Medical Assistance for Employed Persons with Disabilities

2.3.5.1.2 Premiums and Cost Sharing

People enrolled in Medical Assistance for Employed Persons with Disabilities (MA-EPD) must pay monthly premiums to establish and maintain coverage. A premium is based upon:

  • A person’s gross countable income. The minimum premium amount is $35 per month, with a sliding scale for people with gross income at or below 300% of the Federal Poverty Guidelines (FPG). If income is greater than 300% FPG, the premium is 7.5% of gross income.

  • An additional fee that is equal to 0.5% of unearned income. The fee is paid no matter how low gross income is.

The total MA-EPD premium is the combined amount.

An American Indian or Alaska Native who has provided verification of American Indian or Alaska Native status is exempt from paying a premium for MA-EPD. The premium exemption begins the first month after the month the verification was received, unless the verification was received when the application was processed.

An American Indian is defined as a person who is:

  • A member of a federally recognized Indian tribe;

  • Considered by the Secretary of the interior to be an Indian for any purpose: or

  • Determined to be an Indian under regulations promulgated by the U.S. Secretary of Health and Human Services.

Any formal documentation form a tribe, Indian Health Services (HIS), or the Bureau of Indian Affairs (BIA) that verifies a person is an American Indian is acceptable as verification.

An online MA-EPD premium estimator is available. A person’s county or tribal servicing agency is responsible for collecting the initial MA-EPD premium. The Minnesota Department of Human Services (DHS) bills for ongoing MA-EPD premiums monthly.

MA-EPD applicants must pay the initial premium in full within 30 days, before coverage can begin. People can choose which retroactive months they want coverage for, and the months do not have to be consecutive. If the initial premium is not paid within 30 days, MA-EPD coverage will be denied and eligibility is redetermined under all bases. An MA-EPD applicant not eligible for Minnesota Health Care Programs (MHCP) under any basis must reapply for MHCP.

Gross Countable Income

Gross countable income includes countable earned and unearned income of the person and anyone whose income deems to the person, without any disregards or deductions applied. See the MA for People Who Are Age 65 or Older and People Who Are Blind or Have a Disability (MA-ABD) Countable Income policy for more information.

Excluded Income

The MA-ABD excluded income policy applies to MA-EPD. See the MA-ABD Excluded Income policy for more information.

Deeming

Only the MA-EPD enrollee’s income is counted for adults age 18 and older. No spousal income is deemed to the MA-EPD spouse. Parental income is deemed for MA-EPD applicants and enrollees younger than age 18.

Disregards and Deductions

MA-EPD enrollees do not use standard MA-ABD deductions and disregards, because premiums are calculated using the gross countable income.  

The only deduction that applies to the MA-EPD income calculation is the RSDI Cost of Living Adjustments (COLA) disregard. See 2.3.3.3.2.2 MA-ABD Disregards and Deductions for more information about the RSDI COLA disregard.

Family Size

Family size is used to determine premium rates. Family size is determined for each person separately. Family size may be different for each person on an application or in a household.

For MA-EPD enrollees age 21 or older, family size includes the following, if they are living with the person:

  • Enrollee

  • Spouse (unless they are enrolled in MA-EPD)

  • Biological or adopted children, including those who are temporarily absent

  • Spouse's biological or adopted children, including those who are temporarily absent

  • Unborn children of the person or their spouse

For MA-EPD enrollees under age 21, family size includes the following if they are living with the person:

  • Enrollee

  • Spouse (unless they are enrolled in MA-EPD)

  • Biological or adoptive parents

  • Stepparent, if the biological or adoptive parent also lives with the person

  • Siblings (biological, adopted, or step siblings)

  • Unborn children of the person, their spouse or their biological, adoptive or step parents listed above

Monthly Premium Invoices

DHS will send a monthly MA-EPD invoice to enrollees the first month after the initial premium payment is received. These MA-EPD enrollees receive an invoice every month showing the amount of the monthly MA-EPD premium and the due date. Any past-due amount or credit will not be shown on the invoice.

The average anticipated gross monthly countable income is used to calculate the MA-EPD premium amount for a six-month period. The actual gross monthly income is used to calculate the MA-EPD premium amount during any retroactive months.

MA-EPD premiums are calculated for a six-month period. The premium amount is the same for all six months, because the premium is based on average anticipated income.

Premiums can be changed during the six-month period only in the following situations:

  • A reported change results in a decreased premium. The decreased premium is effective the first day of the month after the change is reported.

  • Income guidelines change because of a change in the law.

  • The annual increase in FPG standards.

  • To include increased RSDI benefit amounts when the RSDI COLA disregard ends, effective July 1 of each year.

  • Premiums are recalculated at each six-month renewal.

 

Premium Payment Schedule

Date Invoice Mailed Date Premium is Due For Coverage in this Month
December 4 January 4 February
January 4 February 4 March
February 4 March 4 April
March 4 April 4 May
April 4 May 4 June
May 4 June 4 July
June 4 July 4 August
July 4 August 4 September
August 4 September 4 October
September 4 October 4 November
October 4 November 4 December
November 4 December 4 January


Ongoing MA-EPD premiums are due by the fourth day of the month, but can be paid through noon on the last working day of the month. If an MA-EPD enrollee’s coverage is closed due to non-payment of a premium, then in the month after the month in which coverage was closed they must pay a premium for two months to have coverage reinstated. Premiums should be paid on time to avoid a gap in coverage.

Premium Payments

The first premium must be paid to the county or tribal agency. Ongoing payments can be made by mail, in person, or online. For more information about MA-EPD premium payments, see: How do I pay my MA-EPD premium?

Good Cause for Non Payment of MA-EPD Premiums

People who cannot pay their premium may request good cause. A “good cause” request is an enrollee’s request for premium relief because of circumstances outside their control. DHS is responsible for good cause determinations. When a request is approved, premiums are waived for the period necessary for the enrollee to resolve the situation preventing the enrollee from paying premiums.

Good cause is defined as circumstances beyond a person's control or that they could not reasonably foresee resulting in the enrollee being unable or failing to pay the premium.

Good cause does not include choosing to pay other household expenses instead of the premium. A person cannot request good cause for non-payment of an initial premium. Good cause can only be requested for the non-payment of subsequent premiums.

Requesting Good Cause

People must request good cause using the MA-EPD Good Case Request form (DHS-6939). The form can be submitted electronically, or printed and mailed to DHS. Enrollees needing assistance in completing the form can call Disability Hub MN at 866-333-2466.

DHS provides the person with written notice of their decision within 30 days. People may appeal a finding that good cause does not exist. See the MHCP Appeals policy for more information.

Legal Citations

Minnesota Rules, part 9506.0040, subpart 7, items B to D

Minnesota Statutes, section 256B.057, subdivision 9