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Champions for Children with Disabilities

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DHS Minnesota Health Care Program Application Forms:

State Medical Review Team Forms for Disability Determinations:

The state medical Review team completes disability determinations using the criteria defined by the Social Security Administration (SSA). The Criteria can be found in the SSA blue book.

Children Under 26 on Their Parents’ Plan

The health care reform law states that insurance providers offering dependent coverage must allow adult children to be covered on their parent’s health plans until they reach age 26, regardless of if they are married or if they are not living at home. The only exception is for adult children who can receive insurance from their own employer; this exception ends in 2014. This law took effect on September 23, 2010. Your insurance provider must have an enrollment period for your adult child under 26 to be placed on your family plan. Call your insurance company and ask when the open enrollment times are and how to enroll your child.

For more detailed information on coverage for adult children under 26, please see Explaining Health Care Reform:  Questions About the Extension of Dependent Coverage to Age 26 from the Kaiser Family Foundation or Young Adults and the Affordable Care Act produced by the U.S. Department of Health and Human Services. Contact your own insurance provider about your individual policy.

Minnesota Health Insurance Marketplace:

MNsure is Minnesota’s Affordable Care Act health insurance marketplace where residents can shop for and buy insurance. In Minnesota, the marketplace is run by the state government and is also called an Exchange.

Open enrollment begins Nov. 1, 2016, and runs until Jan. 31, 2017. 

If you are already enrolled in MinnesotaCare (MNCare) or Medical Assistance (MA) you do not have to take any action to renew your coverage unless directed by the Department of Human Services (DHS). Do not sign in to MNsure to renew your MA or MNCare coverage. If you have any questions or concerns about renewing coverage for one of these programs, call the DHS Member Help Desk at 651-431-2670 or 800-657-3739, Monday through Friday, 8 a.m. to 5 p.m.

For those on private insurance, with some family members on Medical Assistance (MA) or MNCare, any changes to the private insurance should be made by reviewing available plans, then contacting the MNsure Contact Center to enroll those family members who will remain on private insurance.  You should NOT log on to MNsure.org, but follow these steps to determine the best plan for you in 2017:

  • Go to Find a Plan on the MNsure site
  • Carefully review all plans for changes to premiums, in-network providers, and benefits.
  • Enter only information for those in your household seeking private insurance, not those receiving Medical Assistance or MNCare
  • Choose a plan, and contact the MNsure Contact Center (1-855-366-7873).

If you have a child or youth with special health care needs or disability, MNsure accepts Medical Assistance applications year-round for eligible individuals. Children may be eligible even if the parent is not.

MNsure checks to see if your child might qualify for Medical Assistance based on disability if you answer ”yes” to at least one of the following questions when you fill out the MNsure application:

  • Do you want help from Medical Assistance (MA) to pay for medical bills from the last three months?
  • Are you blind?
  • Do you have a physical, mental, or emotional health condition that limits your activities (like bathing, dressing, daily chores, etc.)?
  • Do you need help staying in your home or help paying for care in a long-term care facility such as a nursing home?
  • Have you been determined disabled by the Social Security Administration (SSA) or the State Medical Review Team (SMRT)

If you answer “yes” to one or more of the above questions on the MNsure application, your county should send a supplemental application out to you. The county should also send a form to the state to trigger the State Medical Review Team to send information and forms out to you regarding eligibility based on disability. We recommend that you contact your county to let them know that you have a child with a special health care need/disability and that you have completed the MNsure application. This might help expedite the process and make sure that the appropriate forms are sent out to you.

To renew, enroll, see frequently asked questions, visit MNsure’s official website

To learn more about MNsure, contact PACER’s Family-to-Family Health Information Center at (952) 838-9000 or toll free in Minnesota at (800) 53-PACER.

Health Reform for Americans with Disabilities:

HealthCare.gov

HealthCare.gov is a website launched by the federal government to help health care consumers. The website provides:

  • One-stop access to all your insurance options. HealthCare.gov helps in your search for insurance by giving you all your insurance options based on information you provide, including your age, location, and other important life circumstances.
  • Information on the new health reform laws and your rights as a patient. The website gives you information about the different provisions of the Affordable Care Act.
  • Helpful tips for preventative care. HealthCare.gov gives useful tips on how to stay healthy based on your situation.
  • Comparisons of hospital care. The website allows you to enter your zip code and compare the quality of care provided by hospitals in your area.

