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Effective: December 1, 2006 |
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28.15.05ar1 - Managed Care Enrollment - MinnesotaCare (Archive) |
Archived: June 1, 2009 |
The managed care enrollment process for MinnesotaCare is done through the mail and is generally an automated process. When MinnesotaCare coverage is approved as pending awaiting pending awaiting payment Medicaid Management Information System (MMIS) automatically chooses a default health plan and generates a health plan enrollment form.
Automatic Versus Manual Enrollment.
The default health plan (or managed care organization) is the plan the MinnesotaCare household will be enrolled in if they fail to choose a health plan. The default plan is determined by the following criteria:
l If anyone in the household is enrolled in managed care through MA or GAMC, the default plan is the plan the MA or GAMC client is enrolled in unless that plan is not available through MinnesotaCare.
Note: If more than one household member is enrolled through MA or GAMC in different health plans, the system will select the first plan that is available to MinnesotaCare as the default plan.
l If no one in the household is enrolled in managed care through MA or GAMC but anyone in the household has previously been enrolled in managed care through MinnesotaCare, the default plan is the plan in which they were previously enrolled if that plan is still available.
l If neither of the above circumstances applies, MMIS assigns a default plan based on the plans available in the household’s county of residence.
MMIS sends the household a health plan enrollment packet (in addition to the premium notice packet). The health plan enrollment packet includes an enrollment form, letter, guide to managed care enrollment, and other materials. See the PMHCP manual, section 2.01, for detailed information about this packet.
Automatic Versus Manual Enrollment
If the household returns the enrollment form before the date that capitation payments are made to the health plans for the next month, MMIS is updated to show the household’s health plan choice. The capitation date is usually six business days before the end of the month.
Note: After the 15th of the month, there may not be time to enter the information before capitation. Refer the household to their MinnesotaCare worker to complete a manual enrollment form to ensure enrollment in the plan of their choice for the next month.
If the household has been found eligible but there is no enrollment information entered as of the capitation date, either because the household has not returned the form, or, returned it after the 15th and the worker did not complete the manual enrollment process, MMIS will enroll the household in the default plan.
Note: If new enrollment information is entered before the next capitation date, MMIS will enroll the household in the plan of their choice beginning the following month. See Health Plan Changes.
Example:
John is approved for coverage awaiting payment on October 3.
l MMIS mails John a health plan enrollment packet on October 5. MMIS also selects UCare as John’s default plan.
l John returns his premium payment and enrollment form on October 22 indicating HealthPartners as his choice of plan.
l However, there is not time to manually process his enrollment form before capitation on October 23, and he will be enrolled in UCare for November.
Action:
Switch John's enrollment to HealthPartners beginning December 1.
If MinnesotaCare is approved after capitation but before reinstatement (the last business day of the month), the household must choose a health plan by the reinstatement date. Otherwise, MMIS will enroll the household in the default plan.