Minnesota Health Care Programs
Eligibility Policy Manual
Welcome to the Minnesota Department of Human Services (DHS) Minnesota Health Care Programs Eligibility Policy Manual (EPM).The manual contains the official DHS eligibility policies for the Minnesota Health Care Programs including Medical Assistance and MinnesotaCare. It does not provide procedural instructions or system information. Minnesota Health Care Programs policies are based on the state and federal laws and regulations that govern the programs. See Legal Authority section for more information. See the Legal Authority section for more information.
Updates
Beginning June 1, 2023 policy clarifications and policy additions are announced through an Email Subscription. Anyone can sign up to receive the Email Subscription.
Recent Updates
February 16, 2024February 16, 2024
Under the Adults section, fourth bullet point down
2.3.5.4.1 Medical Assistance for Employed Persons with Disabilities Medicare
We changed the Medicare Part B Reimbursement section to Payment for Medicare Part B Premiums.
In the last paragraph of this section, we clarified Medical Assistance for an Employed Person with a Disability (MA-EPD) enrollees not eligible for the Qualified Medicare Beneficiary (QMB) program or Specified Low-Income Medicare Beneficiary (SLMB) program, with income at or below 200% FPG, the Medicare Part B premium must be processed and reimbursed by the county or tribal servicing agency.
2.1.1.2.1.3.2 Medical Assistance Medical Support
We revised the Good Cause section of this page to clarify what good cause is, how it is determined, and to include information about an enrollee's right to appeal the good cause committee's decision.
January 19, 2024January 19, 2024
2.3.5.3.2 Medical Assistance for Employed Persons with Disabilities (MA-EPD) Income
We added this section to include MA-EPD income policy.
*****
We clarified the Medical Assistance for People Who Are Age 65 or Older or People Who Are Blind or Have a Disability (MA-ABD) Shared Ownership policy and how to determine the asset value of a joint bank account.
We removed section 2.3.3.2.4.1.1 MA-ABD Shared Ownership and moved the information into:
We added the following new sub-headings:
-
• Jointly Owned Liquid Assets
• Assumption Dispute
• Dispute Outcome
• Effects on LTC Eligibility
• Other Jointly Owned Assets
We added the Shared Ownership of Personal Property sub-heading.
We removed section 2.3.3.2.4.1 MA-ABD Availability of Countable Assets and combined this information into section 2.3.3.2.4 MA-ABD Countable Assets.
We also developed Information about Joint Bank Accounts (DHS-8511) for use with this policy clarification.
January 12, 2024January 12, 2024
We incorporated information from Bulletin #23-21-16 DHS Clarifies Requirement to Redetermine Medical Assistance Eligibility Under All Bases Before Closure as it applies to the Medical Assistance (MA) for Northstar Kinship Assistance (NKA), Foster Care (FC) and Northstar Adoption Assistance (NAA) into the following EPM sections.
- 2.5.6.2.2.1 MA NKA Basis of Eligibility
- 2.5.6.3.2.1 MA-FC Basis of Eligibility
- 2.5.6.1.2.1 MA-NAA Basis of Eligibility
- 2.5.6.2.4.2 MA-NKA Renewals
- 2.5.6.3.4.2 MA-FC Renewals
- 2.5.6.1.4.3 MA-NAA Renewals (This is a new page)
We updated this appendix with the Medicare cost sharing amounts for the 2024 benefit year.
We updated the IRS mileage rate for 2024.
December 1, 2023December 1, 2023
We revised standards and guidelines in Appendix F that become effective January 1, 2024
Types of Health Care Expenses
We clarify that “once medical necessity is established, enrollees are not required to submit a new Medical Need form for the same expense in subsequent six-month periods.”
We incorporated the following policy changes from Bulletin #23-21-13 DHS Clarifies Medical Assistance Eligibility Policy for when a Disability Certification Ends.
2.1.1.2.4 Medical Assistance (MA) Referral for Other Benefits
We added a person may need to appeal a denial of certification of disability with other programs in order to maintain a basis of eligibility for MA.
