Medical Assistance Bases of Eligibility

Each person must have a basis of eligibility for Medical Assistance (MA). A basis of eligibility is a set of factors such as age, disability, or household composition. The bases of eligibility are based on groups for whom DHS can receive federal reimbursement, also known as Federal Financial Participation (FFP) Federal reimbursement to DHS for some of the cost of a client's health care services. People must meet certain criteria to be eligible for health care programs with FFP..

MA Bases of Eligibility.

Medicare Savings Programs.

Waiver Programs.

NMED and EMA.

Eligibility Method for MA.

Related Topics.

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MA Bases of Eligibility

While having a basis of eligibility is a primary requirement for MA, people must also meet all other program requirements, such as residency, immigration status, income, etc. These requirements may vary, depending on a person's basis of eligibility.

Example:
Paul has a parent/caretaker basis of eligibility for MA. However, his assets exceed the limit.

Action:
Deny MA if Paul cannot reduce his assets to the limit. Even though he has a basis, he does not meet the asset requirements of the program.

All children under age 21 have an MA basis of eligibility. Adults can have a basis of eligibility as pregnant, a parent/caretaker, an adult without children, or age 65 and older, blind, or disabled.

Some people may have an automatic basis of eligibility due to eligibility for another program, or other circumstances. For example, people who receive income assistance through Minnesota Supplemental Aid (MSA) A state-funded program that provides cash assistance to SSI recipients, blind people, people age 65 or older, and disabled people who are age 18 and older. or Refugee Cash Assistance (RCA) A program that provides financial help to refugees ineligible for both MFIP and SSI. have an automatic basis of eligibility for MA. However, they do not have to accept the MA coverage.

Assist people who meet more than one basis of eligibility in determining which basis is most advantageous. See Multiple Bases of Eligibility.

If people become ineligible under one basis, determine if they meet another basis. Leave MA open under the original basis while the determination is in process. See Change in Basis of Eligibility.

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Medicare Savings Programs

People who are eligible for Medicare A federal health insurance program for people who are age 65 or older, disabled, blind, or have permanent kidney failure. may be eligible for QMB, SLMB, QI, or QWD benefits instead of or in addition to MA. See Medicare Savings Programs for an explanation of these programs.

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Waiver Programs

People who meet certain disability or age requirements may be eligible for one of the waiver programs. These programs provide a waiver of some MA eligibility requirements, and covered services beyond those already provided by MA.

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NMED and EMA

The state-funded MA program (also called (Noncitizens Medical Assistance NMED Noncitizens Medical Assistance. A state-funded program that provides MA coverage for some noncitizens who do not meet immigration status requirements for federally funded MA. NMED was enacted by the legislature in 1997 in response to the federal Personal Responsibility and Work Opportunity Act (PRWORA) of 1996. PRWORA brought about the end of federally funded MA for noncitizens with certain immigration statuses.) is limited to noncitizens who receive services through the Center for Victims of Torture. Noncitizens who are eligible for state-funded MA are subject to the same basis of eligibility and other requirements as people who are eligible for federally funded MA.

An MA basis of eligibility is also required for noncitizens who are eligible for Emergency Medical Assistance (EMA) (program EH). This program is federally funded, but has some different program requirements and fewer covered services than state-funded MA (program NM) and federally funded MA (program MA). See Hierarchy of Major Programs and Emergency Medical Assistance for more information.

Example:
Leila, age 16, is an undocumented noncitizen. She has an MA basis of eligibility as a child under 21 and has income within the MA limits.

Action:
Because undocumented noncitizens do not meet the citizenship and immigration requirements for state- or federally funded MA, deny MA eligibility for Leila. Consider EMA if she has a medical emergency.

Example:
Allen, age 40, is a noncitizen with a nonimmigrant status. He does not have any children, and is not blind or disabled. He has a medical emergency

Action:
Open EMA for Allen, if he meets all of the other program requirements, including residence, because he has an adult without children basis of eligibility for MA and he has a medical emergency.

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Eligibility Method

The eligibility method governs how a client’s income and assets are evaluated, including exclusions and allowable income deductions.

There are two methods used to evaluate income and assets:

l  Method A is based on the rules of the former AFDC program in effect as of July 16, 1996. For MA, people using a "families with children" basis of eligibility use Method A.

l  Method B is based on the rules of the Supplemental Security Income (SSI) A program based on financial need operated by the Social Security Administration that provides monthly income to low income people who are age 65 or older, blind or disabled. program. For MA, people whose eligibility is based on being age 65 or older, blind, or disabled use Method B.

In some cases, Method A and Method B do not differ. When Method A and Method B have different rules, follow the instructions for the appropriate method.

Example:
Susan and Bill each pay court-ordered child support for children from previous relationships who do not live with them. Susan has a Method A basis of eligibility, which allows a deduction for court-ordered child support. Bill has a Method B basis of eligibility, which generally does not allow this deduction.

Action:
Allow Susan’s court-ordered child support payments as a deduction when computing her net income, but do not allow Bill’s court-ordered child support payments when computing his net income.

See Assets and Income for instructions on treatment of various types of income and assets.

Note:  For some bases of eligibility, it is not necessary to evaluate income or assets for health care program eligibility. This includes, but is not limited to, MA bases such as auto newborn and people who receive MA automatically with MSA. MAXIS uses the term "Method X" to describe these situations.

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Related Topics

For more information, see:

MA for Families with Children.

MA for People Who Are Age 65 or Older, Blind, or Disabled.

MA for Adults without Children.

Programs for Specific Populations.

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