Medical Assistance

What is medical assistance?

Also known as MA or Medicaid; the program may help pay for all or part of health care costs for those who do not have insurance, cannot get affordable health insurance through employment, have a disability or chronic condition. Eligibility for MA is based on income and assets. It is different than Medicare (Title XVIII) where eligibility is based on client age.
MHCP Eligibility Policy Manual

Medical Assistance is managed two ways in Minnesota:

  1. Minnesota Health Care Programs – Managed Care (MHCP). Providers such as BCBS, UCare, Medica, Health Partners or South County Health Alliance (there are more providers) administer the Prepaid Medical Assistance Program (PMAP). PMAP is a mandatory managed care program for Medicaid (MA) eligible adults, families and children in Minnesota. Certain medical assistance recipients are exempt from enrollment into managed care – individuals with disabilities, those with a terminal illness, those with a spend-down and those with serious and persistent mental illness.
  2. Fee-for-service is the portion of Medical Assistance that covers recipients that are not enrolled,exempt from Managed Care through PMAP (Pre-paid Medical Assistance) – those with serious, persistent medical issues or a spend-down. (See PMAP Excluded Populations pdf)

What is a spend-down?

Federal law provides a state option that allows people to qualify for Medicaid under a “medically needy” basis. Minnesota has elected this option in its Medicaid program, (Medical Assistance (MA)). Under the medically needy option, a person with income over the MA income standard must “spenddown” their income to the MA spenddown standard by deducting incurred medical expenses from their income.