- As of July 1, 2011, there were 847,638 beneficiaries enrolled in Medical Assistance, Minnesota’s Medicaid program. Of these, 556,665 were enrolled in managed care. Children enrolled in Medical Assistance and who are certified disabled are not enrolled in managed care plans; instead, they receive services on a fee-for-service basis.
- Home and Community-Based Services are provided through a number of waivers, including:
- Community Alternative Care (CAC) Waiver, which provides HCBS services to Medical Assistance-eligible children and adults who are chronically ill and who would otherwise require the level of care provided in a hospital;
- Community Alternatives for Disabled Individuals Waiver, which provides HCBS services for Medical Assistance-eligible children and adults who would otherwise require the level of care provided in a nursing facility; and
- Developmental Disability Waiver, which provides HCBS services for Medical Assistance-eligible children and adults with developmental disabilities or related conditions.
Minnesota’s Administrative Rules define medical necessity or medically necessary as “a health service that is consistent with the recipient’s diagnosis or condition” and:
The Administrative Rules describe EPSDT services using the federal definition.
|Initiatives to Improve Access
Minnesota has included multiple financial incentive programs in managed care contracts designed to increase and improve service delivery to children. Managed Care Organizations (MCOs) can receive:
Child and Teen Checkups (C&TC) Reporting
The state uses specialized software to track C&TC-enrolled children and to assist C&TC Coordinators and outreach staff in conducting and documenting outreach and follow-up activities. The software generates and tracks standard mailings to the children and families about the program as well as information on how to access services. Once a month, updated information on enrolled children and families is collected from the state’s Medicaid Management Information System (MMIS) and MAXIS, a computer system used in Minnesota to determine eligibility for public programs. Encounter data is also collected on a monthly basis from health plans. This information is then compiled and distributed to users of the software, who can update beneficiary information such as name, address, and language.
Children’s Therapeutic Services and Supports (CTSS)
CTSS is a flexible package of mental health rehabilitative services available to youth enrolled in Medical Assistance or MinnesotaCare who have been diagnosed with an emotional disturbance of any severity. Services include: psychotherapy, skills training, Mental Health Behavioral Aide (MHBA) and direction of MHBA, crisis assistance, children’s day treatment, and therapeutic preschool programs. CTSS services can be provided both by traditional mental health providers and a variety of approved social service agencies, including Head Start.
Integrated Behavioral Health Homes
Minnesota received a CMS planning grant to develop Section 2703 Health Homes for Medicaid enrollees with chronic conditions. Children experiencing a severe emotional disturbance (SED) are one of four target populations in this initiative. The goals of the integrated behavioral health homes are to: improve health outcomes; improve experience of care for the individual; improve the quality of health & wellness of the individuals; and reduce health care costs.
For more information about behavioral health services for children enrolled in Medicaid, see: “Behavioral Health in the Medicaid Benefit for Children and Adolescents: Minnesota.”
Support to Providers
The Minnesota Department of Human Services operates a Child and Teen Checkups (C&TC) program website, which contains the C&TC provider manual and coordinator handbook; age-specific C&TC documentation forms for providers and clinics; quality indicators for child health and developmental screening documents; screening schedules; and multiple factsheets, among other resources. The state also provides ongoing provider training on the C&TC program. E-Learning training on topics such as hearing, vision, oral health, and developmental screenings.
Child and Teen Checkups (C&TC) Coordinators
Administrative, outreach, and education services are provided to children and their families who are eligible for C&TC services by C&TC Coordinators. Each C&TC contracting Community Health Board/tribe has a C&TC Coordinator, who is often a county or tribal public health nurses (PHN). Among their responsibilities, C&TC Coordinators must:
Since July 2010, the Minnesota Department of Health and the Department of Human Services have led the Health Care Homes Project, which serves more than 2 million Minnesotans (including children) through 190 certified health care homes (“health care home” is Minnesota’s name for a Patient Centered Medical Home). The state defines a health care home as “an approach to primary care in which primary care providers, families and patients work in partnership to improve health outcomes and quality of life for individuals with chronic health conditions and disabilities.” For more information on Minnesota’s Health Care Homes project, see NASHP’s medical homes map.
Accountable Communities for Health
In 2011, Minnesota launched a Health Care Delivery Systems Demonstration within Medicaid. Building upon this work, Minnesota received a State Innovation Model grant from CMS in 2013, which will be used in part to support the development of Accountable Communities for Health. These communities will integrate medical care, mental health and chemical dependency, community health, public health, social services, schools and long-term services and supports. During phase one of this project (January-June 2013), nine accountable care organizations (ACO) were launched within the state. Phases two and three will allow for expanded ACOs and continued testing and infrastructure building. For more information on Minnesota’s ACO work, visit NASHP’s Accountable Care Map.
The Minnesota Department of Health website hosts an Oral Health Screening Online Module that offers primary care providers information on their role in providing oral health screenings for Medicaid-enrolled children.