Medical Assistance for Employed Persons with Disabilities

2.3.5.1.2 Premiums and Cost Sharing (Archive)

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

1. 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.

2. 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.

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 coverage does not begin until the initial premium is paid and remains in place for a six month period, applicants have coverage only in months for which they pay the premium People do not have to be eligible in the month of application. Eligibility may begin later within the six month budget period, if the applicant meets all eligibility factors by the end of the processing period.

 Applicants who request retroactive coverage must pay the premium for any retroactive months before coverage is approved for the retroactive period. Applicants can choose which retroactive months they want covered and the months do not need to be consecutive.

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 for 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 an 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

• Income guidelines change because of a change in 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.

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

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

Published:  September 1, 2018

Archived: September 1, 2020