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. It also offers 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 eight managed health care plans. These include Blue Plus, Hennipin Health, HealthPartners, Itasca Medical Care, Medica, PrimeWest Health, South Country Health Alliance, and UCare.
The major benefit of a managed care program for consumers is a single organization manages all their care needs. The major drawback is a lack of choice in service providers.
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 Parts A and B (for MSHO). One must also be eligible for Medicaid, which has both income and asset restrictions.
Income limits are set at 100% of the Federal Poverty Level (FPL). Minnesota uses the previous year’s FPLs until the end of their fiscal year on June 30 of each year. This means as of July 1, 2022 through June 30, 2023, single seniors cannot have a monthly income greater than $1,133. Married couples cannot have a monthly income greater than $1,527. 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, 2023, the spend down income limit after medical expense deductions is $1,133 for a single applicant and $1,527 for a married couple.
The asset limit is set at $3,000 for a single applicant. However, certain assets are considered exempt from this limit, such as an individual’s primary home (if the senior, or his / her spouse, lives in the home and the equity value is under $636,000), household items, personal effects, and a vehicle. It’s important that one does not give away assets or sell them for less than they are worth in an attempt to meet Medicaid’s asset limit. Medicaid has what is called a Look-Back Period, which is a 5-year period, in which Medicaid looks at all transfers of assets. If an applicant is found to be in violation of the look-back period, a period of Medicaid ineligibility may ensue.
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).
For persons who do not meet the financial eligibility requirements, it can be helpful to seek the services of a Medicaid planning professional.
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
- Interpreter Services
- Lab Work / X-rays
- 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. Those enrolled in MSC+ will not receive Medicare services or prescription drugs via Medicare Part D. For those enrolled in either MSHO or MSC+ and eligible for the Elderly Waiver, long-term home and community based services available via the Medicaid waiver are also included.
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. Information about MSHO can also be found on the MN Department of Human Services website.
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 live, click here.
