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Effective: December 1, 2006 | |
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28.10.10.10 - Minnesota Senior Health Options (MSHO) |
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Minnesota Senior Health Options is a voluntary managed health care program that combines and services for some Medical Assistance (MA) enrollees who are age 65 or older. Federal waivers allow DHS to purchase both Medicare and Medicaid services in the same contract.
Note: Managed care enrollees who are age 65 or older who do not choose to enroll in MSHO are enrolled in Minnesota Senior Care (MSC), or MSC Plus.
This section gives a general overview of the program. Refer to DHS bulletin #06-21-05 (Minnesota Senior Health Options Expansion Update) for further information. For a client-oriented overview of MSHO, see the DHS website.
Waiver Obligations and Spenddowns.
MSHO integrates primary, acute, and long-term care services for people who enroll in the option. A key feature of MSHO is the care coordinator (a nurse, nurse practitioner, or social worker) who is the enrollee’s contact person for help in navigating the health care system and in getting needed services across all care settings.
In addition to the standard MA benefits (sometimes referred to as “state plan services”), the MSHO also provides the following services for eligible enrollees:
l Elderly waiver services.
l 180 days of nursing facility services.
Note: If an MA enrollee resides in a nursing facility on the effective date of enrollment in Minnesota Senior Health Options (MSHO), the nursing facility per diem is not a covered service through the MCO. If a person covered by MA enrolls in MSHO while living in the community and later enters a nursing facility, the MCO is responsible for payment of the nursing facility services for 180 days.
l Medicare services (including Part D). Each MSHO organization contracts directly with the for all Medicare services.
MSHO enrollment is voluntary. People who are eligible for MA may enroll in MSHO if they meet all of the following:
l Are age 65 or older.
l Are MA-eligible, with or without Medicare.
Note: If they are Medicare-eligible, they must have both Part A and Part B to enroll in MSHO.
l Reside in a county where MSHO is available. This includes all counties except for the four fee-for-service counties: Beltrami, Clearwater, Hubbard, and Lake of the Woods.
Waiver Obligations and Spenddowns
People who are eligible for the elderly waiver (EW) and have waiver obligations The amount of income over the maintenance needs allowance that people eligible for SIS-EW must contribute toward the monthly cost of waiver services. may enroll in MSHO. Prior to June of 2005, MSHO enrollees were required to pay their full obligation directly to DHS on a monthly basis, which limited MSHO enrollment to only those who met their full waiver obligation every month.
People with medical spenddowns who are not currently enrolled in MSHO may not enroll. However:
l People who are enrolled in MSHO and had medical spenddowns prior to July 1, 2005 were allowed to stay enrolled in MSHO.
l People who are enrolled in MSHO and then acquire a medical spenddown may choose to stay enrolled in MSHO.
The following enrollees are currently excluded from participating in MSHO:
l People who have Medicare but are not eligible for MA.
l People who have MA and Medicare, but only Part A or Part B (not both).
l People eligible for the Refugee Assistance Program.
l Residents of , unless the MCO approves the placement.
l People who are , but not eligible for MA.
l People who are , but not eligible for MA.
l People who have Medicare coverage through United Mine Workers.