Medical Assistance for Families with Children and Adults

2.2.2.1 Bases of Eligibility

Minnesota provides Medical Assistance (MA) to certain groups of people as allowed under law. These groups are referred to as a basis of eligibility. A person’s basis of eligibility determines the non-financial criteria and financial methodology used to determine MA eligibility.

The following are the bases of eligibility for MA for Families with Children and Adults (MA-FCA):

  • Parent:

    • Biological, natural, adoptive or step parent

    • Living with a child younger than age 19

    • Has primary responsibility for the child’s care

  • Caretaker Relative, including foster parents, legal guardians or others, who are:

    • A relative of a child younger than age 19, by blood, adoption, or marriage. Including:

      • Grandparents, siblings

      • First cousins, nephews, nieces, aunts or uncles and people of preceding generations as denoted by grand, great or great-great

      •  Stepbrother or stepsister

      • Spouses and former spouses of the people named above

    • Living with a child younger than age 19

    • Has primary responsibility for the child’s care

    • The spouse of a caretaker relative can also use the caretaker relative basis of eligibility

  • Pregnant Woman:

    • A woman who is pregnant

    • A woman within the 60 days postpartum period

  • Auto Newborn: child born to a mother enrolled in MA

  • Infant: child age 0 through 1:

    • Children's Health Insurance Program (CHIP) funded MA may be available for infants with income between 275%  and 283% FPG who are not enrolled in other health insurance

    • A CHIP-funded infant who gains other health insurance becomes eligible for MA as a non-CHIP-funded infant

  • Child age 2 through 18

  • Child age 19 and 20

  • Adult age 21 through 64 who:

    • Is not eligible for or enrolled in Medicare Part A or Medicare Part B

    • Is not a Supplemental Security Income (SSI) recipient

    • Is not eligible for MA under 1619 a/b

    • Is not a former SSI recipient who stopped receiving SSI when they began receiving Retirement, Survivor, Disability (RSDI) benefits from the Social Security Administration (SSA) under a deceased spouse or deceased or retired parent’s earning record

    • Is not eligible for MA under the parent, caretaker relative, pregnant woman or former foster care basis of eligibility

    Adults not eligible for this basis may meet the eligibility requirements for MA for People Who Are Age 65 or Older or People Who Are Blind or Have a Disability.

  • Former Foster Child:

    • Was in Title IV-E or Non-IV-E foster care on 18th birthday

    • Currently younger than age 26

    • Was enrolled in MA or MinnesotaCare when foster care ended

    • Is not eligible for MA under the parent, relative caretaker, pregnant woman or child age 19 and 20 basis of eligibility

  • Beginning and Ending Bases of Eligibility

    A person must have one of the following bases of eligibility for MA-FCA. A person whose basis of eligibility ends must be evaluated for other MA bases of eligibility before MA is closed.

    Applicants who meet eligibility requirements at any time within a month are eligible for the entire month with the following exceptions:

    • A person’s eligibility ends on the date of death

    • A person’s eligibility begins the date they become a Minnesota resident

    • A person’s eligibility begins the date they meet their spenddown requirement

    The begin and end dates for the following bases of eligibility are:

    • Pregnant woman:

      • Begins the first day of the month of conception

      • Ends the last day of the month following the 60-day postpartum period

      • Begin and end dates for the pregnant woman basis of eligibility are determined using information the applicant or enrollee attests. Verification of pregnancy is not required to establish this basis.

    • Auto newborn:

      • Begins the first day of the month of birth

      • Ends the last day of the month of their first birthday

    • Infant:

      • Begins the first day of the month of birth

      • Ends the last day of the month of their second birthday

    • Child age 2 through 18:

      • Begins the first day of the month following their second birthday

      • Ends the last day of the month of their 19th birthday

    • Child age 19 and 20:

      • Begins the first day of the month following their 19th birthday

      • Ends the last day of the month of their 21st birthday

    • Parent or caretaker relative:

      • Begins the first day of the month of the birth or adoption of a child under the age of 19 or the first day of the first full month when a child younger than age of 19 moves into their home.

      • Ends the last day of the month when:

        • The only child or youngest child for whom the person is a parent or relative caretaker turns 19

        • The only child, or all children who live in the home under the age 19, leave the home and the absence is not temporary

        • The parent or caretaker relative no longer lives with a child younger than age 19

    • Adults without children:

      • Begins the first day of the month following their 21st birthday

      • Ends the last day of the month prior to their 65th birthday

    • Former foster child:

      • Begins no earlier than the first day of the month after the month that Medicaid for Title IV-E foster care or Non-Title IV-E ends

      • Ends the last day of the month following their 26th birthday

    Multiple Bases of Eligibility

    People may have more than one basis of eligibility. A person’s countable income, asset limit, cost sharing, service delivery options and benefits may differ depending on the eligibility basis used. The county, tribal or state servicing agency must allow a person with multiple bases of eligibility to have eligibility determined under the basis that best meets their needs.

    Change in Basis of Eligibility for Enrollees

    A change in circumstances may affect an MA enrollee's basis of eligibility. People who lose eligibility under one basis must be redetermined under another basis without interruption in their coverage. Additional information may be required to determine continued eligibility under another basis. Some changes that may affect an enrollee's basis of eligibility include, but are not limited to:

    • Age

      • An auto newborn basis of eligibility ends the last day of the month in which the child turns one

      • A child basis of eligibility ends the last day of the month of the child's 21st birthday

      • An adult without children basis of eligibility ends the month before the enrollee’s 65th birthday

    • Disability status

    • Household Composition

    • Medicare A or B. An adult without children basis of eligibility ends the month before the enrollee is eligible for or enrolled in Medicare A or B.

    • Pregnancy. A pregnant basis of eligibility ends on the last day of the month in which the 60-day postpartum period ends.

    If an enrollee is no longer eligible for MA under any basis, eligibility must be determined under another Minnesota Insurance Affordability Program.

    Legal Citations

    Code of Federal Regulations, title 42, section 431.213

    Code of Federal Regulations, title 42, section 435

    Code of Federal Regulations, title 42, section 457.1

    Minnesota Statutes, section 256B.055