Health Care Coverage

After someone receives a diagnosis of autism spectrum disorder (ASD), the next step is to identify available services and supports. People with ASD or related conditions often need a variety of supports and services over the course of their lifetime. To meet the needs of each person and family, the state of Minnesota offers programs that provide basic health care services, behavioral health services, services for people with physical and developmental disabilities and educational services. 

If you or your child is enrolled in a health plan and you have questions about coverage for services, call that health plan's member services. Contact information for the health plan is typically found on the back of your health plan member card.

For more information on the following go to the Minnesota Autism Resource Portal.

MNSure

MNSure is where you may want to go if you do not have health insurance. This website is a marketplace where you can apply for Minnesota health insurance plans and also find out if you meet the requirements for Minnesota Health Care Programs. If you have questions about eligibility, contact the local county agency or tribe where you or your child resides or contact the Minnesota Health Care Programs Member Help Desk. 

Additional Medical Assistance Options for Children with ASD / MA-TERRA

Tax Equity and Fiscal Responsibility Act (TEFRA) allows Medical Assistance eligibility for children with disabilities whose parents have too much income to qualify for Medical Assistance or other Minnesota Health Care Programs or who qualify but the cost would be too high. 

Disability Benefits 101

Disability Benefits 101 (DB101) is a website that gives people tools and information on health coverage, benefits and employment. DB101 helps people with disabilities learn how income may impact benefits so they can make informed choices, reduce fears, and ensure work is part of the plan.

Minnesota Health Care Programs

People who live in Minnesota may qualify for different programs and services through Minnesota Health Care Programs. People with ASD or their families may be eligible for coverage to help pay for health care and other needed services. Coverage and out-of-pocket costs vary depending on the program. Here is an overview of MN Healthcare Programs and how to apply.

Indian Health Services

Indian Health Services (IHS) is an agency within the Department of Health and Human Services and is responsible for providing federal health services to American Indians and Alaska natives.

The Native American Community Clinic, located in the Twin Cities metro area, has walk-in clinic and additional services.

Bridge to Benefits

Bridge to Benefits is a project by the Children’s Defense Fund-Minnesota to improve the wellbeing of families and individuals by linking then to programs. A core component of the project is an online screening tool designed to help families and individuals understand if they are eligible for eight public work support programs and two income tax credits.

Achieving Better Life Experience (ABLE) Account

If you have a qualifying disability that began before you turned 26, you may be able to save up to $30,590 each year in an ABLE account without affecting Medical Assistance, Supplemental Security Income (SSI), and most other benefits, as long as you meet all the other benefits rules. Visit DB101 Minnesota - ABLE Accounts: The Basics to learn more.

Medical Assistance for Employed Persons with Disabilities (MA-EPD)

Medical Assistance for Employed Persons with Disabilities (MA-EPD) ensures that people with disabilities don't lose their Medical Assistance (MA) coverage when they work or start earning more money.

Social Security Income

To apply for SSI, contact the local Social Security office or visit the Social Security Administration online.

The Social Security Administration has resources to help understand SSI.

The ARC Minnesota also has an Guide to Social Security Income (SSI) that you can reference.

Cost Effective Insurance

In Minnesota, there are different ways of accessing healthcare coverage. Having health care coverage may provide access to services and supports.

Private insurance is provided through an employer or not through MNSure.

Public health insurance includes Medical Assistance or MA. Also known as Medicaid. MA-TEFRA, MinnesotaCare, and pre-paid health plans, which are part of the MA system. These are administered by the Managed care organizations or MCOs.

Families may have coverage through private insurance, public insurance or both. If a family’s private insurance is deemed cost effective, then they be eligible for reimbursement for their premiums.

Cost effectiveness can help families receive reimbursement for co-pays, deductibles and other out of pocket costs. The county agency must pay health care coverage premiums if:

• DHS or the county determines the premiums are cost effective, and
• All of the reimbursement requirements are met

If the plan is deemed cost-effective, the family can submit pay stubs for monthly reimbursement. If a plan is deemed cost-effective and the child is on a pre-paid medical assistance plan (PMAP), the child will be moved to Fee-for-Service (FFS) MA.

An MA client is eligible for cost effective reimbursement retroactively, up to 12 months, if both of the following are met:

• The client meets all of the reimbursement requirements.
• The client is eligible for MA during the retroactive months.

The ARC Minnesota has a Guide to Cost Effective Health Insurance (CEHI) you can also review.