Manual Letter #10

This manual letter lists new and revised material for the Health Care Programs Manual. Unless otherwise noted, new and revised instructions are effective March 1, 2008.

Employer-Subsidized Insurance (ESI) - Bulletin #08-21-01 and Other Updates

Includes new and revised policy for determining and verifying access to employer-subsidized insurance (ESI).

Incorporates the new rules for verifying access to ESI from bulletin #08-21-01, ”Changes to MinnesotaCare Verification of Access to Employer-Subsidized Insurance.” Effective February 1, 2008, it is no longer necessary to verify access to ESI for all MinnesotaCare applicants and enrollees at each application and renewal or to obtain repeated verification from the same employer. Verification requirements are now targeted to those enrollees more likely to have access to ESI.  

Contains extensive revisions and new examples to emphasize that access to ESI is determined separately for the employee and for dependents in all cases, including situations where the employer offers ”family” coverage (employee plus dependents). Always separate the employee’s share of the cost of coverage from the dependents’ share and determine the amount the employer contributes to each. Do not compare the total employer contribution to the total cost of the coverage for the employee and dependents combined.

See below for further information.

Chapter 15 - Insurance and Third Party Liability.

Client Rights and Responsibilities - Updates to Language

Makes various updates to these chapters to more closely align the text with the related material on the DHS website and the Data Practices Manual. There are also corresponding glossary updates. See below for further information.

Chapter 05 - Client Rights.

Chapter 06 - Client Responsibilities.

Chapter 07 - Applications.

Other Updates

This manual letter includes a number of other updates and policy clarifications. See below for further information.


Chapter 09 - Verification Requirements.

Chapter 19 - Assets.

Chapter 20 - Income.

Chapter 25 - Premiums.

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Employer-Subsidized Insurance (ESI)

Chapter 15 - Insurance and Third Party Liability

l  Section 15.05.20, Employer-Subsidized Insurance (ESI).

Adds that to be considered ESI, the employer must contribute at least 50% of the cost for the employee and 50% for the dependents, and adds an example of how to determine the employer’s share of dependent coverage separately from the employee’s coverage.

Replaces the first part of the subsection ”Verification of ESI” with new instructions listing the specific circumstances when access to ESI must be verified and adds examples.

Adds ”of ESI” to the phrase ”Acceptable verification includes” and moves the Note underneath to follow the first bullet instead.

Adds that a verbal statement from the employer can be accepted as verification of access to ESI.

Updates the last example to reflect the new verification requirements.

Adds information to the subsection on ”Special Enrollment Period and ESI.”  Deletes the statement that clients meeting the criteria for special enrollment are required to request access to ESI from the employer, because these clients have already been closed or denied MinnesotaCare and are therefore not subject to any program requirements.

l  Chapter, Determining ESI.

Adds text to the introductory paragraphs to emphasize that access to ESI is determined separately for the employee and for dependents in all cases. Distinguishes between the terms ”dependent coverage” and ”family coverage.”  

Under ”Determining ESI - Employee,” adds text and detail to the steps to clarify that the determination is based on only the employee’s cost, not the dependent’s, and adds an example.

Makes minor additions and clarifications to the first two examples.

Adds an example of family coverage and an example of coverage for which the cost varies by number of dependents.

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Clients Rights and Responsibilities

Chapter 05 - Client Rights

l  Section 05 - Client Rights.

Revises the Note under "Client Rights" to specify that the DHS-3182, rather than "appropriate brochures," should be provided with each application. The DHS-3182 gives an overview of Minnesota's Health Care Programs and eligibility requirements. Also updates contact information for the DHS Civil Rights Coordinator and the U.S. Department of Health and Human Services under "Client Civil Rights."

l  Section 05.05 - Limited English Proficiency (LEP).

Revises the introductory paragraph to more clearly state the purpose of the LEP program, and add a reference to Title VI of the Civil Rights Act of 1964.  Also adds a link to the DHS LEP Plan.

