Health Maintenance Organizations in Minnesota

Health Maintenance Organizations in Minnesota

In Minnesota, an HMO is either a non-profit corporation or a local government unit. An HMO provides comprehensive health maintenance services, or arranges for the provision of these services, to enrollees on the basis of a fixed prepaid sum without regard to the frequency or extent of services furnished to any particular enrollee.

Minnesota HMOs are licensed pursuant to Minnesota Statutes, chapter 62D and Minnesota Rules, part 4685.

Blue Plus
Blue Plus Information | Blue Plus Reports

Group Health
Group Health Information | Group Health Reports

HealthPartners Information | HealthPartners Reports

Humana, Inc.
Humana Information

Medica Information | Medica Reports

Medica Community Health Plan
Medica Community Health Plan Information | Medica Community Health Plan Reports

Hennepin Health (formerly known as Metropolitan Health Plan)
Hennepin Health Information | Hennepin Health Reports

PreferredOne InformationPreferredOne Reports

Quartz Information | Quartz Reports

Sanford HealthPlan of Minnesota
Sanford InformationSanford Reports

UCare InformationUCare Reports

UnitedHealthcare of Illinois
UnitedHealthcare of Illinois InformationUnitedHealthcare of Illinois Reports

Health Plan Information - County Based Purchasing

County Based Purchasing (CBP) is a health plan operated by a county or group of counties. The CBP entity purchases health care services for certain residents enrolled in Medical Assistance, Prepaid Assistance Medical Program, and MinnesotaCare. The participating counties are primarily rural.

Generally, counties propose arrangements that add value to public programs by:

  • Assuring improved access to providers and community resources
  • Improving coordination of health and human services
  • Stabilizing and supporting existing community provider networks

CBP is authorized by Minnesota Statutes, section 256B.692, permitting counties to elect this purchasing system. CBP entities must meet the same requirements as HMOs or Community Integrated Service Networks (CISNs), as provided for under Minnesota Statutes, chapters 62D and 62N. Requirements are also set out in portions of Minnesota Statutes, chapters 62A, 62J, 62M, 62Q, and 72A.; and in Minn. Rules Part 4685.These requirements include standards for access, quality and financial solvency.

Implementing CBP Arrangements

CBP entities submit proposals and documentation to the Minnesota Department of Human Services (DHS) and the Minnesota Department of Health (MDH), the regulatory authority for HMOs. MDH reviews the proposals to assure that all consumer protections provided by law are reflected in the county-based purchasing arrangements. MDH makes a recommendation to DHS regarding the county-based purchasing proposal. DHS typically initiates competitive procurement and requests approval for a change in its agreement with the federal Centers for Medicaid and Medicare Services (CMS). Once operational, a county-based purchasing entity is subject to a contractual agreement with DHS and ongoing regulatory oversight by MDH.

Status of CBPs

Currently, three entities, representing 20 counties and over 26,000 enrollees, are operational. These entities are:

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Updated Wednesday, 29-Sep-2021 13:07:40 CDT