Minnesota Medicaid Senior Health Options (MSHO) and Minnesota Senior Care Plus (MSC+)

Last updated: October 19, 2021

 

Overview of the Minnesota Medicaid MSHO & MSC+ Programs

Minnesota Senior Health Options (MSHO) and Minnesota Senior Care Plus (MSC+) are Medicaid managed care programs for elderly state residents through which medical and long-term services and supports are available. While limited nursing home care is an available benefit of both MSHO and MSC+, a variety of home and community based services (HCBS) are also available to prevent unnecessary nursing home admissions. This includes respite care to relieve a primary caregiver, adult day care, home delivered meals, homemaker services, personal care assistance, and home modifications for safety and accessibility.

MSHO and MSC+ program participants receive all of their benefits via a single Medicaid health plan provided by a managed care organization (MCO). A MCO is essentially a private healthcare company. The MCO has a network of care providers and program participants receive services via these providers. The availability of MCO’s vary based on one’s geographic region, although many counties offer multiple options of MCOs / health plans.

For the MSHO program, the health plan also provides Medicare benefits, as MSHO is intended for “dual eligible” seniors. “Dual eligible” refers to someone who is eligible for both Medicaid and Medicare. To be clear, MSC+ does not include Medicare benefits, but dual eligible persons can continue to receive their Medicare benefits via Medicare.

 The main difference between the Minnesota Senior Health Options (MSHO) Program and the Minnesota Senior Care Plus (MSC+) Program is that in addition to medical and long-term care Medicaid benefits, MSHO also integrates Medicare benefits into its managed care plan. MSHO is a voluntary program. However, seniors who do not enroll in MSHO must enroll in MSC+.

There is some flexibility of providers for persons receiving personal care assistance via MSHO and MSC+, as program participants have two options of participant-directed care. This means that rather than receive services via the MCO’s network of licensed care providers, a program participant can choose their own caregiver. The first option is through the Personal Care Assistance Program (PCA), which will be transitioning into the Community First Services and Supports Program (CFSS). With PCA, relatives, such as adult children, can be hired as caregivers, but spouses generally cannot be hired. CFSS, however, will allow the hiring of spouses.

Consumer Directed Community Supports (CDCS) is the other participant-directed option. Within an allotted budget, program beneficiaries select the services, supports, and providers to best meet their needs. This includes hiring the caregiver of their choosing to provide personal care assistance and help with other daily living activities, such as mobility, laundry, light housecleaning, and preparation / cleanup of meals. Relatives, including adult children and spouses, can be hired to provide care.

With both PCA/CFSS and CDCS, a financial management services agency handles the financial aspects of employment responsibilities such as tax withholding and caregiver payments.

Program beneficiaries can reside in their own home, the home of a close friend or relative, an adult foster care home, or an assisted living residence.

MSHO and MSC+ are entitlement programs, which means as long as an applicant meets eligibility criteria, benefits will be received. However, with the exception of personal care assistance, the majority of long-term home and community based services (HCBS) are available via Minnesota’s Elderly Waiver. This waiver is not an entitlement program. This means the state limits the number of persons who can participate in the program, and if all participants slots are filled, a waitlist for HCBS forms.

The Minnesota Senior Health Options Program is part of the state plan and is authorized for voluntary managed care enrollment under a 1915(a) Waiver. The Minnesota Senior Care Plus Program is authorized under a 1915(b) Waiver, which authorizes mandatory enrollment of seniors who do not enroll in MSHO. For both MSHO and MSC+, home and community based services are authorized under Minnesota’s 1915(c) Elderly Waiver. The Minnesota Senior Care Plus Program previously was called the Minnesota Senior Care Program. Medicaid in Minnesota is called Medical Assistance (MA).

 What is Medicaid Managed Care?
Medicaid pays doctors, hospitals, and other providers in one of two ways, either “Fee-For-Service” or “Managed Care”. Under Fee-For-Service, Medicaid pays providers directly for each service they provide. Beneficiaries can receive services from any Medicaid-certified provider. Under Managed Care, Medicaid contracts with a Managed Care Organization (MCO). Medicaid pays the MCO a set amount for each beneficiary, rather than for each service provided. The MCO has a network of doctors, hospitals, and other providers and the MCO pays them. Beneficiaries must use providers within the network.

 

Benefits of the MSHO & MSC+ Programs

Via MSHO & MSC+, the following benefits are available.

– Care Coordination
– Dental Care
– Durable Medical Equipment – i.e., wheelchairs
– Emergency Room Care
– Home Health Care – i.e., skilled nursing and home health aides
– Hospital Care
– Interpreter Services
– Laboratory Work / X-rays
– Nursing Facility Care (limited to 180 days)
– Personal Care Assistance
– Physician Visits
– Prescription Drugs
– Transportation – medical and non-medical

MSHO and MSC+ program participants who qualify for home and community based services via the Elderly Waiver will also receive these long-term services and supports. This may include adult foster care services, assisted living services, homemaker services, home modifications, personal emergency response systems, respite care, and more.

Persons enrolled in MSHO will also receive all of their Medicare benefits (Part A, B, and D) via their MSHO health plan.

While program participants can reside in an adult foster care home or an assisted living residence, MSHO and MSC+ do not cover the cost of room and board.

 

Eligibility Requirements for the MSHO & MSC+ Programs

The Minnesota Senior Care Plus (MSC+) and Minnesota Senior Health Options (MSHO) Programs are for MN residents who are 65+ years old. For MSHO, seniors must be enrolled in Medicare parts A & B. Additional eligibility criteria follows.