Renames the subsection "Why LEP Plans Were Developed" to "LEP Plan Purpose and Legal Basis," and revises the text to clarify the origin and purpose of LEP plans.

Changes the name of the subsection "Worker Action Providing LEP Plans" to "Role of the Worker," and modifies the wording to stress the importance of workers being familiar with their own agency's LEP plan.

l  Section 05.10 - Data Privacy.

Moves the link to the DHS Data Practices Manual from the end to the beginning of the section.

Revises the definitions for "private data" and "confidential data" to more closely match the definitions in the DHS Data Practices Manual, and adds a definition for "public data." Replaces the term "Tennessen Notice" with "Notice of Privacy Practices" and adds a link to the DHS-3979.  

Expands the information about what workers should tell people when they provide private or confidential data under "Worker Responsibilities" to more closely match the DHS Data Practices Manual. Also adds instruction to fax private data only if the fax is secure or encrypted, and not to include private data in Internet e-mail.  

Changes the name of the subsection "Records Review" to "Data Review," adds a link to the information about costs of providing copies in the DHS Data Practices Manual, and makes minor wording and formatting changes for clarity.  

Changes the name of the subsection "What Privacy Rights Do Children Have?" to "Privacy Rights of Children," and adds a link to information about minors in the DHS Data Practices Manual. Also adds examples of medical treatment for which parental consent is not required.

l  Section 05.10.05 - Health Insurance Portability and Accountability Act (HIPAA).

Makes minor formatting and wording changes to more closely match the information about HIPAA on the DHS website.

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Chapter 06 - Client Responsibilities

l  Section 06 - Client Responsibilities.

Under "How to Inform Clients of Responsibilities," replaces the existing text with the instruction to return the Notice of Privacy Practices and Important Information pages to the client if they are submitted with the health care application or renewal form.

Adds several links and makes minor wording changes to the Note under "What Are a Client's Responsibilities?".

l  Section 06.05 - Cooperation.

Makes minor wording and formatting changes for clarity and adds links throughout the section. Also removes the word "Responsibilities" from the name of each subsection to enhance readability.

Removes the subsection "Definitions" and adds glossary links for the relevant terms elsewhere in the section.  

Changes the name of the subsection "Quality Control/Quality Assurance Cooperation Responsibilities" to "Medicaid Eligibility Quality Control and Quality Review Cooperation," and replaces the reference to "quality assurance reviews" to "MinnesotaCare quality reviews." Also adds a Note stating that clients of state-funded programs do not have QC reviews.

Clarifies under "Medical Support Cooperation" that assignment of rights occurs when signing the application or renewal.

l  Section 06.10 - Changes in Circumstances.

Makes minor wording and formatting changes for clarity throughout the section. Also adds a reference and link to IEVS under "How Changes May Be Reported," and adds links to additional sections under "Specific Types of Changes."

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Chapter 07 - Applications

l  Section 07.05.05, Application Forms.

Under "General Application Form Requirements," adds the instruction to include the DHS-3182 with each application, in conjunction with the update for section 05, Client Rights.

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Other Updates


l  A-F.

Updates the definition of "confidential data" to more closely match the definition in the DHS Data Practices Manual.

l  G-L.

Updates the definition of ”inconsistent information” to clarify that information from sources other than the client could be inconsistent.

Revises the definition of ”life estate” to match the changes in Life Estates.

Updates the definition of "limited English proficiency (LEP)" to more closely match the definition on the DHS website.

l  M-R.

Adds a definition of "public data." Updates the definition of "private data" to more closely match the definition in the DHS Data Practices Manual. Adds a definition of "Notice of Privacy Practices" to replace the term "Tennessen Notice."

 l  S-Z.

Revises the definition of "Tennessen Notice" to reflect that "Notice of Privacy Practices" is the current term. Also adds a definition of "Title VI of the Civil Rights Act of 1964" in conjunction with the updates to section 05.05, LEP.

