Minnesota Children and Youth with Special Health Needs (MCYSHN)
RESOURCES - FINANCIAL AND OTHER
Finding services for children and youth with special health needs can be a puzzling job.
The following are tools and links to sites available to assist youth and families through this process.
On this page...
Minnesota Department of Health Resources
Other Resources
MINNESOTA DEPARTMENT OF HEALTH RESOURCES
Information and Assistance Line - The Minnesota Children and Youth with Special Health Needs (MCYSHN) Information and Assistance Line can provide help identifying and locating resources in your area for children with special health needs.
Directory of Resources for Children and Families in Minnesota provides information on resources that may help children, families, providers and others working with families and children. Users are able to search for resources by specific counties or school districts (Help Me Grow - Early Intervention only). There is also information included within each search that provides statewide resources and programs available to Minnesota families.
Who Pays - Taking the Maze
out of Funding: MCYSHN staff developed a manual designed to inform both families and professionals about a wide range of potential funding sources. The goal is to help persons know what programs and resources exist in order to improve access to health care and more effectively advocate for children, youth, young adults and their families. The content in the manual is geared towards all children and youth, including but not limited to those with special health needs. It includes major funding programs, other possible funding options, and "tools" to help in identifying funding resources. The manual is updated annually.
A copy of the manual is available to download for those who have attended a training in the past and are interested in getting the updated materials. Who Pays - Taking the Maze out of Funding Manual
Women, Infants and Children (WIC) Program:
- WIC is a nutrition program that helps eligible pregnant women, new mothers, babies and young children eat well, learn about nutrition, and stay healthy.
- WIC provides nutrition education and counseling, nutritious foods, and referrals to health and other social services.
OTHER RESOURCES
Medical Assistance (MA)is a Minnesota Public Health Care Program that covers a full range of health care services that are medically necessary such as hospital care, physician care, home health care, medications, medical supplies and equipment, dental and mental health care, rehabilitation therapies and other health care services. MA may pay for medical bills going back three months from the date you turn in the application. MA also pays for current and future medical bills.To get MA, you must: live in MN, meet income and asset limits (there is no asset limit for pregnant women and children) and be one of the following: under age 21, a parent of a minor child in the home, pregnant, age 65 or older, or be blind and disabled.
Financial eligibility is determined by income and family size. If your income is over the income limit, you may still qualify if you have enough medical bills to meet a spenddown. A spenddown is like an insurance deductible.
You do not have to pay a monthly premium with MA. You can have other health insurance, even if it is through an employer, and still qualify for MA. If you have other health insurance, MA may even pay your health insurance premium. If your MA ends, you can get coverage again whenever you meet the program rules.
To apply you must fill out a Minnesota Health Care Programs (MHCP) Application. You can get one at your local county human services/family services agency. You can also get one online at the Minnesota Department of Human Services.
MinnesotaCare is a Minnesota Public Health Care Program available for people who do not have health insurance. (Some children may get MinnesotaCare even if they have insurance or access to insurance through an employer.) You will have to pay a monthly premium for MinnesotaCare. The cost depends on your family size and income. When you pay your first MinnesotaCare premium, coverage will begin on the first day of the next month.
To get MinnesotaCare, you must: live in Minnesota, adults without children must live in Minnesota for 180 days and be a U.S. citizen or a qualifying noncitizen. You must, also, have had no health insurance and no Medicare for the last four months and meet income and asset limits. [There is no asset limit for pregnant women and for children under 21].
You cannot enroll in MinnesotaCare if your current employer offers health insurance and pays half or more of the monthly cost of the insurance. Nor can you enroll if you employer offered health insurance, paid half or more of the monthly cost, and stopped insurance within the last 18 months. If you are a parent, legal guardian, foster parent or relative caretaker, and your gross income is over $50,000, you can not enroll in MinnesotaCare. Your children may, however, be eligible for MinnesotaCare.
To apply you must fill out a Minnesota Health Care Programs (MHCP) Application. You can get one at your local county human services/family services agency. You can also get one online at the Minnesota Department of Human Services.
TEFRA The name TEFRA comes from the name of the law passed by Congress in 1982, the Tax Equity and Fiscal Responsibility Act). It is a federal program providing Medical Assistance (MA) benefits to some children with disabilities who live with at least one parent. TEFRA is an option for families who are over income guidelines for regular Medical Assistance (MA). TEFRA provides the same covered services as MA.
To qualify for TEFRA, a child must meet ALL of the following conditions: child's income meets MA income limits, lives with at least one parent, is under 19 years of age, is certified disabled by the State Medical Review Team (SMRT), needs a certain level of home health care to stay at home which compares to the level of care provided in a hospital, nursing home or an intermediate care facility for the developmentally disabled, and the cost for home care must not be more than the cost for care in a medical institution.
Some parents may be required to pay a Parental Fee (as partial reimbursement to the state for the child's MA costs). Parental fees are based on family size and income. To assist in estimating a monthly parental fee check out the Department of Human Services Parental Fee Estimator.
The child can have other health insurance, and still qualify for MA. If the child has other health insurance, MA may even pay the health insurance premium
To apply you must fill out a Minnesota Health Care Programs (MHCP) Application. You can get one at your local county human services/family services agency. You can also get one online at the Minnesota Department of Human Services.
