*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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: March 1, 2013 |
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03.25.15 - Medical Assistance (MA) for Children Under 21 |
Archived: June 1, 2016 (Previous Versions) |
All children have a basis of eligibility for MA through the month of their 21st birthday. See the following sections for specific eligibility guidelines for children who are:
l Ages 0-1, whose mothers were MA- or MinnesotaCare-eligible for the month of birth (auto newborns).
l In foster care placement.
l Receiving adoption assistance.
Eligibility factors and links to standard program guidelines are provided below.
Note: Some children under age 21 may also have a MA disabled or blind basis. See Relationship to Other Groups/Bases below.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
Relationship to Other Groups/Bases.
Application Process (standard guidelines)
Children under 18 who do not live with a parent, relative caretaker, foster parent, or legal guardian may apply on their own behalf. This includes minor caretakers and minors without children.
Children who are applying only for MA may apply at outstation locations other than the county agency, such as some hospitals and clinics.
Follow standard MA guidelines.
Renewals (standard guidelines)
Follow standard MA guidelines.
Do not require verification of age.
Social Security Number (standard guidelines)
Follow standard MA guidelines.
Children who are U.S. citizens or lawfully present noncitizens may be eligible for MA with Federal Financial Participation (FFP) if they are Minnesota residents and meet all other MA eligibility criteria.
Noncitizen children who are undocumented or have a temporary nonimmigrant status (such as students or tourists) are not eligible for MA, but may be eligible for Emergency Medical Assistance (EMA).
Children under 21 who are citizens or lawfully present noncitizens must follow citizenship verification requirements or immigration status requirements.
Note: Children currently or previously enrolled in either MA or MinnesotaCare as an auto newborn are exempt from citizenship verification requirements.
Example:
Layla applies for MA for herself and her son, