbow Lake

Family Tree Clinic
Amy Gilbert, Barbara Peterson

St. Paul

Fergus Falls Medical Group
Mary Casper, Carol Johnson

Fergus Falls

Glacial Ridge Health System
Kari Manthei

Glenwood

Glencoe Regional Health Services
Barbara Seipel

Glencoe

HCMC Family Medical Center
Kevin A. Ball, Beth Johnson, Jodi Kaiser, Marie Maes-Voreis

Hennepin County Medical Center
Mary E. Peterson, CANP

Minneapolis

Lake City Medical Center
Rita Rabehl

Wabasha

Lake Superior Community Health Center
Christine Sandal

Duluth

Lakewood Clinic/Greater Staples Hospital
Julie Goff

Staples

Madelia Parkview Clinic
Audrey J. Weldlin

Madelia

Mayo Clinic
Denise Ring

Rochester

Meritcare Clinic - Pelican Rapids
Rita A. Cowie

Pelican Rapids

Mid-Minnesota Family Medicine Center
Pam Siewert, Shar Wallack

St. Cloud

New Ulm Medical Center
David Jones

New Ulm

Northland Ob-Gyn Associates
Nancy Rubin

Duluth

Northpoint Health and Wellness Center
Angelique Brown, Dal (Dia) Xiong

Minneapolis

Olmsted Medical Center
Susan J. Baker

Rochester

Open Door Health Center
Lisa M. Rochl

Mankato

Owatonna Clinic/MHS
Delores Kubicek, Cynthia Oleson, Marilyn Styndl

Owatonna

Pipestone County Medical Center

Pipestone

Planned Parenthood MN/SD
Heidi M. Olson

Alexandria

Planned Parenthood MN/SD
Amy Shepard

Burnsville

Planned Parenthood MN/SD
Cathy Sandmann

Mankato

Planned Parenthood MN/SD
Kristin Goff, Amy Kabore, Patti Morrison, Michelle Rach, Kari Reinbold

Minneapolis

Planned Parenthood MN/SD
Sara Meincke, Mia Rauenhorst

Rochester

Planned Parenthood MN/SD
Judy Huebner

St. Cloud

Regina Medical Group

Hastings

St. Cloud Hospital
Cindy Lanars

St. Cloud

St. Paul-Ramsey County Department of Public Health
Carol Ball, Norma Cheesebrow, Sheila Pelzel, Mary Sonnen

St. Paul

Stevens Community Medical Center
Jody Melchert, Sharon Nelson, Rolinda Sanders

Morris

United Family Practice Health
Joyce Osborne

St. Paul

West Side Community Health Services
Mary C. Nesvig

St. Paul

Western OB/GYN
Marge Goodroad, Janice Keller

Waconia

White Earth Health Center
Julie Heisler, Bev Robbins

Ogema

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