***This version of the Health Care Programs Manual has been replaced and is no longer in effect. Please see the current Health Care Programs Manual for policy in effect as of December 1, 2006.***
The terminology used to describe people with disabilities has changed over time. The Minnesota Department of Human Services ("Department") supports the use of "People First" language. Although outmoded and offensive terms might be found within documents on the Department's website, the Department does not endorse these terms.
MDHS Health Care Programs Manual (Eligibility Policy through 11/30/06)
Chapter 0918 - Other Related Programs
All chapters are numbered beginning with 09. The first chapter is 0901 (Table of Contents).
Chapter 09180918 / OTHER RELATED PROGRAMS / PDF(s): Jan 02
0918.03 / LONG TERM CARE CONSULTATION (LTCC) / PDF(s): Jan 02
0918.05 / ALTERNATIVE CARE - AC / PDF(s): Jun 02
0918.07 / CHILD & TEEN CHECKUPS - C&TC / PDF(s): Nov 00
0918.09 / HILL-BURTON ACT / PDF(s): Mar 99
0918.11 / MINNESOTA COMPREHENSIVE HEALTH ASSOCIATION / PDF(s): Jan 06 | Mar 99
0918.13 / MINNESOTA CHILDREN WITH SPECIAL HEALTH NEEDS / PDF(s): Jan 05 | Jul 01
0918.15 / HIV/AIDS PROGRAMS / PDF(s): Aug 04
0918.17 / FOOD STAMPS AND RELATED PROGRAMS / PDF(s): Mar 99
0918.19 / WOMEN, INFANT, AND CHILD (WIC) AND MAC / PDF(s): Mar 99
0918.21 / SCHOOL LUNCH PROGRAM / PDF(s): Mar 99
0918.23 / DHS CASH ASSISTANCE PROGRAMS / PDF(s): Oct 02
0918.25 / FAMILY SUPPORT GRANT PROGRAM / PDF(s): Mar 99
0918.27 / CONSUMER SUPPORT GRANT PROGRAM / PDF(s): Mar 99
0918.29 / WORKERS' COMPENSATION / PDF(s): Mar 99
0918.31 / VETERANS' BENEFITS / PDF(s): Mar 99
0918.33 / UNEMPLOYMENT INSURANCE / PDF(s): May 01
0918.35 / REPATRIATION PROGRAM / PDF(s): Mar 99
0918.37 / TELEPHONE ASSISTANCE PLAN - TAP / PDF(s): Mar 99
0918.39 / SOCIAL SERVICES / PDF(s): Mar 99
0918.41 / PUBLICLY ASSISTED HOUSING / PDF(s): Mar 99
0918.43 / LOW INCOME HOME ENERGY ASSISTANCE PROGRAM / PDF(s): Mar 99
0918.45 / CHILD CARE SUBSIDY FUNDS / PDF(s): Mar 99
0918.47 / RELATIVE CUSTODY ASSISTANCE PROGRAM / PDF(s): Mar 99
OTHER RELATED PROGRAMS 0918
Clients may be eligible for other programs to help with medical care or maintenance needs. Give clients information about programs that may meet their needs.
Some programs are administered by DHS or county agencies. Others are administered by other local, state, or federal government agencies or by other entities.
See §0911.09.15 (Income From RSDI and SSI) and §0910.05.05 (Medicare Premium Payment) for information on programs administered by the Social Security Administration.
See the following sections for information on health programs that may help clients meet some of their medical needs:
§0918.03 Long Term Care Consultation (LTCC)
§0918.05 Alternative Care - AC
§0918.07 Child and Teen Checkups - C&TC
§0918.09 Hill-Burton Act
§0918.11 Minnesota Comprehensive Health Association
§0918.13 Minnesota Children with Special Health Needs
§0918.15 HIV/AIDS Programs
See the following sections for information on programs that may help clients meet their nutritional needs:
§0918.17 Food Stamps and Related Programs
§0918.19 Women, Infant, and Child (WIC) and MAC
§0918.21 School Lunch Program
See the following sections for information on programs that may help clients with maintenance needs or provide financial assistance for specific expenses. Some of these programs may help with medical needs as well.
