Information for Medical Assistance members who are not enrolled in a health plan
Most Minnesota Health Care Programs (MHCP) members are required to enroll in a health plan. Some members who have Medical Assistance (MA) coverage are not in a health plan. If you are not required to be in a health plan, the Department of Human Services (DHS) will pay for your health care services on a fee-for-service basis. More information about how this works and what you need to know is below.
Also, see the new member information page if you have questions that are not answered here.
Fee-for-service means your health care providers bill DHS for your health care services.
You will receive a Minnesota Health Care Programs (MHCP) member ID card in the mail. Always carry it with you. Show your member ID card and all other types of health care cards (Medicare, private health insurance through an employer) to all health care providers.
MHCP enrolls clinics, hospitals, pharmacies, doctors, dentists and many other health professionals. You must get care only from these enrolled providers or in-network providers. MHCP does not pay for services from non-enrolled or out-of-network providers.
There is limited coverage for services outside of Minnesota. Also, MHCP does not enroll providers located out of the United States. More details about coverage and limits are in the Benefits and services section below.
When you show the provider your member ID card and the provider delivers services, the provider sends the bill to MHCP for payment. MHCP sends you an explanation of benefits to show what was billed and any amounts you are responsible to pay for your services. The provider can then send you a bill requesting payment.
MHCP covers health care services and items that are medically necessary. Some services and items may require prior authorization. You may have to pay a portion of the cost of some services.
Here's more information about your MA coverage benefits and costs:
You may receive a bill if MHCP does not cover the service you received. See the MHCP member evidence of coverage for people not enrolled in a health plan for more information about non-covered services.
Providers may bill you for services that are never covered by MHCP. They must first tell you that the service is not covered. They must have you sign one of the forms below before providing the service.
Retroactive coverage to pay for service before coverage is approved
Retroactive coverage is when MHCP backdates the date your coverage begins. If retroactive coverage is approved, MHCP can pay for dates of service before coverage was approved.
Providers are not required to bill MHCP retroactively, however, many do.
To ask a provider to bill us for retroactive coverage dates:
Contact the provider
Give them your MHCP member ID number
Ask them to bill fee-for-service (some providers call this billing straight MA)
Retroactive pharmacy expenses
To request reimbursement for pharmacy expenses, give your receipts and MHCP member ID card to the pharmacy where you purchased your medications. If the pharmacy bills us and receives payment, they must give you a refund. Some pharmacies have a company policy that they cannot give refunds after a certain amount of time.
All MHCP providers may send in claims for services up to a year after the date of service. You may need to speak to a store manager or contact the pharmacy's corporate headquarters for transactions that are over a few weeks old.
You can go to the doctor before you are sick. Going to the doctor before you are sick will help you stay healthy and keep you from getting sick. This is called preventive care.
MHCP covers preventive care. It includes tests and doctor visits that spot health issues before they become problems. These services include:
Consider going to only one clinic. This will help your doctor get to know you and your family. You will also get to know the doctor, nurses and other clinic staff. They will have your health history and keep your medical records in one place.
Make a separate appointment for each person in your family.
Tell your clinic that you are an MHCP member.
Tell your clinic if you have any other insurance.
Write down the appointment date and time. Always call the clinic if you have to cancel (cannot get to the appointment).
If you are sick
If it is not urgent, call your clinic to make an appointment with your family doctor.
If you need immediate medical attention, but there is not a risk of permanent damage to your health, call your family doctor or usual clinic. They may make an appointment for you or ask you to go to an urgent care clinic. MHCP pays for visits to enrolled urgent care clinics.
If you have an emergency, call 911 or go to the nearest hospital. Here are some examples of emergencies:
Possible heart attack
Bleeding that won't stop
Trouble breathing
Poisoning
Unconscious or knocked out
Labor and childbirth
If you are pregnant
Make an appointment with a doctor as soon as you know you are pregnant, or think you are pregnant. Doctors who take care of pregnant women are called obstetricians.
Look for in-network providers in the MHCP Provider Directory. Select Physician Services in the main menu. On the next page, select Obstetrics/Gynecology in the sub-type menu. You can narrow your search by clinic, your county or ZIP code, or other options.
Get regular check-ups. See your doctor or nurse midwife when he or she asks to see you.