HHS has announced a new website, CuidadodeSalud.gov, the first website of its kind in Spanish, to help consumers take control of their health care by connecting them to new information and resources to help them access quality, affordable health care coverage. CuidadodeSalud.gov is a partner site of HealthCare.gov, and has information specifically for people with disabilities in the Personas con Incapacidad section of the site.

Greater Choices for Americans with Disabilities

Expands the Medicaid Program

  • Expands the Medicaid program to more Americans, including people with disabilities.

Extends Essential Benefits

  • For most insurance policies, the following will be considered essential:  ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services (including behavioral health treatment), prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services including oral and vision care.

New Options for Long-Term Supports and Services

  • Creates new options for states to provide home and community based services in Medicaid, enabling more people with disabilities to access long-term services in the setting they choose.
  • Makes improvements to the Medicaid Home- and Community-Based Services (HCBS) option.

Eliminates Insurance Company Discrimination

  • The Act prohibits insurance companies from denying coverage or charging more to any person based on their medical history, including genetic information.

More Affordable Choices and Competition

  • Requires the creation of state-based health insurance Exchanges in all states to provide families with the same private insurance choices that the President and Members of Congress have, including multi-state plans to foster competition and increase consumer choice. 

One-Stop Shopping

  • Provides standardized, easy-to-understand information through the Exchange on different health insurance plans so Americans can easily compare health plans to choose a quality, affordable option that is right for them.

Insurance Security

  • Ensures that families always have guaranteed choices of quality, affordable health insurance whether they lose their job, switch jobs, move, or get sick, through the creation of Exchanges.

Makes Health Care Accessible to Everyone

  • Provides access to health insurance through Exchanges to those without job-based coverage and provides premium tax credits to those who cannot afford coverage, significantly increasing access to a choice of health insurance plans for individuals with disabilities.  This will enable individuals to keep their jobs rather than giving up employment in order to receive Medicaid benefits. 

Lowering Costs by Rewarding Quality and Cutting Waste

Insurance Industry Reforms that Save Money
  • The Act eliminates all lifetime limits on how much insurance companies cover if beneficiaries get sick and bans insurance companies from dropping people from coverage when they get sick.  The Act also restricts the use of annual limits in all plan.
  • Going forward, plans in the new Health Insurance Exchanges and all new plans will have a cap on what insurance companies can require beneficiaries to pay in out-of-pocket expenses, such as co-pays and deductibles. 
  • Health insurance companies are required to submit justification for requested premium increases, and insurance companies with excessive or unjustified premium exchanges may not be able to participate in Exchanges.
  • Cracks down on excessive insurance overhead by applying standards to how much insurance companies can spend on non-medical costs, such as bureaucracy, executive salaries, and marketing, and provides consumers a rebate if non-medical costs are too high.

Assuring Accessible, Quality & Affordable Health Care for People with Disabilities

Preventive Care for Better Health
  • Non-grandfathered plans now cover most prevention and wellness benefits at no charge to American families by exempting these benefits from deductibles and other cost-sharing requirements.
  • Invests in prevention and public health to encourage innovations in health care that prevent illness and disease before they require more costly treatment. People with disabilities will be more likely to receive preventive care and less likely to be diagnosed with screen-able cancers during later stages.
  • Improves access to medical diagnostic equipment so people with disabilities can receive routine preventive care.

Addresses Health Disparities

  • Moves toward eliminating disparities by improving data collection on health disparities for individuals with disabilities and improving training of health providers.

Improves Care for Chronic Disease

  • Invests in innovations such as medical homes and care coordination demonstrations in Medicare and Medicaid to prevent disabilities from occurring and progressing and to assist the one in every ten Americans who experience a major limitation in activity because of a chronic condition.

-Adapted from “Health Reform for Americans with Disabilities” produced by WhiteHouse.gov

For more detailed information on the health reforms, please see the following links:

  • HealthCare.gov managed by the U.S. Department of Health & Human Services
  • MNSure.org is Minnesota's one-stop marketplace where you can shop for a health insurance plan and enroll for coverage.
  • Families USA:  Health Reform Central gives detailed information about the new health care laws, including what they mean, how they will be implemented, and what may be roadblocks in implementing the law.
  • Summary of New Health Reform Law, produced by the Kaiser Family Foundation, is a detailed summary of the exact provisions of the Patient Protection and Affordable Care Act.
  • Summary on Affordable Health Care for America is a short summary of the Patient Protection and Affordable Care Act that was written by a House Committee.

To learn more about the new federal health reforms, contact PACER’s Health Information Center at (952) 838-9000 or (800) 53-PACER, toll free in Minnesota.

 

 

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