§0918.23 DHS Cash Assistance Programs
§0918.25 Family Support Grant Program
§0918.27 Consumer Support Grant Program
§0918.29 Workers' Compensation
§0918.31 Veterans' Benefits
§0918.33 Reemployment Insurance
§0918.35 Repatriation Program
§0918.37 Telephone Assistance Plan - TAP
§0918.39 Social Services
§0918.41 Publicly Assisted Housing
§0918.43 Low Income Home Energy Assistance Program
§0918.45 Child Care Subsidy Funds
§0918.47 Relative Custody Assistance Program
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Long Term Care Consultation (LTCC) 0918.03
The purpose of the Long Term Care Consultation (LTCC) program is to prevent inappropriate nursing or certified boarding care facility placements. Everyone seeking admission to a nursing or certified boarding care facility must be screened before admission regardless of pay or source.
Refer people seeking admission to a nursing home or certified boarding care facility to the county LTCC team. The county LTCC team will determine whether the person needs a nursing home or certified boarding care facility level of care by assessing the person's health and psychosocial needs. The team must inform people of available alternatives to institutionalization and recommend either a facility placement or community-based care. The person may choose between community-based and facility care. However, MA will not pay for nursing or certified boarding care for people who choose to enter a facility when the county LTCC team has determined that the person does not meet nursing/boarding facility level of care criteria. The LTCC team enters this risk status on the LTC Screening Document.
Verify that MA applicants or enrollees have either had or are exempt from LTCC screening before admission. MA will not pay for nursing facility or certified boarding care services received before the LTCC date indicated on the LTC Screening Document.
People who refuse long term care consultation or who are not determined to be at risk or in need of a nursing or certified boarding facility level of care may not receive:
· MA nursing or certified boarding care facility services.
· Waivered services provided under EW, CADI, and the TBI-nursing facility waiver which are designed to provide community alternatives to facility care. See §0907.23.11 (MA Waiver Programs: EW), §0907.23.03 (MA Waiver Programs: CADI), and §0907.23.13 (MA Waiver Programs: TBI).
These people may receive other MA services such as home care.
LTCC screening and completion of the LTC Screening Document are also required for people at risk of long term hospital placement to receive services through CAC or the TBI Neurobehavioral waiver and for people requesting services through AC. See §0907.23.07 (MA Waiver Programs: CAC), §0907.23.13 (MA Waiver Programs: TBI), and §0918.05 (Alternative Care - AC).
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ALTERNATIVE CARE - AC 0918.05
Alternative Care (AC) provides funding for home and community-based services for people who would otherwise need nursing facility care. People who are enrolled in or would be eligible for MA without a spenddown or EW waiver obligation are not eligible for AC. People who would be eligible for SIS-EW but choose AC are not eligible for MA at the same time (except for eligibility during a retroactive period and while MA is pending as described in §0913.13.07 (Relationship Between AC and SIS-EW). People whose income exceeds the SIS may be eligible for AC and MA with a spenddown. See §0907.23.11 (MA Waiver Programs: EW) and §0913.21 (Allowable Medical Bills to Meet Spenddown). People can receive AC and QMB, SLMB, QI and/or PDP at the same time. See §0907.21.09 (Medicare Supplement Programs).
· Adult day care
· Respite care
· Homemaker services
· Adult foster care (other than room and board costs)
· Home health aide
· Case management
· Equipment and supplies
· Nutrition service
· Assisted living and assisted living plus
· Chore service
· Home health nursing
· Transportation
· Home-delivered meals
· Companion services
· Caregiver training and education
· Environmental modifications
· Private duty nursing
· AC cash grant
· AC discretionary services
· Residential care
· Personal care services
To receive Alternative Care funding for home and community-based services, a person must meet all the following conditions:
· Go through a long term care consultation (LTCC).
· Require a nursing facility level of care (NF-I or NF-II), as determined by the LTCC team.
· Be age 65 or older.
· Be able to remain in the community rather than a nursing facility, as determined by the LTCC team.
· Choose community care.
· Community care will cost less than 75% of the average monthly MA payment for nursing home care.
· Would meet the financial requirements for MA within 180 days of entering a nursing facility as determined by a case manager under the lead agency for the local AC program.
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CHILD & TEEN CHECKUPS - C&TC 0918.07
The Child and Teen Checkups (C&TC) Program is Minnesota's name for the federal Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. C&TC promotes early and preventive health care for children through comprehensive screening for health problems at an early stage. This allows treatment before the problem becomes more serious and expensive to treat. Children from birth to age 21 who are eligible for MinnesotaCare or MA are eligible for the C&TC Program. Participation on the part of the children/families is voluntary.
C&TC includes an administrative services component (outreach and follow-up). County agencies may choose to provide the administrative services directly OR they may contract with another agency for these services. The agency that provides administrative services (either the county agency or a contracted agency) is the county C&TC agency.
