UCare was placed into court-supervised rehabilitation in December 2025, and Medica acquired its Medical Assistance contracts. DHS said UCare’s PMAP, MinnesotaCare, MSC+ and SNBC products would continue under the UCare name from January 1, 2026; UCare’s closure FAQ now says "UCare Medical Assistance (Medicaid) plans are now known as Medica One Health Plan. These plans transitioned to Medica on Oct. 1, 2026." DHS’s October 2026 EIDBI grid lists Medica One Health Plan as its own column, administered through Optum like Medica.
DHS’s December 18, 2025 bulletin said Medica was acquiring certain UCare contracts, that UCare’s PMAP, MinnesotaCare, MSC+ and SNBC products "are not impacted" and would continue under the UCare name from January 1, 2026, and that "Medica commits to providing advance notice of any future changes." UCare’s FAQ records the next step: the Medical Assistance plans became Medica One Health Plan on October 1, 2026, and UCare remains in court-supervised rehabilitation, whose plan changed some claim-filing and appeal deadlines for older UCare claims ("2026 claims are not impacted"). DHS’s rules on changing MCOs also say a new plan "Must provide members medically necessary covered services that another MCO or MHCP FFS had authorized before enrollment," which protects existing EIDBI authorizations through a plan change.[1][2][4][3]
For EIDBI the October 2026 DHS grid gives Medica One Health Plan the same behavioral-health fax as Medica (855-454-8155, "Fax ITP and CMDE requests"), "No referral requirements," authorization of all services for noncontracted providers, Member or Provider Services at 800-850-6141, and network contracting through Optum Provider Services (877-614-0484). No EIDBI policy specific to Medica One Health Plan is published.[1][2][4][3]
The questions that decide whether a family can start with Medica One Health Plan (formerly UCare Medical Assistance), and what they have to bring. Each maps onto something intake should ask on the first call.
Under 21. The statute defines the covered "person" as "an individual under 21 years of age" (§ 256B.0949, subd. 2(q)), and DHS lists "Younger than age 21" among the eligibility criteria.[5][15]
No plan-specific rule is published. No expiry on the diagnosis itself; the clock is the CMDE. DHS says the CMDE "must be completed to initiate services and updated at least once every three years" (or sooner when the condition, diagnosis, family, placement or setting changes), the CMDE provider must complete the direct observation within 60 days of the CMDE date, and to restart services after termination "If the person’s CMDE is more than 36 months old … the person must receive a new CMDE." The annual CMDE for reauthorization is due 30 to 60 days before the current service authorization ends.[16][17]
Set by statute: the diagnosis of ASD or a related condition must be "completed by either (i) a licensed physician, advanced practice registered nurse, or physician assistant, or (ii) a mental health professional," be based on current DSM criteria with direct observation and caregiver information, and meet the standard diagnostic assessment rules of § 245I.10, subd. 6 (§ 256B.0949, subd. 4). DHS’s eligibility page says assessors use the DC:0-5 for children five and younger and the DSM from age six. The CMDE provider (physician, APRN, PA, mental health professional, or qualified clinical trainee with 2,000 hours of ASD experience or equivalent coursework) then confirms medical necessity.[5][15]
No instrument is mandated for EIDBI itself: DHS "strongly encourages providers to use standardized assessment tools" but "does not require specific assessment tools." The exception is a CMDE submitted for other disability or benefit decisions (waiver enrollment, SSI): there DHS requires "A direct observational assessment (e.g., ADOS-2)" and "A structured caregiver interview (e.g., ADI-R)," and says developmental history or non-autism-specific screens alone are "insufficient."[15][16]
No. DHS’s October 2026 grid, for Medica One Health Plan: "No referral requirements."[3]
No plan-specific EIDBI telehealth rule is published. Yes, for most EIDBI services. The statute says Medical Assistance "covers medically necessary EIDBI services and consultations delivered via telehealth … in the same manner as if the service or consultation was delivered in person" (§ 256B.0949, subd. 13(l)). DHS lists the CMDE (97151), coordinated care conference, family/caregiver training (97156/97157), ITP development and progress monitoring (H0032), individual and group intervention (97153/97154) and observation and direction (97155) as telehealth-eligible; higher-intensity intervention (0373T) "cannot occur via telehealth." Same thresholds, authorization and rates as in person; QSP observation and direction may be remote for at most two consecutive months. Bill POS 02 (not at home) or POS 10 (at home), modifier 93 for audio-only, and never use telehealth POS or modifiers for non-client-facing services. Providers enroll for telehealth on the Telehealth Provider Assurance Statement (DHS-6806).[5][18][19]
