Medical Assistance for People Who Are Age 65 or Older or People Who Are Blind or Have a Disability

2.3.2.1 Bases of Eligibility (Archive)

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 bases of eligibility for Medical Assistance for People Who Are Age 65 or Older and People Who Are Blind or Have a Disability (MA-ABD) are:

• People age 65 or older

• People certified blind

• People certified disabled

Multiple Bases of Eligibility

People may have more than one basis of eligibility. A person’s countable income, asset limits, 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.

Beginning and Ending Bases of Eligibility

When an enrollee’s basis of eligibility ends, they must be evaluated for other MA bases of eligibility and other health care programs before their coverage is closed.

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

• Adults age 65 and older:

  • Begins the first day of the month of their 65th birthday

• People certified blind or disabled:

  • Begins the first day of the month of the disability onset date as determined by the Social Security Administration (SSA) or the State Medical Review Team (SMRT)

  • Ends the last day of the last month a person is certified disabled as determined by SSA or SMRT

The blind or disabled basis of eligibility continues while a person appeals their disability status, until an adverse ruling by an administrative law judge. The blind or disabled basis of eligibility ends the last day of the month in which the appeal results in a finding the person no longer meets the SSA or SMRT disability criteria.  See MA-ABD Certification of Disability for more Information.

If SSA benefits are denied solely on earnings above Substantial Gainful Activity (SGA), the blind or disabled basis of eligibility can only be continued with a new disability determination from SMRT. The blind or disabled basis of eligibility may continue while the SMRT determination is completed. See the MA-ABD Certification of Disability policy for more information.

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 requested to determine continued eligibility under another basis. Some changes that may affect an enrollee's basis of eligibility include, but are not limited to:

• A disability certification ending

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

• Becoming a parent or relative caretaker of a minor child

• Turning age 21 or 65

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

Legal Citations

Code of Federal Regulations, title 42, section 435.121

Code of Federal Regulations, title 42, section 435.201

Code of Federal Regulations, title 42, section 435.230

Code of Federal Regulations, title 42, section 435.330

Code of Federal Regulations, title 42, section 435.520

Code of Federal Regulations, title 42, section 435.522

Code of Federal Regulations, title 42, section 435.530

Code of Federal Regulations, title 42, section 435.540

Code of Federal Regulations, title 42, section 435.541

Code of Federal Regulations, title 42, section 435.911

Code of Federal Regulations, title 42, section 435.916

Minnesota Statutes, section 256B.055

Minnesota Statutes, section 256B.057

Published:  March 4, 2020

Archived: September 1, 2022