We separated the Beginning and Ending Bases of Eligibility section into two sections labeled Begin Dates and End Dates. We also clarify "If a person is receiving MA with a blind or disabled basis with a certification of disability by SMRT and then is found not disabled by SSA, the SSA determination supersedes the SMRT determination and the blind or disabled basis ends."
November 17, 2023November 17, 2023
3.2.3.2 MinnesotaCare Employer-Sponsored Coverage
Family Affordability Standard
We decreased the employee’s portion of the annual premiums for family coverage to not exceed 8.39 percent from 9.12 percent of their annual household income for the tax year to be considered affordable.
2.3.5.1.3 Medical Assistance for Employed Persons with Disabilities Work Requirements
Verification of Employment Income
We clarified employment income must be verified at application, at six months, and at renewal.
We also added, “only verification of employment income is required when the premium is recalculated at six months. Verification of assets is not required unless the enrollee reports a change in assets.”
DHS discontinued the use of manual letters to announce policy clarifications and policy additions effective June 1, 2023. You can see a list of manual letters published between June 1, 2016 to June 1, 2023 in the EPM Archive Manual Letters. As of June 1, 2023 this home page is no longer archived, since it does not contain eligibility policy.
Bulletins
DHS bulletins provide information about policy changes and direction to county and tribal health and human services agencies and other DHS business partners. According to DHS policy, bulletins more than two years old are obsolete. Anyone can subscribe to the Bulletins mailing list.
A DHS Bulletin supersedes information in this manual until incorporated into this manual. The following bulletins have not yet been incorporated into the EPM:
- Bulletin #22-21-05 DHS Explains Treatment of Minnesota’s Public Program Frontline Worker Payments
- Bulletin #23-21-07 DHS Clarifies MA Eligibility Policy and Coverage Suspension for People who are Incarcerated
- Bulletin #23-21-12 DHS Cancels Unpaid MinnesotaCare Premiums and Temporarily Waives Premiums for all Enrollees
- Bulletin #23-21-15 DHS Revises the MHCP Application, Renewal and Supplement Forms for Certain Populations
- Bulletin #23-21-18C Corrected #23-21-18: DHS Announces a Simplified Renewal Process for Certain MA-ABD Enrollees
- Bulletin #23-21-21 DHS Eliminates Parental Fees for Children Receiving MA under the TEFRA Options and HCBS Waivers
- Bulletin #23-21-24 DHS Announces Medical Assistance for Former Foster Care Youth
- Bulletin #23-21-25 DHS Revises the Application for Health Coverage and Help Paying Costs and Supplement Form
- Bulletin #23-21-27 DHS Implements Continuous Medical Assistance Eligibility for Children Under Age 19
- Bulletin #23-21-28 DHS Eliminates the Asset Limit for MA for Employed Persons with DIsabilities
COVID-19 Emergency Bulletins: These bulletins announce temporary policy modifications, which supersede policies in this manual, during the COVID-19 emergency. Because these bulletins provide temporary guidance, they will not be incorporated into this manual.