Federal regulations require the state to have an 80% participation rate for children eligible for C&TC screening. County C&TC agencies must make the initial contact with eligible children and their families to provide information about the purpose and benefits of the program. County C&TC agencies must also inform families that support services such as transportation, interpreter services, and appointment scheduling assistance are available. If the family needs support services, C&TC agencies must obtain the request orally or in writing. The C&TC agency must enter this information into the CATCH II electronic tracking system to allow county C&TC coordinators to assist with support services when needed.
County C&TC agencies receive lists of newly eligible MA and MinnesotaCare children from MMIS. The C&TC agency contacts the families to offer services and determine if the family wishes to participate. Financial workers and enrollment representatives who have contact with families during the application process are encouraged to inform families that C&TC is a benefit of the MA and MinnesotaCare programs and that the county C&TC agency will contact them with more information.
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HILL-BURTON ACT 0918.09
Congress passed the Hill-Burton Act in 1964. This Act gives hospitals and other health facilities money to build and remodel. Facilities which receive these funds agree to provide a limited amount of services to people who cannot pay for health care.
Hill-Burton facilities choose the type of services to provide at no or reduced charge. They do this in an annual allocation plan. Because of this, services provided vary among facilities. The facility where people apply for the program will tell them what types of free or reduced charge services it provides, and what income levels qualify for the program.
People may apply for Hill-Burton funds before or after they receive care (including bills for care already sent to a collection agency). They may apply at any Hill-Burton assisted facility, including hospitals, nursing homes, and clinics.
Tell people who are not eligible for MA, GAMC, EMA, or EGAMC about the Hill-Burton program. People who are eligible for MA or GAMC with a spenddown may also be eligible for Hill-Burton funds for all or part of the spenddown amount. However, any expenses covered by Hill-Burton funds before MA or GAMC is approved may not be used to meet a spenddown.
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MINNESOTA COMPREHENSIVE HEALTH ASSOCIATION 0918.11
The Minnesota Comprehensive Health Association (MCHA) provides health insurance to people who have been turned down for individual coverage in the private market. To be eligible, people must have been Minnesota residents for at least 6 months before making application. They must provide proof of denial of private coverage within the past 6 months unless they have been treated for certain presumptive conditions within the past 3 years.
MCHA often has high premiums as well as deductibles and co-pays. People most likely to benefit from MCHA are those who are ineligible for any of the Health Care Programs because of income or assets who have pre-existing medical conditions that prevent private coverage. Some people with large spenddowns may benefit from MCHA. Some people may have a 6-month waiting period before MCHA will cover certain pre-existing conditions.
Refer people who are interested in applying or receiving more information to MCHA's customer service line at 1-866-894-8053 or 651-456-5290, or 651-456-8700 for TTY.
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MINNESOTA CHILDREN WITH SPECIAL HEALTH NEEDS 0918.13
Minnesota Children with Special Health Needs (MCSHN) is administered by the Minnesota Department of Health.
MCSHN provides an information and referral telephone line for families, teachers, social workers, and others to help identify and locate resources and services for children with special health needs and their families.
Refer interested families to MCSHN at 651-215-8956 or 1-800-728-5420.
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HIV/AIDS PROGRAMS 0918.15
DHS has several programs to help people with HIV gain access to medical care. The programs are open to residents of St. Croix and Pierce counties in Wisconsin as well as to Minnesota residents. All of the programs have an income limit of 300% FPG and a cash asset limit of $25,000.
The HIV/AIDS insurance program pays medical and dental insurance premiums for eligible people, including COBRA extension policies, Medicare supplement policies, and private coverage. People are not eligible if they have insurance for which an employer pays more than 50% of the premium.
The HIV/AIDS drug reimbursement program pays the patient's portion of the cost of many major drugs used to treat or prevent HIV-related conditions. People must be uninsured or insured with a drug co-payment. MA, GAMC, and MinnesotaCare enrollees are not eligible.
The HIV/AIDS dental program pays for routine preventive and restorative dental care. MA and GAMC enrollees and people with dental insurance are not eligible.
The HIV/AIDS nutrition program pays up to $50 per month for enteral nutritional supplements and generic multiple vitamins, and Lactaid prescribed by a physician. People are not eligible if they can receive these products through MA, GAMC, or MinnesotaCare.
Refer people who want to apply or receive more information to:
HIV/AIDS Programs
Dept. of Human Services
444 Lafayette Road
St. Paul, MN 55155-3872
651-297-3344 or
1-800-657-3761
Applications are also available at many community and clinic-based sites serving people with HIV.