Medical Assistance for Employed Persons with Disabilities (MA-EPD) MA-EPD allows working people with disabilities to qualify for MA under higher income and asset limits than regular MA. The goal of the program is to encourage people with disabilities to work and enjoy the benefits of being employed.
To qualify for MA-EPD, a person must: be certified disabled by either the Social Security Administration (SSA) or by the State Medical Review Team (SMRT). Be at least 16 but less than 65 years of age, be employed and have required taxes withheld or paid from earned income, and have monthly earnings of more than $65.
The person must also, not be eligible for MA under another category, must meet the asset limit, pay a sliding fee premium based on income and household size, and pay an “unearned income obligation” if required. (Persons who have unearned income such as Social Security Disability, must pay .05% of their unearned income.).
The person can have other health insurance, and still qualify for MA. If the person has other health insurance, MA may even pay the health insurance premium
To apply you must fill out a Minnesota Health Care Programs (MHCP) Application. You can get one at your local county human services/family services agency. You can also get one online at the Minnesota Department of Human Services.
Home and Community Based Services (HCBS) [also called "Waivers"] These “waiver” programs help people with disabilities or chronic illness who require certain levels of care meet health needs, get support to stay at home and stay out of medical facilities. Under these waivers, a menu of cost-effective services is covered, which are not available under straight MA (Medical Assistance). These service options are available to consumers in addition to services covered by MA.
NOTE: person could qualify but the HCBS may not be available in the county due to a waiting list. This is most common for the Developmental Disabilities Waiver. Each county human services agency provides HCBS within a state-set allowable budget. Persons eligible for HCBS are encouraged to get on the waiting list.
To be able to get HCBS, persons must meet ALL of the following criteria: Be on MA (either straight MA, TEFRA-MA, or MA-EPD), be certified disabled by either the federal Social Security Administration (SSA) or by the SMRT (State Medical Review Team), need a specified level of care, and have a written support plan assuring health and safety and outlining the service needs of the recipient. (Examples of potential HCBS services may include: respite care, home modifications, assistive technology, etc).
Parents may be required to pay a Parental Fee (as partial reimbursement to the state for the child’s MA costs.). Parental fees are based on family size and income.To assist in estimating a monthly parental fee check out the Department of Human Services Parental Fee Estimator.
Generally, these HCBS services are targeted to people with specific needs or diagnosis. There are some differences in the menu of services available in each waiver and differences in the amount of money that a person can use to purchase services and supports. Home and community-based services (waivers) available to children, who meet the eligibility criteria include:
- Developmental Disabilities (DD) Waiver (formerly known as the Mental Retardation and Related Conditions [MR/RC] Waiver) for persons with intellectual disabilities or a related condition who need the level of care provided in an intermediate care facility for persons with developmental disabilities or related conditions (ICF/MR)
- Community Alternative Care (CAC) Waiver for chronically ill individuals who need the level of care provided in a hospital
- Community Alternatives for Disabled Individuals (CADI) Waiver for people with disabilities who require the level of care provided a nursing facility
- Traumatic Brain Injury (TBI) Waiver or people with traumatic or acquired brain injuries who need the level of care provided in a nursing home or neurobehavioral hospital
You can apply for waiver programs at your local county human services agency. You will need to complete a Minnesota Health Care Programs (MHCP) Long-Term Care and Waiver Services Application and go through a county waiver screening process.
Supplemental Security Income (SSI) These are monthly checks sent out by the federal Social Security Administration (SSA) to disabled people (children and adults) with limited income and assets. To be eligible, the person must meet specific income and asset guidelines and be certified disabled by the Social Security Administration (SSA). People who get SSI are also eligible for Medical Assistance (MA) and usually can get food support benefits to help buy food, too.
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Minnesota Comprehensive Health Association (MCHA) MCHA was established in 1976 by the Minnesota Legislature to offer health insurance policies to individuals who have been turned down for health insurance by the private insurance companies. Most frequently persons are turned down for private insurance due to pre-existing health conditions such as cancer or diabetes. MCHA sometimes is referred to as Minnesota's "high risk pool" for health insurance or the “health insurance of last resort”. Persons must pay their own health premium to MCHA.
No benefits are payable during the first six months of coverage for expenses for any preexisting condition, injury, illness, or other physical or mental condition that was diagnosed, treated or evaluated during the 90 days preceding the effective date of coverage. However, there may be some exceptions to this preexisting condition limitation, if you request a waiver when completing your MCHA application.
Prescription Drugs:
- For some individuals with no prescription drug coverage there
may be assistance. The Minnesota Department of Health Information Clearinghouse has a list of drug coverage programs available. MCSHN does not guarantee results.
Minnesota Department of Health Information Clearinghouse - Prescription Drugs
- RX Connect is also available for people who have a difficult time paying for their prescriptions. It is available for people of all ages with low to moderate income. Minnesota RxConnect has an Online brochure available. You are welcome to print this color brochure (PDF: 2 pages/1.38MB) and distribute it to those with an interest in Minnesota RxConnect Online.
- Glasses and Eye Examinations:
The Minnesota Vision Project will cover eye exams by selected
optometrists as well as provide glasses for children whose families
meet certain criteria.
Minnesota Vision Project