Managed Health Care Options

If you qualify for a public health care program [Medical Assistance (MA), General Assistance Medical Care (GMAC), or MinnesotaCare], you should choose a health plan (see below) to receive health care services. Most plans will also ask you to choose a primary clinic.

Contact

• Managed Health Care Advocates
• Enrollment and Advocate Line 612-596-8860

Frequently Asked Questions

I haven't applied for a public health care program yet, how do I apply?

When can I go to the doctor?

I am disabled; do I have to sign up for managed health care?

I am already in an HMO.

If I don't want to choose a health plan, can I just stay on straight Medical Assistance (MA)?

I need to choose a health plan for my children and I want them to go to their current clinics. They don't all accept the same insurance.  What can I do?

Can I change my health plan if I decide I don't like it? 

What do I do if I receive medical bills for services the health plan should be covering?

The health plan has denied my request for a particular medical service.  What can I do?

Who can help with problems and questions?

Q:  I haven't applied for a public health care program yet, how do I apply? 

A:  See How to Apply. Complete a Combined Application Form (CAF) that includes other financial support or the Health Care Application (HCAPP) for medical coverage only. Contact hs.bp.unit@co.hennepin.mn.us or 612-596-1300. 

Q: When can I go to the doctor? 

A: Once you get access to MA or GAMC, it can take several months to get enrolled in a health plan.  In the meantime, you (and those who don't need to choose a health plan - see below) can have fee-for-service medical assistance.  This means you can go to any health provider that accepts MA or GAMC, and the provider will bill the state directly.  Note: This does not apply to MinnesotaCare. 

Once you are enrolled in a health plan, you must get all medical care approved by that plan.  If you go somewhere else without approval, you will have to pay the bills.  If you have questions about your health plan, call the health plan (see the phone numbers above) or call the Hennepin County Managed Health Care Office 612-596-8860.

Q: I am disabled; do I have to sign up for managed health care?

A: Some people receiving MA or GAMC may not have to sign up for a managed health care plan, such as those who are disabled and under 65 years old.

Q: I am already enrolled for health coverage in an Health Maintenance Organization (HMO). 

A: If you have private coverage through a state-certified HMO, you may choose not to participate in a health plan to receive MA or GAMC.  If you do not want to sign up for a health plan (above), there may be other options.

Q: If I don't want to choose a health plan, can I just stay on straight Medical Assistance (MA)?

A: Probably not because most Medical Assistance recipients are required to participate in managed care.  There are some exceptions, and these are discussed in detail in the managed Health Care presentations at application sites.

Q: I need to choose a health plan for my children and I want them to go to their current clinics. They don't all accept the same insurance.  What can I do?

A: You can choose a different health plan for each child.  You will need to verify which plan each clinic accepts and then choose accordingly.

Q: Can I change my health plan if I decide I don't like it? 

A: Yes, you may change your heath plan at any time during the first 12 months you are in the managed health care plan.  After the first year, you can only change health plans once a year during open enrollment period which begins in November. Open enrollment changes are effective the first of January of the next year.

Q: What do I do if I receive medical bills for services the health plan should be covering?

A: When you are enrolled in a health plan you must receive all your medical services through the primary clinic or have a referral from the primary doctor to go outside of the health plan network for medical services.  Most billing problems are the result of not following this rule.  Billing problems should be referred to the Managed Health Care Advocate at 612-596-8860 for investigation.

Q: The health plan has denied my request for a particular medical service.  What can I do?

A: Your first step is to contact a Managed Health Care Advocate at 612-596-8860 for assistance.  They will contact your doctor to determine medical necessity and negotiate with the health plan.  If this does not generate satisfactory results, the advocate will assist you in filing an appeal to the State of Minnesota and represent you in the appeal hearing if you so desire.

Q: Who can help with problems and questions? 

A: The Hennepin County Managed Health Care Office at 612-596-8860 will help with enrollment questions, billing questions, or complaints. They can work with you and advocate for you when you have problems with the HMO. The staff also can give presentations to individuals and groups on managed health care.