Medical Assistance (MA) is Minnesota’s Medicaid program for people with low income. It serves people with disabilities based on income and or a disability certification. MA is important to the Down syndrome community for 2 main reasons:
1 - It provides access to healthcare.
2 - It funds vital disability support programs through home and community-based services.
DSAMn Family Connectors often walk families through the many benefits and details of accessing MA. Here’s an overview of some common topics we discuss:
MA gives access to healthcare and helps pay for medical expenses. MA covers a variety of services like doctor’s visits, prescriptions and hospital stays. It helps pay for habilitative services including physical, occupational, speech and feeding therapy. It may cover expenses for medical devices and specialized equipment such as orthotics. Starting at age 4, diapers are covered through a prescription. This is only a snapshot of what MA covers. Learn more here: Department of Human Services Summary of Coverage
MA can act as secondary insurance. Families whose income is over MA limits may access MA benefits for their child with a disability through an option called TEFRA. In this situation, families often have private health insurance and MA under TEFRA. The private insurance is billed first and MA is billed second. MA pays the remaining balance as long as it is for a MA covered service and the health care provider is enrolled with MA. The portion MA pays usually counts towards the private insurance deductible. For private co-pay plans, MA usually pays co-pays.
Private insurance may be deemed cost effective. For families who have private insurance and access MA as secondary insurance, the state may decide that the private plan is cost effective health insurance. In this case, families may receive reimbursement from the state to help pay for part of the private insurance monthly premium.
MA coverage can be backdated for medical expenses. When families apply for MA, they may choose to have coverage begin 3 months prior to the application date to help pay for previous medical expenses. Families can seek reimbursement for payments already made for expenses incurred during that time frame. For bills still owed, families can let billing departments know they have backdated MA coverage and request claims to be submitted to MA for coverage.
MA provides gas mileage reimbursement for medical appointments. Families may sign up for gas mileage reimbursement for medical appointments for their loved one with Down syndrome. This includes doctor appointments, specialists and therapies (PT, OT, speech and feeding).
Children under age 5 who are enrolled in MA may access WIC. The WIC program provides nutrition education and counseling, food, and referrals to health and other social services.
MA members may receive discounted memberships and entrance fees. Different organizations offer special rates and deals for MA participants and their caregivers. For example, the Minnesota Zoo, the Science Museum of Minnesota and the University of Minnesota Landscape Arboretum all offer discounts for MA members.
MA enrollment opens the door to accessing vital disability services and supports. MA enrollment is required for most home and community-based services. The program Community First Services and Supports and disability waivers cannot be accessed without MA. These programs provide funds for goods and services to help meet needs related to a person’s disability. These programs can help pay for support staff, respite, alternative therapies, home modifications, safety measures, day programs and more. Learn more here: What are County Services?
DSAMn Family Connectors are here to talk through medical assistance and help navigate its many benefits. Reach out today to start the conversation!
Connect with a Family Connector:
Call: 651-603-0720 option 2
Email: connect@dsamn.org
Click here to complete Family Connector support request form
