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 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.

Top of Page

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

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. Koloski

Alexandria

Essentia Health Walker
Marsha Krisko

Walker

Family Tree Clinic
Amy Gilbert, Barbara Peterson

St. Paul

Glacial Ridge Health System
Kari Manthei

Glenwood

Glencoe Regional Health Services
Barbara Seipel

Glencoe

Gundersen Clinic, Ltd.
Patricia A. Kohn

LaCrosse, WI

HCMC Whittier Clinic
Kevin A. Ball, Jodi Kaiser

Hennepin County Medical Center
Riki Ann Bredenberg, Jean Peters

Minneapolis

Innovis Health Care
Naomi Hagen

Fosston

Lake City Medical Center
Rita Rabehl

Wabasha

Lake Superior Community Health Center
Jessica Crowley, John Herbertz

Duluth

Lakewood Clinic/Greater Staples Hospital
Julie Goff

Staples

Madelia Parkview Clinic
Audrey J. Welchin

Madelia

Mayo Clinic
Denise Ring

Rochester

Mid-Minnesota Family Medicine Center
Pam Siewert, Shar Wallack

St. Cloud

Migrant Health Service, Incorporated

Sandra Rangel, Bonnie Raddatz, Thare Ilift, Lori Boike, Mary T. Stetzel

Wilmar

Northland Ob-Gyn Associates
Nancy Rubin

Duluth

Northpoint Health and Wellness Center
Dal (Dia) Xiong

Minneapolis

Olmsted Medical Center
Susan J. Baker

Rochester

Open Door Health Center
Lisa M. Proehl

Mankato

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

Owatonna

Pipestone County Medical Center

Pipestone

Sanford Health
Laura Potthoff

Jackson

Sanford Clinic - Pelican Rapids
Rita A. Cowie

Pelican Rapids

St. Cloud Hospital
Cindy Hilden

St. Cloud

St. Croix Family Medical Clinic

Leon Nesvacil, Milan Za

Stillwater

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

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

Top of Page