- Bulletin #20-21-01 DHS Announces a Change in Service Delivery for Medical Assistance Applicants and Enrollees Temporarily Absent from Minnesota
- Bulletin #20-21-02, DHS Announces Temporary Policy Changes to Minnesota Health Care Programs During the COVID-19 Peacetime Emergency
- Bulletin #20-21-03, DHS Announces Medical Assistance for COVID-19 Testing of Uninsured Individuals
- Bulletin #20-21-04, DHS Explains Treatment of Federal Coronavirus Aid, Relief, and Economic Security Act Payments for Minnesota Health Care Programs
- Bulletin #20-21-05, DHS Explains Treatment of Federal Pandemic Unemployment Compensation Payments for Minnesota Health Care Programs
- Bulletin #20-21-06, DHS Explains Treatment of State, Local and Tribal COVID-19 Relief Payments for Minnesota Health Care Programs
- Bulletin #20-21-10, DHS Announces Updates to Temporary Policies for Minnesota Health Care Programs during the COVID-19 Public Health Emergency
- Bulletin #20-21-13, DHS Announces a Change to Processing PARIS Interstate Matches for MHCP Enrollees During the COVID-19 Public Health Emergency
- Bulletin #20-21-14, DHS Explains Treatment of Coronavirus Response Payments under the Consolidated Appropriations Act, 2021, for Minnesota Health Care Programs
- Bulletin #21-21-02, DHS Explains Treatment of Coronavirus Response Payments under the American Rescue Plan Act of 2021, for MHCP
- Bulletin #21-21-03, DHS Explains Treatment of PUA and PEUC for Minnesota Health Care Programs
- Bulletin #21-21-04, DHS Explains Redetermination and Closure of MHCP for Enrollees Not Validly Enrolled due to Fraud or Agency Error
- Bulletin #21-21-05, DHS Announces a Change to the MAGI Methodology for Medical Assistance and MinnesotaCare
- Bulletin #21-21-06 DHS Announces MinnnesotaCare Premium Reductions for 2021 and 2022
- Bulletin #21-21-07 DHS Explains Redetermination and Closure of MHCP for Enrollees Not Validly Enrolled due to Abuse
- Bulletin #21-21-08 DHS Explains Treatment of RentHelpMN Assistance and Child Tax Credit Payments for Minnesota Health Care Programs
- Bulletin #22-21-11 DHS Announces Temporary Policy to Accept Minnesota Address Updates on USPS Returned Mail for Minnesota Health Care Programs
- Bulletin #23-21-05 DHS Announces Temporary Policy to Accept Contact Information Updates from MCOs for MHCP
- Bulletin #23-21-08 DHS Announces Key MHCP Eligibility Policies during the Unwinding Period
- Bulletin #23-21-09 DHS Announces the Resumption of Minnesota Health Care Programs Annual Eligibility Renewals
- Bulletin #23-21-14 DHS Explains Transition from COVID-19 Temporary MA-EPD Policies to Standard MA-EPD Policies
- Bulletin #23-21-17 DHS Explains Handling Renewal-Related Returned Mail During the Unwinding Period
- Bulletin #23-21-19 DHS Announces Temporary Asset Disregard and Other Asset Policies for Certain MHCP Enrollees
- Bulletin #23-21-20 DHS Announces Temporary Changes to Deadlines for Medical Assistance and MinnesotaCare Eligibility Appeals
- Bulletin #23-21-26 DHS Implements Mitigation Plan 2.0 and Clarifies Post Renewal Policies
Prior versions of EPM sections are available upon request. This manual consolidates and updates eligibility policy previously found in the Health Care Programs Manual (HCPM) and Insurance Affordability Programs Manual (IAPM). Prior versions of policy from the HCPM and IAPM are available upon request.
Contact Us
Direct questions about the Minnesota Health Care Programs Eligibility Policy Manual to the DHS Health Care Eligibility and Access (HCEA) Division, P.O. Box 64989, 540 Cedar Street, St. Paul, MN 55164-0989 or fax (651) 431-7423.
Health care eligibility workers must follow agency procedures to submit policy-related questions to HealthQuest.
Legal Authority
Many legal authorities govern Minnesota Health Care Programs, including but not limited to:
- Title XIX of the Social Security Act;
- Titles 26, 42 and 45 of the Code of Federal Regulations;
- Minnesota Statutes chapters 256B and 256L, and
- Certain federal regulations from the Centers for Medicare & Medicaid Services (CMS).
Each topic in the EPM includes applicable legal citations at the bottom of the page.
DHS has made every effort to include all applicable statutes, laws, regulations and other presiding authorities; however, erroneous citations or omissions do not imply that there are no applicable legal citations or other presiding authorities. The EPM provides program eligibility policy and should not be construed as legal advice.
EPM Subscription
After you set up an account, you will have the opportunity to scroll down to select Minnesota Health Care Programs Eligibility Policy Manual, which will provide an update or all sections, or you can select which individual sections of the EPM you want to be notified when an update occurs.You can change your subscriber preferences at any time by logging into your account.