Minnesota Health Care Programs

1.3.2.1 Change in Circumstances

Minnesota Health Care Programs (MHCP) enrollees must report changes that may affect their eligibility. County, tribal and state servicing agencies must act on reported changes. Changes that people may be required to report include, but are not limited to:

Household composition, including household members moving in or out, births, deaths and marriages
Household tax filing and tax dependent status
Access to other health insurance, including Medicare
Pregnancy
Address
Assets
Income

Reporting Changes

Applicants and enrollees must report changes to their county, tribal or state servicing agency. They may report changes via:

Phone
Mail
In person
Using a renewal form

Inconsistent Information

Changes are discovered in other ways, such as:

Changes reported by another person or agency
Changes reported by an enrollee to another program, such as the Supplemental Nutrition Assistance Program (SNAP)
Information reported by electronic matches
Upcoming or potential changes that the agency has been tracking

Any of these changes may be inconsistent information. See MHCP Inconsistent Information policy for more information.

Reporting Deadline

MA, MFPP and Medicare Savings Program enrollees have 10 days to report changes to their county, tribal, or state servicing agency. MinnesotaCare enrollees have 30 days to report changes.

Eligibility Redetermination

When an MHCP enrollee reports a change in circumstances, eligibility must be redetermined with the new information.

Medical Assistance

When an MA enrollee reports a change in circumstance that maintains MA eligibility but results in a beneficial outcome, such as additional benefits or lower cost sharing, the new MA eligibility begins the first day of the month in which the change occurred.

When an MA enrollee reports a change in circumstances that maintains MA eligibility but results in an adverse outcome, such as lesser benefits or higher cost sharing, the date the new MA eligibility begins depends on when the change occurred. A 10-day advance notice is required for adverse changes. See the MHCP Notices policy for more information.

When an MA enrollee reports a change in circumstance that results in the loss of their current MA basis of eligibility, they must be redetermined under all MA bases they are potentially eligible for, without interruption in their coverage. If an enrollee is no longer eligible for MA under any basis, eligibility must be redetermined for

MinnesotaCare
Advance Premium Tax Credits
Qualified Health Plan

The agency must send the relevant MHCP supplemental form (DHS-6696A or DHS-6696B) to the enrollee when additional information is required to determine eligibility under another MA basis or a different health care program. See the MHCP Application Forms policy for more information.

When additional information is required to determine eligibility under another basis:

The enrollee must remain eligible under their current MA basis without interruption in their coverage until the eligibility redetermination is complete.
The enrollee has 35 days to provide the relevant supplemental form and an additional 35 days to provide requested proofs.

When a MA enrollee reports a change in circumstance that results in the loss of MA eligibility under all possible bases of eligibility, MA coverage ends the last day of the month for which advance notice can be given. Generally, 10-day advance notice is required to end MA coverage. See the MHCP Notices policy for more information.

When a person enrolled in MinnesotaCare, Advance Premium Tax Credits or Qualified Health Plan reports a change in circumstance that results in MA eligibility, MA begins the first day of the month the change was reported, if the person does not need or is not eligible for retroactive coverage. The earliest possible begin date for MA is the first day of the month three months prior to the month the change was reported. A person may add a request for retroactive MA coverage up to 12 months from the month the person became eligible for MA. The person may be eligible for each retroactive month they meet the MA eligibility requirements and have paid or unpaid medical expenses that would be covered by MA in each month.

The Account Validation Service (AVS) must be used when a person enrolled in MA for Families with Children and Adults (MA-FCA), MinnesotaCare, or another Insurance Affordability Program reports a change in circumstances that results in eligibility for MA for People Who Are Age 65 or Older and People Who Are Blind or Have a Disability (MA-ABD) or Medicare Savings Programs (MSP). However, the eligibility determination for MA-ABD must not be delayed by the 10-day AVS processing period.

MinnesotaCare

When a MinnesotaCare enrollee reports a change in circumstance that maintains MinnesotaCare eligibility but results in a different premium or cost sharing amount such as a change in income, the effective date of the premium change depends on whether it is a premium decrease or premium increase. A premium decrease is effective the month after the change was reported. A premium increase is effective for the month billed with the next regular billing cycle.

When a MinnesotaCare enrollee reports a change in circumstances that results in MA eligibility, MinnesotaCare eligibility ends the day before MA eligibility begins.

When a MinnesotaCare enrollee reports a change in circumstances that results in Advance Premium Tax Credit eligibility, MinnesotaCare eligibility and coverage ends the last day of the month for which advance notice can be given. Generally, 10-day advance notice is required to end MinnesotaCare coverage. See the MHCP Notices policy for more information.

When a MinnesotaCare enrollee reports a change in circumstances that results in loss of all health care eligibility, MinnesotaCare eligibility and coverage ends the last day of the month for which advance notice can be given. Generally, 10-day advance notice is required to end MinnesotaCare coverage. See the MHCP Notices policy for more information.

When a person enrolled in MA reports a change in circumstances that results in MinnesotaCare eligibility, MinnesotaCare eligibility begins no earlier than the first day of the month following the month MA ends. When a person enrolled in another Insurance Affordability Program reports a change in circumstance that results in MinnesotaCare eligibility, the earliest possible begin date for MinnesotaCare eligibility is the month the change was reported. MinnesotaCare coverage generally begins the first day of the month after the month in which eligibility is approved and a first premium payment is received, if the person is required to pay a premium. The coverage begin date for a person who is not required to pay a premium is the first day of the month after the month in which eligibility is approved. See MinnesotaCare Begin and End Dates for more information and exceptions for a person added to an existing MinnesotaCare household.

Medicare Savings Programs

When a Medicare Savings Program (MSP) enrollee reports a change in circumstances that results in a change to a more beneficial MSP program, the new MSP eligibility begins the first day of the month in which the change occurred.

When a MSP enrollee reports a change in circumstances that results in a change to a less beneficial MSP program, the date the new MSP eligibility begins depends on when the change occurred. A 10-day advance notice is required for adverse changes. See the MHCP Notices policy for more information.

When a MSP enrollee reports a change in circumstances that results in the loss of MSP eligibility, MSP coverage ends the last day of the month for which advance notice can be given. Generally, 10-day notice is required to end MSP coverage. See the MHCP Notices policy for more information.

Exceptions

Changes in circumstances do not effect eligibility in the following situations:

Income increases between renewals do not change MA for Employed Persons with Disabilities (MA-EPD) monthly premiums. MA-EPD premiums may change at each six-month renewal. See the MA-EPD Premium policy for more information.
Changes in income, assets and household composition to not change eligibility for Refugee Medical Assistance (RMA). See the RMA chapter for more information.
Income and household composition changes only change eligibility for the Minnesota Family Planning Program at renewal or when the person fails to report a change at renewal. See the MFPP Change in Circumstances policy for more information.

Legal Citations

Code of Federal Regulations, title 42, section 435.916

Code of Federal Regulations, title 42, section 435.1200

Code of Federal Regulations, title 42, section 457.350

Code of Federal Regulations, title 45, section 155.330

Minnesota Rules, part 9505.0115, subpart 1

Minnesota Statutes 256B.057