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Chapter 09 - Verification Requirements

This chapter contains wording clarifications and minor updates in all of the sections, and consolidates three sections.

l  Section 09 - Verification Requirements.

Removes the words ”from the client” from the definition of ”inconsistent information” to match the change to the glossary definition. Information provided by sources other than the client can also be inconsistent with other information on file.

l  Section 09.05 - Mandatory Verifications.

Adds text to emphasize that the section provides a basic overview of verification requirements and links to the topic-specific sections which provide detailed requirements.

Removes the subsection ”Verification Requirements - All Programs.” Instead, links to the sections on immigration status, social security number and income appear at the top of the section. U.S. citizenship, which was formerly listed in the ”All Programs” subsection, does not appear here because it does not apply to GAMC.

Under ”MCRE Verification Only:”   

n  Adds U.S. citizenship for families with children.

n  Removes the paragraph describing ESI verification requirements. The policy has changed with this manual letter and is described in the ESI subsection.

n  Removes the note under Pregnancy.

n  Adds that the continuing care retirement community entrance fee is the only asset verification required for MinnesotaCare.

n  Removes the note regarding verification of active military duty. This is covered in another section.

Under ”MA Verification Only:”

n  Adds U.S. citizenship.

n  Adds links to the blind and disabled bases of eligibility sections to the second bullet.

n  Adds a link to the medical expenses section to the last bullet.

n  Deletes the Long-Term Care Consultation bullet. This is discussed in other manual sections and is not a client verification.

l  Section 09.05.05 - Inconsistent Information.

Adds at the end of the section that reporting zero income but paying regular expenses can be a type of inconsistent information, and adds a link to the subsection ”No Income Reported” under ”Availability of Income.”

l  Section 09.10 - Verification Documentation, Timelines, and Retention.

Changes the section name from ”Verification Documentation” because this section and two others, ”Verification Timelines” and ”Verification Retention,” have been consolidated into this renamed section.

Adds to assist clients in obtaining verification as needed.

Adds links to several topic-specific sections that contain detailed information on the type of documentation required.

Removes ”special” from the title of the subsection on photocopying requirements and rewords the information on copying certain immigration documents.

Removes the subsection ”Assets - Common Types of Documentation.” This information is now located in Verification of Assets.

Removes the subsection ”Income - Common Types of Documentation.” The same information is already included in Verification of Income.

Adds the information on ”Verification Timelines - General,” ”Application,”  ”Renewals” and ”Adding a Person” from former section 09.20.

Adds information on record retention from former section 09.25. Replaces a link to obsolete bulletin #02-85-01, ”County Human Services Record Retention Schedule” with a link to the same information, which is now located elsewhere on the DHS web site.

l  Section 09.15 - Obtaining Verifications.

Adds that agencies must assist clients in obtaining verification and must not deny or close coverage when clients are cooperating in attempting to verify eligibility.

Adds ”publicly available data” as a possible source to assist clients and moves up an example under this new bullet.

l  Section 09.20 - Verification Timelines.

This section is deleted. See Section 09.10 above.

l  Section 09.25 - Verification Retention.

This section is deleted. See Section 09.10 above.

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Chapter 19 - Assets

l  Section 19.20 - Verification of Assets.

Adds the material on common types of asset documentation that was previously found in section 09.10, verification documentation.

l  Section - Life Estates.

Adds a definition section at the beginning and adds that life estates apply only to real, not personal, property.

Clarifies the description of what a life estate is.

Adds an example of a conditional limitation resulting in a life estate terminating before the life estate owner’s death.

Under the subsection ”Life Estate Owner:”

n  Revises and reformats the text to clarify the definition of life estate owner.  

n  Adds to exclude the life estate if it is the life estate owner’s homestead.

n  Clarifies that the life estate owner is entitled to all income and profits from the property, not just rental income, and adds an example.

n  Changes the ”Alice” example to replacement of an irreparable furnace rather than replacement of siding. This is a more clear-cut example of a life estate owner’s responsibilities for upkeep.

n  Replaces the existing example of a jointly held life estate with a new example that illustrates a more typical situation.

