Manual Letter #15

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


Changes have been made to a number of Chapter 19 sections, including those pertaining to the Continuing Care Retirement Communities (CCRC) and the Home Equity Limit.

Other Updates.

Chapter 03 - Eligibility Groups and Bases of Eligibility.

Chapter 10 - Social Security Numbers.

Chapter 11 - Citizenship and Immigration Status.

Chapter 18 - Deeming Income and Assets.

Glossary - A number of new terms have been added and revised.

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Clarifications and links have been added throughout these sections:

l  Section 19.25 - Asset Types.

Wording changes help to clarify that applicants and enrollees may report asset information on the renewal form, or through any other type of correspondence. Workers should contact the client if the information provided is incomplete.  

l  Section 19.25.45 - Continuing Care Retirement Community (CCRC) Entrance Fee.

n  Definitions are removed from this section - glossary definitions are available when the terms are used.  

n  A new subsection is added to this page - Determining the Availability of a CCRC Entrance Fee.

n  Minor language changes are made throughout for clarification.  

n  Corrections are made in calculations for months two and three of the Marta example.

l  Section - Minnesota Continuing Care Retirement Communities (CCRC).

A note is added to this section to clarify that this list may not be inclusive. Direct all questions about whether an organization is a registered CCRC to the County Recorder’s office.

l  Section 19.40 - Transfers.

A correction was made under ”What is a Transfer” regarding a cost involved for a person accepting an inheritance. The client may refuse an inheritance if doing so will result in a greater cost to the client than the value of the income or assets.

l  Section 19.40.20 - Purchases as Transfers.

n  This new page replaces the existing page in its entirety. The new information more clearly defines types of purchases and how to evaluate each type to determine when an uncompensated transfer occurs.  

n  It also corrects policy described incorrectly in Bulletin #06-21-13 for evaluating purchases made on or after July 1, 2006. Follow policy as outlined in this manual section effective September 1, 2008.

l  Section 19.55 - Long-Term Care (LTC) Home Equity Limit.

n  This section was previously titled LTC/EW Home Equity Limit. EW is deleted from the title because the home equity limit applies to all persons receiving LTC services, including services through all of the home and community-based services waiver programs (CAC, CADI, DD, EW and TBI).    

n  Definitions are removed from this section - glossary definitions are available when the terms are used.

n  Added a note to clarify that either the home’s fair market value (FMV) or estimated marked value (EMV) may be used for purposes of the home equity limit policy.

n  Wording changes were made to clarify the policy in subsections Steps to Applying the Home Equity Limit, and Notice Requirements.  

n  Deleted worker instructions to send form DHS-4916 when an enrollee’s MA payment of LTC services is closed because the DHS-4916 is obsolete. Use DHS-4915 as defined in the last bullet.

l  Section 19.55.05 - Home Equity Limit Flowchart.

n  Question one is clarified to add language inclusive of a client having an ownership interest in a property and that the property must have been occupied as a primary dwelling before the start of receiving LTC services.

n  Other questions include language clarification for accurate application of the home equity policy.

l  Section 19.55.10 - Applying Home Equity Limit.

Language clarifications added throughout to help with understanding this policy, especially the home equity interest.

l  Section 19.55.15 - Home Equity Limit Exceptions.

n  Renamed the subsection ”Request Prior to January 1, 2006,” to ”Annual Renewal of MA-LTC Eligibility when no Break in LTC Services Occurred,” and added additional clarification.

n  Added language to clarify home ownership and ownership interest in a home.

n  Moved the Hardship Waiver section information to this section (with some additional clarifications) as an exception to the home equity limit.

n  Deleted the subsection Request for January 1, 2006 - June 30, 2006. This information will be available in the archived section if it is needed.

l  Section 19.55.20 - Calculating Home Equity.

Changes clarify information for determining a person’s home equity interest for the home equity limit policy.

l  Section 19.55.25 - Agricultural Homestead.

n  Definitions have been deleted from this section. Glossary definitions are available when the terms are used.

n  Clarification is added for using the estimated market value (EMV) and the fair market value (FMV) when determining equity value of an agricultural homestead.

l  Section - Agricultural Homestead Flowchart.

Changes made to state that the client’s equity interest must be determined using the EMV, not the FMV.

l  Section 19.55.30 - Home Equity Limit Hardship Waiver.

This section is deleted from the Health Care Programs Manual. Information on demonstrating a hardship waiver is included with the other exceptions to the home equity limit in section 19.55.15.

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Other Updates

Chapter 03 - Eligibility Groups and Bases of Eligibility

l  Section - MA-EPD Employment Definition.

n  Language added to clarify that when calculating earned income for MA-EPD, workers may use average gross monthly earnings for the six-month certification period or an individual month, whichever is more beneficial to the client.

n  Reference to the Temporary Manual added for more information about MA-EPD income calculation.

l  Section 03.30.35 - Medical Assistance for People Receiving Minnesota Supplemental Aid (MSA).

Updates on this page clarify that MSA recipients may decline MA coverage, but may not choose MinnesotaCare or GAMC instead. Other information is added throughout, including updated Service Delivery information.

l  Section 03.45.20 - Group Residential Housing (GRH).

The first part of this section is reworded to help clarify who is eligible for GRH funding. Other information is added throughout, including updated Service Delivery information.

Chapter 10 - Social Security Numbers (SSN)

l  Adds SSN exception for children who are eligible for IV-E Foster Care and Adoptions Assistance.

Chapter 11 - Citizenship and Immigration Status

l  Section 11.05 - Verification of U.S. Citizenship.

Clarifies the process for requesting and obtaining verification of U.S. citizenship as a condition of eligibility for MHCPs.

Chapter 18 - Deeming Income and Assets

l  The definition of deeming is removed from the section. A glossary definition is available when the term is used in the text.  

l  A change was made under exceptions to deeming a spouse’s income to the other spouse, deleting EW and adding DD as one of the exceptions.  

l  Under ”Exceptions” the statement, ”The client is on the DD waiver, and DHS has given written approval to disregard spousal income” is deleted because this is no longer in effect.


l  A - F.

The following terms have been added or revised in this section of the glossary:

n  Agricultural Homestead.

n  Agricultural Land.

n  Agricultural Products.

n  Agricultural Purpose.

n  Agricultural Services.

n  Continuing Care Retirement Community (CCRC).

n  Eligibility Group.

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