*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: November 1, 2012 |
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03.20.35 - MinnesotaCare for Certain Children Exiting Foster Care or a Juvenile Residential Correctional Facility |
Archived: June 1, 2016 |
Children may be eligible for MinnesotaCare (MCRE) as part of this eligibility group through their 21st birthday upon termination from foster care or release from a juvenile residental correctional facility. The child must reside in foster care or a juvenile residential correctional facility on his or her 18th birthday.
For children who remain in foster care, see MinnesotaCare for Children Under 21.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
MinnesotaCare Major Program Eligibility Type (MPET).
Relationship to Other Groups/Bases.
Application Process (standard guidelines)
Qualifying children may submit an application 30 days prior to the date of termination from foster care or release from a juvenile residential correctional facility but no later than six months from the date of termination or release from care. Children enrolled in Medical Assistance (MA) on or within six months from their release date, are deemed to have applied for MinnesotaCare.
These children apply for MinnesotaCare by submitting the Request for MinnesotaCare (DHS-6179), the Minnesota Health Care Programs Application (HCAPP) (DHS-3417) or through ApplyMN. The Request for MinnesotaCare form cannot be used to apply for MinnesotaCare for persons who do not qualify under this section.
Eligibility Begin Date (standard guidelines)
Eligibility is effective the first day of the month following the date of termination from foster care or release from a juvenile residential correctional facility or August 1, 2012, whichever is later.
Eligibility continues through the month of the child's 21st birthday as long as the child meets Minnesota residency requirements and wants continued coverage.
Upon approval:
l Enter case notes with the heading **MCRE Foster Care or Juvenile Residential Correctional Facility**.
l Complete the MinnesotaCare Approval (DHS-6179A) letter and send it to the enrollee. The letter tells the enrollee when his or her coverage begins, when enrollment in a health plan occurs and if he or she has an "fee-for-service" months.
l Complete the MMIS User Services Help Desk MinnesotaCare Request web form available on SIR to activate coverage. Indicate on the form when coverage begins, the child's redetermination date and that the enrollee is a foster care or juvenile residential corrections facility child.
Renewals (standard guidelines)
Enrollees are exempt from standard renewal requirements until the month of their 21st birthday. Complete the MMIS Users Services Help Desk MinnesotaCare Request web form available on SIR to request an enrollee's redetermination date be set to the last day of the month of the enrollee's 21st birthday.
Contact enrollees annually to confirm they still reside in Minnesota and want to continue coverage. Contact the enrollee via phone or send the MinnesotaCare Continued Coverage (DHS-6179B) letter the month prior to the enrollee's second year of enrollment and each year thereafter until the month prior to the enrollee's 21st birthday.
Enrollees are not required to return the MinnesotaCare Continued Coverage letter or contact the agency if their address has not changed and they want to continue their coverage.
Example:
Brandon has had MinnesotaCare coverage for the past year as a child who
resided in foster care on his 18th birthday. An attempt to contact Brandon
by phone is unsuccessful since the number is disconnected
Action:
Send the MinnesotaCare Continued Coverage (DHS-6179B)
letter to Brandon. No other action is required. Do not track the return
of the form. Assume Brandon remains in Minnesota and wants his MinnesotaCare
coverage to continue unless he notifies you otherwise or the postal service
returns the renewal as undeliverable.
A Minnesota Health Care Programs Renewal (DHS-3418) is due the month of the enrollee's 21st birthday. The renewal is systematically sent to the enrollee 45 days before the redetermination date. Process the renewal applying all MinnesotaCare eligibility requirements including household composition rules, the all or nothing rule, income limits, insurance barriers, premium payments and renewal requirements. Screen for MA for adults without children and refer for MA if they appear to qualify. Follow current policy to determine eligibility for MA or to transfer the application to the appropriate agency for a complete MA determination. See Processing MinnesotaCare Renewals.
If the enrollee continues to qualify for MinnesotaCare coverage, a premium amount is calculated based on the information entered in MMIS. The system-generated MinnesotaCare Premium Notice notifies the enrollee of his or her new premium amount. The premium must be paid in order for coverage to continue.
Verifications (standard guidelines)
Applicants and enrollees are not required to submit verifications other than those required for citizenship and identity or immigration status. Enrollees must report a change in address within 10 days from the date of change.
Social Security Number(standard guidelines)
Follow standard MinnesotaCare guildelines.
Citizenship/Immigration Status (standard guidelines)
Follow standard MinnesotaCare guidelines..
Residency (standard guidelines)
Follow standard MinnesotaCare guidelines.
