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Effective: December 1, 2006 |
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03.05ar1 - MinnesotaCare Eligibility Groups (Archive) |
Archived: February 1, 2008 |
All MinnesotaCare enrollees are assigned to eligibility categories and groups based on characteristics such as age, pregnancy, household composition and income level. Eligibility factors are considered from two perspectives for MinnesotaCare:
l First, is the enrollee pregnant; a child under age 21; a parent, relative caretaker, legal guardian, or foster parent; or an adult without children? These population distinctions will affect eligibility factors such as income limit, asset limit, and residency requirements.
l Second, what is the enrollee's citizenship/immigration status and income? This will place the enrollee in one of four numeric eligibility groups, which will affect insurance barrier requirements and benefit sets.
This section discusses the criteria for the four numeric eligibility groups. The eligibility criteria for distinct populations (pregnant, under age 21, etc.) are discussed in the sections specified under MinnesotaCare.
Re-evaluate group status at each renewal. Once people are assigned to an eligibility group, their group status remains unchanged between renewals except in the circumstances described in Change in MinnesotaCare Eligibility Group.
Children with Group One status are exempt from some of the insurance barrier requirements. Adults with Group One status are not exempt.
Note: See MinnesotaCare Insurance Barriers for a detailed description of the insurance barriers and to whom they apply.
Group One enrollees include all of the following:
l Children under age 21 (including pregnant women) whose household income is at or below 150% FPG.
Example:
Bobby was enrolled in Group One as a child in a household with total income at or below 150% FPG.
Action:
Re-evaluate group status at the time of each renewal. If household income remains at or below 150% FPG, Bobby will retain Group One status. If income increases beyond 150% FPG, assign Bobby to Group Two.
l Children who were originally enrolled in the Children's Health Plan (CHP) on or before June 30, 1993 who have maintained continuous enrollment. These children retain Group One status until they reach age 21.
Note: ”Continuous enrollment” means enrollment in MinnesotaCare, Medical Assistance (MA), or General Assistance Medical Care (GAMC) without a break in coverage of one month or more.
Example:
Charles was enrolled in the Children’s Health Plan in 1992 when he was an infant. He was terminated from MinnesotaCare effective June 1, 1999, and applied for MA on June 10, 1999. He was enrolled in MA from June 1999 until December 31, 2005. He reapplied for MinnesotaCare on December 10, 2005, and was re-enrolled effective January 1, 2006. Charles’s family’s current income is now 200% FPG.
Action:
Even though his household income is now over 150% FPG, since Charles has maintained continuous enrollment, he retains Group One status. If he continues to be continuously enrolled until age 21, re-evaluate his group status for the first available month after his 21st birthday.
l Adults without children whose income is at or below 75% FPG.
Note: Adults with Group One status are subject to the same insurance barrier requirements as other adults. Group One status is used only to distinguish them from Group Three adults, who have a different income level and benefit set.
Group Two enrollees cannot have current health insurance and cannot have had health insurance in the four months prior to enrollment in MinnesotaCare. They may be subject to other insurance barriers, including restrictions on current and past availability of employer-subsidized insurance (ESI).
Group Two enrollees include all of the following:
l Children under age 21 (including pregnant women) whose household income is over 150% FPG.
n At application, income may not exceed 275% FPG.
n Enrollees under 21 in Group Two, who meet the MCHA exemption and maintain continuous enrollment, can have income over the limit and remain enrolled.
Exception: Children under 21 who were enrolled in the Children’s Health Plan on or before June 30, 1993 who have maintained may have household income over 150% FPG and retain Group One status.
l Parents or relative caretakers of children under 21 with incomes at or below 100% FPG or over 200% FPG.
Note: Assign parents and relative caretakers with incomes over 100% FPG but no more than 200% FPG to Group Four if they are citizens or have an immigration status that qualifies them for federal financial participation (FFP). See Funding Health Care for Noncitizens.
l Pregnant women.
n At application, income may not exceed 275% FPG.
n Pregnant women in Group Two who maintain continuous enrollment can have income over the limit and remain enrolled until the end of the 60-day postpartum period. See Income Changes - MinnesotaCare.
