Minnesota Medicaid Senior Health Options (MSHO) & Senior Care Plus (MSC+) Programs

 

Program Description

For Minnesotans who require long term care (either in their home or in a residential setting), the state has a Medicaid program called Medical Assistance. Medical Assistance (MA) is a managed Medicaid program. This means that the state has contracts with managed care organizations (MCOs), which are often simply referred to as “health plans.”

Eligible seniors receive Medicaid benefits and all their medical services through their chosen health plan. Currently, Minnesota has two statewide options that are relevant to elderly individuals under the Minnesota Managed Care Program: Minnesota Senior Care Plus (MSC+) and Minnesota Senior Health Options (MSHO).

MSC+, previously called the Minnesota Senior Care Program, offers short-term care for serious injuries or illnesses, as well as long-term care, such as in-home assistance and up to six months of nursing home care for frail, low- income seniors. This nearly doubles the amount of covered nursing home care allowed under just Medicare.

MSHO, also known as “Dual Demo,” combines both Medicaid and Medicare services for eligible seniors. The benefits and services offered under this health plan are like MSC+, with the exception that enrollees in this plan also receive all their Medicare benefits (this includes Part D for prescription drugs) under this option.

Both MSC+ and MSHO options are managed by the Minnesota Department of Human Services and the seven managed health care plans: Blue Plus, HealthPartners, Itasca Medical Care, Medica, PrimeWest Health, South Country Health Alliance, and UCare.

The major benefit of a managed care program to the consumer is a single organization manages all their care needs. The major drawback is a lack of choice in service providers. Some Minnesota seniors may prefer to receive care services under the state’s Elderly Waiver.

Eligibility Guidelines

To be eligible for MSC+ or MSHO, one must be a resident of Minnesota, at least 65 years of age, and be eligible for Medicare. One must also be eligible for Medicaid, which has both income and asset restrictions.

Income limits are set at 100% of the Federal Poverty Guideline (FPG). Minnesota uses the previous year’s FPGs until the end of their fiscal year on June 30, 2017. This means seniors cannot have a monthly income more than $990, or on or after July 1, 2017, not more than $1005. It’s important to note that Minnesota is what is considered a “spend down” state. This means that applicants can spend down excess monthly income on reoccurring medical or care services to be eligible for Medicaid. Until June 30, 2017, the spend down income limit after medical expense deductions is $792.

The asset limit is set at $3,000. However, certain assets are considered exempt from this limit, such as an individual’s primary home (if the senior lives in the home and it is valued under $560,000), household items, personal effects, and a vehicle.

The main difference between eligibility requirements between MSC+ and MSHO is that, to be eligible for MSHO, seniors must not only be eligible for Medicaid, but must also be enrolled in Medicare (Part A & Part B).

 

Benefits and Services

Eligible seniors receive a variety of benefits and services through MSC+ and MSHO, which may include the following:

  • Acute care
  • Care Coordination
  • Doctor / Dentist Visits
  • Durable Medical Equipment
  • Hospital / Emergency Room Care
  • In-home care (homemaker / personal care services)
  • Nursing Home Care (up to 6 months)
  • Prescription Drugs
  • Private Duty Nursing / Home Health Aide
  • Transportation

Seniors enrolled in MSHO, will also receive Medicare services via their health plan, while those enrolled in MSC+ will not receive Medicare services or prescription drugs via Medicare Part D.

 

How to Apply / Learn More

For more information about MSC+ and MSHO, contact your local Department of Human Services office.  Click here to find your local office and their corresponding phone number. One can also call the Senior LinkAge Line at 800-333-2433.

To apply for the MSHO option, one must contact a MSHO managed health plan in their county. To see which health plans serve your area, click here

To see the available health plans for MSC+ for the county in which you reside, click here