Insurance and Benefit Recovery (standard guidelines)
Enrollees are not subject to MinnesotaCare other health insurance coverage barriers or third party liability requirements. Enter other health insurance coverage information in the Third Party Liability (TPL) system.
Household Composition (standard guidelines)
Eligibility under this section is for the child only, a household of one. Do not count other household members. Other household members must apply for coverage following standard policy. See Applications for Minnesota Health Care Programs. Count the child as a household member when determining eligibility for other household members under standard MinnesotaCare household size policy. See Determining Household Size for MinnesotaCare for further information. Remove the child as a covered household member from existing households.
Example:
Mark is enrolled in MinnesotaCare with his parents. Mark was placed in a juvenile residential correctional facility on July 1. While in the facility, Mark turned 18. He was released from care on September 1.
Mark's mother contacts her worker on September 10 to report that Mark has returned home from care.
Action:
Remove coverage for Mark from his parent's case using C-25. Continue to count Mark as a household member on his parent's case.
Create a case for Mark, as a household of one. Do not deem Mark's parents' income to Mark.
All enrollees approved under this section have an eligibility type of C1. See MinnesotaCare Major Program Eligibility Type (MPET) for information on determining a child's major program..
Asset Guidelines (standard guidelines)
Asset guidelines do not apply.
Income Guidelines (standard guidelines)
Income guidelines do not apply. Do not consider income. All earned and unearned income received by the enrollee is excluded.
Premiums (standard guidelines)
Premiums do not apply.
If an enrolled child is assessed a premium on their own case as a household of one, update the case to reflect zero income. The premium will be adjusted to zero. See Initial, Ongoing and Changes to Premiums for more information about premium adjustments.
Example:
Wade was terminated from foster care on September 1, two months after his 18th birthday. Wade has worked for Menards since March and earns $1,600 per month. He is enrolled in MinnesotaCare and pays a monthly premium of $73.
Wade contacts his worker on September 10 to report a new address and that he is no longer in foster care effective September 1.
Action:
Update the income on RINC to zero. End the current eligibility span on RELG. Enter a new eligibility span with "C1" in the ELIG TY field. Enter case notes regarding the change with the header: **MCRE Foster Care Or Juvenile Residential Facility Child**.
Wade's premium is adjusted to zero effective October.
Covered Services (Prepaid MHCP Manual)
Children under 21 are eligible for the same benefits as MA enrollees with minor exceptions. They are not subject to deductibles, co-payments, or the service limitations that apply to some adults.
Service Delivery (Prepaid MHCP Manual)
Follow standard MinnesotaCare guidelines.
Eligibility may end prior to the child's 21st birthday if the child no longer meets Minnesota residency requirements or requests closure. Children who request voluntary termination are exempt from the four-month penalty.
Children whose MinnesotaCare coverage ended prior to their 21st birthday may ask to have eligibility reinstated without completion of a new application. Upon verbal or written request, reinstate coverage back to the date of termination or the date the child returned to MinnesotaCare, if applicable, whichever is later.
Complete the MinnesotaCare Approval (DHS-6179A) letter and send it to the enrollee. The letter tells the enrollee when his or her coverage begins, when enrollment in a health plan occurs and if he or she has any fee-for-service months. Complete the MMIS User Services Help Desk MinnesotaCare Request web form available on SIR to re-activate coverage. Indicate on the form when coverage begins and to remove the four-month penalty, if applicable, and that the enrollee is a foster care or juvenile residential correctional facility child.
Example:
19-year-old Charla is enrolled in MinnesotaCare as a child who resided in foster care on her 18th birthday. Charla contacts her worker in December and asked the worker to close her MinnesotaCare coverage since she has insurance through her employer. MinnesotaCare ends December 31.
Three months later, Charla contacts the agency and asks for MinnesotaCare since she has lost her job and no longer has coverage through her employer.
Action:
Reinstate Charla's MinnesotaCare effective January 1. Do not require a new application or apply a four-month penalty. Request other health insurance information for those months in which other insurance was in place. Enter other insurance in the TPL subsystem.
Send the MinnesotaCare Approval (DHS-6179A) letter to Charla to notify her that MinnesotaCare is reinstated effective January 1 and how to access services. Complete a MMIS User Services Help Desk MinnesotaCare web form. Include a request to remove the four-month penalty.
When children turn 21, their eligibility must be re-evaluated. See Renewals above for information on redetermining eligibility.
Relationship to Other Groups/Bases (standard guidelines)
Children enrolled in MA who qualify under this section are eligible for MinnesotaCare coverage the first day of the month following the month the child's MA ends.