No plan-specific clock is published. State and federal law apply: since January 1, 2026 standard determinations are due within five business days of a complete request and expedited ones within 48 hours (§§ 62M.01, subd. 3(b), 62M.05), inside the federal 7-calendar-day ceiling (42 CFR 438.210(d)).[8][9][10]
Medical Assistance is still the payer of last resort, but EIDBI is "pay and chase." DHS: "EIDBI providers are not required to bill a member’s commercial insurance before billing Medicaid. MHCP or the MCO will seek reimbursement from third parties … This ‘pay and chase’ process applies to both fee-for-service and managed care members," though a payment received from another source must still be reported. That matches the federal rule letting states pay EPSDT claims and recover later (42 CFR 433.139(b)(3)(i)). For authorization, DHS tells providers with privately insured members to "follow the primary insurance’s authorization procedures."[7][11]
Coverage decides whether Medica One Health Plan (formerly UCare Medical Assistance) pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
No plan-specific EIDBI supervision rule is published. Set by statute for every Medical Assistance member, fee-for-service or managed care. An EIDBI agency must "provide clinical supervision for a minimum of one hour for every 16 hours of direct treatment per person, unless otherwise authorized in the person’s individual treatment plan," and must provide "the required EIDBI intervention observation and direction by a QSP at least once per month" (Minn. Stat. § 256B.0949, subd. 16(a)(15)–(16), as amended by Laws 2026, ch. 95). The QSP may do that monthly observation and direction by telehealth for no more than two consecutive months; the third month must be in person. DHS’s clinical supervision page (updated 9/15/26) adds that each person gets one primary QSP (who signs the ITP), a backup QSP must be available, and a different ratio needs an exception documented in the ITP and approved through service authorization. Every intervention must be "provided by a qualified EIDBI provider and supervised by a QSP" (subd. 13(a)).[5][6][13]
No plan-specific note rule is published. Statutory since 2026. New subdivision 19 of § 256B.0949 (Laws 2026, ch. 95, art. 4, sec. 26) requires all CMDE and EIDBI documentation to be "signed and dated by the provider completing the documentation with the provider’s full name, title, and credentials," to "be entered within 72 hours of service and contain a record and explanation of any delays in entry," and to "include a record of supervision and oversight for staff providing services requiring supervision." "Each EIDBI service occurrence must be documented in a progress note." DHS-7108 (CMDE) must be signed by the CMDE provider and the caregiver or guardian, and DHS-7109 (ITP) by the QSP and the caregiver or guardian; those signatures are the family’s consent to start or continue services.[6][14]
Not published by Medica One Health Plan.[3]
Blocked on: Medica One Health Plan Provider Services, 800-850-6141.
Not published by Medica One Health Plan.[3]
Blocked on: Medica One Health Plan Provider Services, 800-850-6141: ask whether DHS’s billing-grid limits apply.
Not published by Medica One Health Plan.[3]
Blocked on: Medica One Health Plan Provider Services, 800-850-6141: confirm EIDBI POS codes.
Not published by Medica One Health Plan.[3]
Blocked on: Medica One Health Plan Provider Services, 800-850-6141: ask whether rendering provider and supervising QSP must both be on the claim.
UCare’s Medical Assistance plans moved to Medica and became Medica One Health Plan on October 1, 2026. UCare itself is in court-supervised rehabilitation.
DHS requires a plan to provide medically necessary services that a previous MCO or fee-for-service had authorized before enrollment. Send the new plan the current authorization, CMDE and ITP and confirm.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.
Carelu collects all of this automatically.
Every ID, document, and detail this payer requires — gathered conversationally the moment a family reaches out, with insurance verified before your team touches the file.
Get a Demo