 The American Council on Aging provides a quick and easy Medicaid eligibility test for Minnesota seniors that require long term care. 

 

Financial Criteria: Income, Assets & Home Ownership

Income
The applicant income limit is equivalent to 100% of the Federal Poverty Level (FPL), which increases on an annual basis in January. However, for MN Medicaid, the income limits increase each July. For elderly, blind and disabled Medicaid, the effective income limit from July 2021 – June 2022 is $1,074 / month for a single applicant. Married couples, regardless of if one or both spouses are applicants, can have a monthly income up to $1,453.

 To receive most home and community based services via MSHO or MSC+, program participants must be eligible for the Elderly Waiver (EW). The eligibility criteria vary from the criteria listed on this page. For instance, the EW allows a non-applicant spouse a monthly maintenance needs allowance (income allowance) from his/her applicant spouse and entitles the non-applicant spouse to a community spouse resource allowance. Furthermore, the EW requires an applicant to have a nursing facility level of care (NFLOC) need.

Assets
In 2021, the asset limit is $3,000 for a single applicant. For married couples, the asset limit is slightly higher at $6,000. This hold true whether one or both spouses are applicants.

Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.

While there is a 60-month look back rule in which Medicaid checks past asset transfers of those applying for nursing home Medicaid or home and community based services via a Medicaid waiver, it is thought it is not relevant for the MSHO and MSC+ Programs. In other words, the look back period is not applicable. However, it is applicable for the Elderly Waiver, via which home and community based services are available.

 To determine if you might have assets over Medicaid’s countable limit, and if so, receive an estimate of the amount, use our spend down calculator

Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take their home. Fortunately, for eligibility purposes, Minnesota Medicaid considers the home exempt (non-countable) in the following circumstances.

– The applicant lives in the home or has “intent” to return to the home and his / her home equity interest is no greater than $603,000. Home equity interest is the current value of the home minus any outstanding mortgage.
– A spouse lives in the home.
– The applicant has a minor child (under 21) living in the home.
– The applicant has a blind or disabled child living in the home.

To learn more about the potential of Medicaid taking the home, click here.

Medical Criteria: Functional Need

To be eligible for MSHO or MSC+, there is no functional eligibility criteria. However, for some services, an applicant must demonstrate a functional need. For instance, for personal care assistance, an applicant must require assistance with one activity of daily living (ADL) or exhibit a qualifying behavior. ADLs are essential for day-to-day functioning, and include mobility, transferring, positioning, eating, toileting, bathing, grooming, and dressing. A qualifying behavior is one that puts oneself, another person, or property in danger. Relevant to persons with Alzheimer’s disease or a related dementia, this might include wandering. However a diagnosis of Alzheimer’s disease does not mean one will automatically meet the level of care need.

 For more information about long-term care Medicaid in Minnesota, click here.

 

Qualifying When Over the Limits

Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for MN Medicaid / Medical Assistance. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.

Minnesota has a Medically Needy Spend-Down Program for applicants who have high medical expenses relative to their income. Via this program, applicants are permitted to spend “excess” income on medical expenses and health care premiums, such as Medicare Part B, in order to meet Medicaid’s income limit.

When persons have assets over the limits, trusts are an option. Irrevocable Funeral Trusts are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Another option are Medicaid Asset Protection Trusts, which not only protects assets from Medicaid’s asset limit, but also preserves them as inheritance by protecting them from Medicaid’s estate recovery program. Although no longer a commonly used technique, some married couples with significant assets choose a Medicaid divorce. There are many other options when the applicant has assets exceeding the limit.

Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid planners are educated in the planning strategies available in the state of Minnesota to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. While there are a variety of planning strategies, some do violate Medicaid’s 60-month look back rule, and therefore, should be implemented well in advance of the need for long-term care. However, there are some workarounds, like the Modern Half-a-Loaf Strategy, and Medicaid planners are aware of them. For all of these reasons, it is highly suggested one consult a Medicaid planner for assistance in qualifying for Medicaid / Medical Assitance when over the income and / or asset limit(s). Find a Medicaid planner.

 

How to Apply for Minnesota Medicaid MSHO & MSC+ Programs

Before You Apply

Prior to applying for MSHO or MSC+, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a free Medicaid eligibility test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid eligibility test.

As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, previous bank statements, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, a common reason applications are held up is required documentation is missing or not submitted in a timely manner.

 

Application Process

To apply for the MSHO Program or the MSC+ Program, seniors must be eligible for MN Medicaid / Medical Assistance. The Application for Certain Populations can be found here. Alternatively, persons can apply online at MNsure or contact the human services office in their county to apply. Contact information can be found here.

Seniors who are already enrolled in Medical Assistance and wish to enroll in MSHO should contact a MSHO health plan in their area. To see available health plans by county, click here, and for health plan contact information, click here.

For additional information about Minnesota Senior Health Options, click here. Persons can also contact the Senior Linkage Line at 800-333-2433 for more information. The Minnesota Department of Human Services (DHS) administers the Minnesota Senior Health Options and Minnesota Senior Care Plus Programs.

 

Approval Process & Timing

The MN Medicaid / Medical Assistance application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed even further. In most cases, it takes between 45 and 90 days for the Medicaid agency to review and approve or deny one’s application. Based on law, Medicaid offices have up to 45 days to complete this process (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even longer. Furthermore, if there is a waitlist for home and community based services via the Elderly Waiver, applicants may have to wait for a participant slot to become available.

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