Note: Husbands of pregnant women may be in either Group Two or Group Four. See Enrollee Becomes Pregnant.
l Noncitizen parents or relative caretakers with incomes at or below 275% FPG who do not have an immigration status that qualifies them for FFP.
l Legal guardians and foster parents.
Example:
Joe and Susan Brown and their children, Emily, age 19 and Bruce, age 18, have a household income of 225% FPG. Their household income has been above 150% FPG throughout their enrollment in MinnesotaCare.
Action:
Assign Group Two status to all household members.
Group Three enrollees cannot have current health insurance and cannot have had health insurance in the four months prior to enrollment in MinnesotaCare. They may be subject to other insurance barriers, including restrictions on current and past availability of employer-subsidized insurance (ESI).
Group Three enrollees are adults who meet all of the following criteria:
l Have incomes greater than 75% FPG but no more than 175% FPG.
l Are not pregnant.
l Do not have children under 21 (including foster children or children under guardianship in the household) living with them.
Example:
John, age 26, is applying for MinnesotaCare. His income is 100% FPG. He has no children under 21 in his household.
Action:
Assign John to Group Three.
Group Three status is used to identify people who are eligible for the MinnesotaCare Limited Benefit (MLB) set. Adults without children, with incomes equal to or less than 75% FPG, have a different benefit set and are coded with a Group One status to make this distinction.
Group Four is used to identify parents and relative caretakers for whom DHS receives enhanced federal funding. Group Four enrollees cannot have current health insurance and cannot have had health insurance in the four months prior to enrollment in MinnesotaCare. They may be subject to other insurance barriers, including restrictions on current and past availability of employer-subsidized insurance (ESI).
Group Four enrollees are parents and relative caretakers who:
l Have household incomes over 100% FPG but at or below 200% FPG, and
l Are U.S. citizens or have an immigration status that qualifies for federal financial participation (FFP).
See MinnesotaCare Income Guidelines (DHS-4479) for the specific differences in income limits for Groups Two and Four. Except for citizenship/immigration status and income, Group Four parents and caretakers have the same eligibility requirements as Group Two parents and caretakers.
To correctly identify the various MinnesotaCare populations in the system, the four numeric eligibility group codes are paired with the following alphabetical codes:
l A Non-pregnant adults with children and income > 175% and < 275% FPG.
l C Children ages 2 to 21.
l I Infants from birth to age 2.
l M Non-pregnant adults with or without children and income < 175% FPG.
l P Pregnant women.
The result is an eligibility type code which, along with the major program code, identifies the correct benefit set and funding source. The eligibility type codes, by numeric group, are:
Group One
C1 Children ages 2 to 21 with income < 150% FPG, or who meet the Children's Health Plan exception described above in Eligibility Group One.
I1 Infants to age 2 with income < 150% FPG.
M1 Non-pregnant adults without children with income < 75% FPG.
P1 Pregnant women ages 2 to 21 with income < 150% FPG.
Group Two
A2 Non-pregnant adults with children who meet the major program criteria for:
n Program FF, and have income > 200% and < 275% FPG.
n Program JJ, and have income > 175% and < 275% FPG.
C2 Children ages 2 to 21 with income above 150% FPG.
I2 Infants to age 2 with income above 150% FPG.
M2 Non-pregnant adults with children who meet the major program criteria for:
n Program FF, and have income < 100% FPG.
n Program JJ, and have income < 175% FPG.
P2 Pregnant women ages 2 to 21 with income above 150% FPG.
Group Three
M3 Non-pregnant adults without children with income > 75% and < 175% FPG.
Group Four
A4 Non-pregnant adults with children who meet the major program criteria for program FF, and have income > 175% and < 200% FPG.
M4 Non-pregnant adults with children who meet the major program criteria for program FF, and have income > 100% FPG and < 175% FPG.
See the following sections for further information:
MinnesotaCare for Pregnant Women.
MinnesotaCare for Auto Newborns.
MinnesotaCare for Children Under 21.
MinnesotaCare for Adults With Children.