State Offers Co-Payments

Some people with disabilities will have more money in their pocket at the end of each month if they are enrolled in a small but effective state health program.

The Minnesota Disability Health Options Program, or MnDHO, is a managed care program for people with physical disabilities. If you have Medical Assistance and live in the Metro area, you can choose to sign up for MnDHO. One of the perks of MnDHO, in addition to having a health coordinator assist you in navigating the often confusing health care system, is that you get to skip the co-payments for medications.

“UCare Minnesota has chosen to waive the Medical Assitance Pharmacy co-pays for all MnDHO enrollees, picking up those costs themselves,” said Pam Parker, who oversees the MnDHO program for the Department of Human Services. “That is an advantage for MnDHO enrollees compared to people who stay in the regular fee-for-service Medical Assistance Program.”

In 2003, lawmakers added $1 and $3 co-payments to prescription drugs and some office visits for anyone enrolled in the Medical Assistance, MinnesotaCare and General Assistance Medical Care programs. Advocates for the disabled were able to cap the monthly prescription charges for co-payments at $20, and were successful in exempting certain services like physical and occupational therapy from the co-pay requirements. Likewise, anti-psychotic drugs were exempted to benefit people with certain mental health issues.

Those $1 and $3 charges might not sound like a lot, “but many of the people we talk to hit that $20 limit every month,” said Chris Duff, CEO at AXIS Healthcare, the organization that coordinates the health care for the 450 people now in the MnDHO program. “A lot of these people are trying to make ends meet with a monthly budget of less than $100. I’d challenge anyone to try and do that and still have a good quality of life,” he added.

For anyone living in a group home, or for the 3,000 working age people with disabilities now living in Minnesota nursing homes, they can only keep about $90 per month of their personal income. Whether their money comes from a job or a Social Security check, in order to qualify for Medical Assistance people with disabilities have to turn over most of their monthly income to the state. What they get to keep – roughly $90 every month – is called a ‘personal needs allowance.’ Out of this budget comes all the everyday essentials like toothpaste, clothes, the phone bill, and Metro Mobility tickets. Co-payments must also come out of this monthly allowance.

“We hope that taking away the co-payments will make things a little easier for people that often have to make very tough choices,” said Parker.

Advocates are back at the Capitol this year lobbying for an increase in the personal needs allowance, “but it’s going to be tough,” said Joel Ulland, public policy director for the National Multiple Sclerosis Society-Minnesota Chapter. “It will cost the state several million dollars to do this and there’s not a lot of money laying around for lawmakers to spend.”

Lobbyists for the disabled are also calling for expansion of the MnDHO program. A small provision in HF980/SF984 would ask the state to get permission to bring the voluntary managed care program to rural Minnesota. That might sound easy, but in order to do that, the Department of Human Services would need to work with AXIS Healthcare and UCare, (the organization that actually contracts with the doctors and other health care providers and processes the claims), to make sure that good services are available in smaller communities throughout the state.

Satisfaction surveys show that MnDHO enrollees are very happy with their quality of care and most say their health has improved since joining the program. New research being done by the National Rehabilitation Hospital’s Center for Health and Disability Research also show that hospital stays and emergency room visits have significantly declined for people in the program.

“More people need to know about the benefits of MnDHO, and that it’s a choice they can make if they want to” Parker said. “We hope by removing the co-payments more people might take time to learn what MnDHO can do for them.”

For more information on the program or to discuss enrolling you can visit the DHS website and type “MnDHO” in the search window www.dhs.state.mn.us or call AXIS Healthcare at 651-641-0887; TTY 651-556-0860.