Medical Assistance

2.1.1.2.1.3.2 Medical Support

The Medical Assistance (MA) program requires parents or relative caretakers to help provide health care for their children. When both parents live with the child, this requirement is generally met by deeming the parents’ income to the child. When one parent does not live with the child, a referral for medical support may be required.

Medical support is health insurance coverage or cash payments that a parent, who is not living with the child, provides or is court-ordered to provide to meet the medical needs of their child. For MA eligibility, the parent or relative caretaker who lives with the child is required to cooperate with medical support referral requirements for children younger than age 19 on MA.

Assignment of Rights and Cooperation

A parent or relative caretaker assigns the child’s right to medical support by signing a paper or online health care application or renewal form.

County, tribal or state servicing agencies are required to mail a medical support referral packet to the parent or relative caretaker. The MA enrolled parent or relative caretaker must return the form within 30 days of the date on the referral packet. Regardless of whether the forms are returned or not, the county, tribal or state servicing agency must initiate a referral to the county or tribal child support agency, also called the IV-D agency.

For medical support, cooperation may include:

  • Establishing paternity

  • Establishing an order for medical support, or enforcing an existing order

  • Providing information about non-custodial parents

  • Forwarding any medical support payments received directly from the non-custodial parent to the Department of Human Services (DHS)

A pregnant woman, or a parent or relative caretaker who is pregnant, is not required to cooperate with medical support for the child she is expecting or for any other child during pregnancy or during the postpartum period.

Non-Cooperation

The county or tribal child support office determines non-cooperation with medical support requirements and notifies the county, tribal or state servicing agency. The parent or relative caretaker’s MA coverage is closed with 10-day notice.

If MA is closed for non-cooperation, MA coverage cannot be reopened until the parent or relative caretaker cooperates with medical support requirements. If the parent or relative caretaker cooperates, MA may reopen the first day of the month in which cooperation occurs.

The MA coverage of a child, or of anyone without the legal ability to assign rights, is not impacted by non-cooperation with medical support requirements, such as the non-cooperation of a parent or relative caretaker.

Good Cause

A parent or relative caretaker may request “good cause” when there are circumstances beyond their control which keeps them from cooperating with medical support requirements. Information about good cause is included in the medical support referral packet sent to parents who are referred to medical support. A good cause committee reviews the good cause request. A person may withdraw a claim of good cause at any time in the process.

A parent or relative caretaker who meets all other program requirements are eligible for health care coverage while the good cause claim is being decided. If the good cause committee notifies the worker that the caretaker is not cooperating or does not meet the criteria for a good cause claim, the parent or relative caretaker’s MA may be closed with ten-day notice.

Good cause claims must be reviewed annually. If a household with an approved good cause claim moves to another county, the review date for the good cause exemption remains one year from the date it was approved by the good cause committee at the original county.

If a household with an approved good cause claim moves to another county, the new county good cause committee is not required to make the same good cause finding. If the custodial parent or relative caretaker requests it, the county committees must share the evidence between counties.

When Medical Support Referrals are Made

A medical support referral is made when a child younger than age 19 resides with one parent or a relative caretaker, both the child and the parent or relative caretaker are eligible for MA, and none of the Referral Not Required criteria below applies.

Referral Not Required

A medical support referral is not made in any of the following circumstances:

  • One parent in a two-parent household has a temporary absence. Refer to Section 1.4.4 Minnesota Health Care Programs Temporary Absence for more information.

  • Only a child, and not a parent or relative caretaker, is enrolled in MA.

  • The parent is deceased.

  • The parent or relative caretaker is pregnant.

  • The parent is a minor child under age 18 or is an emancipated minor.

  • The child receives Northstar Adoption Assistance.

  • The child receives Northstar Foster Care or Kinship Assistance.

  • A parent is involuntarily out of the household because he or she is being detained by U.S. Immigration and Customs Enforcement (ICE) or is waiting for immigration authorization from U.S. Citizenship and Immigration Services (USCIS) from outside of the United States.

Voluntary Referral

A parent or relative caretaker may request voluntary medical support or child support referral services from the county or tribal IV-D agency when a referral for MA eligibility purposes is not required. The county or tribal IV-D agencies can assist people in getting the medical or child support referral services.

Legal Citations

Code of Federal Regulations, title 42, section 433.145

Code of Federal Regulations, title 42, section 433.146

Code of Federal Regulations, title 42, section 433.147

Code of Federal Regulations, title 42, section 433.148

Code of Federal Regulations, title 42, section 435.610

Minnesota Statutes, section 256.741

Minnesota Statutes, section 256B.056, subdivisions 6 and 8