MHCP covers all related medically necessary services: prenatal vitamins, lab tests, ultrasounds, clinic visits, labor and delivery.
Childbirth education and breastfeeding classes are also covered.
MHCP covers breast pumps for mothers who are separated from their infant.
MHCP does not cover newborn circumcision unless there is a medical reason for it.
Health care homes (HCH) or medical homes is a care coordination service for members who have complex and chronic medical conditions. HCHs help provide timely access to resources and care. The primary care provider, member and member's family work together to improve:
Health outcomes
Health care experience
Affordable cost of care
Examples of conditions that may qualify for HCH services include:
Transportation and related travel services are covered when necessary for you to get to and from a covered health service. This may include personal mileage reimbursement, bus or taxi fare, use of volunteer drivers, bus/light rail, wheel chair and stretcher capable vehicles, meals, parking and lodging expenses.
Transport services always includes assistance to help you get into and out of the transport vehicle and to secure you while transported in the vehicle. It may also include assistance to and from the vehicle and your home or medical appointment check-in desk based on a physical or mental impairment.
Local County or Tribal Agency Services
Some transportation services you will be able to get are provided to you by the county or tribal human service agencies. You will need to contact your local agency for assistance and information about scheduling the rides you need.
Fee-for-service members who live in Anoka, Benton, Chisago, Dakota, Hennepin, Isanti, Mille-Lacs, Pine, Ramsey, Sherburne, Stearns, Washington or Wright county must contact MTM MNET at 651-645-3982 or 866-467-1724 for access transportation service.
(Effective Jan. 1, 2019) Fee-for-service members who live in Aitkin, Carlton, Lake or St. Louis county must contact MTM MNET at 844-399-9466 for local agency NEMT and related ancillary services. Members in Carver and Scott counties must contact Smart Link at 952-496-8341.
Local agencies cannot guarantee rides to scheduled appointments with less than three business days' notice. MNET staff and county and tribal workers will do their best to arrange transportation for urgent care and appointments that the provider changed. MHCP cannot guarantee transportation to appointments without adequate notice.
Call the Member Help Desk to ask whom you should talk to about help with transportation.
For emergencies, call 911. They will send an ambulance to take you to the emergency room at the hospital.
State Coordinated Transportation Services
Some transportation services are provided by companies (transportation providers) who work directly with you to schedule your transports. Some members who are unable to use buses, taxis or volunteer drivers — because they require wheelchair, scooter, or stretcher transport — will need to contact these providers directly to schedule transports.
Determining the correct level of transport
To set-up your fee-for-service rides you will need to contact your local county or tribal agency for the transports. In some situations if you need direct assistance getting from your home or pick-up location and the medical facility, or if you require wheelchair, scooter or stretcher rides, you will need to obtain a level-of-service (LOS) certification from the State medical review agent, KEPRO.
If you need these transportation services you will need to contact KEPRO for a level-of-service (LOS) assessment to determine the level of transport you will be certified for. You will need to complete this process yourself but may be assisted by local agency and/or medical staff famaliar with your condition(s). Contact KEPRO at 612-354-5589 or 866-433-3658 to complete the LOS process.
It is important to understand the information your doctor gives you. If you do not speak the same language as your doctor, your clinic must provide a person to explain the information the doctor tells you in the language you speak. This person is called an interpreter. If you need an interpreter at your medical appointment, tell the person you talk to at the clinic. Your clinic may also be able to give you written information in your own language.
If you ask for an interpreter and your provider does not provide an interpreter, contact the MHCP Member Help Desk.
To request an interpreter
Notify the provider that you will need an interpreter for the appointment. Be sure you give the provider a reasonable amount of time to arrange for an interpreter.
All providers are required to provide language interpreter services for all patients who are deaf or hard of hearing or have limited English proficiency. Providers are responsible for arranging the interpreter service and paying the interpreter. They may bill us for the interpreter's services.
Sign language interpreter services may be provided using a video relay.
International language interpreter services may be provided over the phone.
Complaints about interpreter services
Hospital and clinics hire their own interpreters. If you have a concern or complaint about an interpreter, report it to the provider, clinic or hospital. Talk to the patient representative, the clinic director or hospital manager.