Adds under ”Remainderman” that the remainder interest is treated as non-homestead real property if the remainderman does not live on the property and applies for health care.

Removes the subsection ”Life Estate Exclusions.” The information is now under ”Life Estate Owner” and ”Remainderman.”

Combines the subsections ”Life Estate Availability” and ”Life Estate Counted Amount” into a new subsection ”Life Estate Evaluation.”

n  Clarifies that the life estate interest is unavailable and not counted unless the remainderman buys the life estate interest or the entire property is sold. The value of the life estate interest is excluded until the sale proceeds are received.

n  Adds that written statements or other verification of whether the remainderman intends to purchase the life estate or sell the property are not required. Accept the life estate owner’s verbal declaration. Adds an example.

n  Deletes the note that life estates have a zero value for asset assessment purposes and adds that the life estate interest is counted as part of an asset assessment.

Clarifies which date to use to determine the property value at different times under ”Determining Life Estate Interest.”  

Modifies the ”Gregory” example so that the establishment of the life estate takes place during the transfer lookback period.

Modifies the ”Austin and Alberta” example to illustrate how to determine the life estate value when the entire property is sold.

Modifies the example under ”Determining Remainder Interest” to illustrate a remainderman applying for health care.

l  Section - Trusts Established On or After August 11, 1993.

Makes minor wording and formatting revisions throughout the text.

Under ”Client-Established Trust,” adds that the trust can be established by a person, court or administrative body acting at the direction of or on request of the client or client’s spouse.

Moves the information that was previously shown as Step 2 directly under the sentence ”Follow the steps below to evaluate a trust established on or after August 11, 1993.” The previous Steps 3 and 4 are now Steps 2 and 3.

Deletes ”Supplemental Needs Trust” from Step 1 because only supplemental needs trusts that are also special needs trusts can be excluded.

Adds that establishment of a revocable trust is never evaluated as an uncompensated transfer.

Rearranges the material under non-excluded irrevocable trusts into three parts:  

n  Irrevocable trusts created before July 1, 2005.

n  Irrevocable trusts created on or after July 1, 2005 when the client is not requesting MA payment of LTC services. In this case, irrevocable trusts created on or after July 1, 2005, are treated the same as irrevocable trusts created before that date.  

n  Irrevocable trusts created on or after July 1, 2005 when the client is requesting MA payment of LTC services. At that time, the trust becomes revocable and is treated the same as all other revocable trusts. Previous material about these trusts that differed slightly from the instructions for other revocable trusts has been removed.

Divides the ”John” example into two parts and clarifies in the second part that the trust is now revocable because John is requesting MA payment of LTC services.

Under ”Other Trusts,” rewords the Method B/GAMC instructions to follow the format of the Method A section more closely.

Under ”Trust Income,” adds for all categories of trusts to count payments made to someone acting on the client’s behalf as well as payments made directly to the client, and adds that the payments are unearned income. Moves the instructions and note about counting undisbursed income as an asset from client-established irrevocable trusts to client-established revocable trusts.

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Chapter 20 - Income

l  Section 20.30.05 - MinnesotaCare Income Changes.

Adds a link under ”Income Change - Between Renewals” to the new subsection ”Special Provisions - Active Military Duty” in Four Month Penalty.

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Chapter 25 - Premiums

l  Section 25.05.20 - Four Month Penalty.

Adds a new subsection, ”Special Provisions - Active Military Duty” with additional information from bulletin #05-21-04, ”2005 Legislative Change for MinnesotaCare Enrollees Called to Active Military Duty.” Households with enrollees who are called to active military duty may choose to disenroll the household from MinnesotaCare and may reenroll without penalty during or after the active tour of duty. At the time of reenrollment, increases in income or assets are disregarded until the next renewal.

This policy has been in effect since the bulletin was issued.

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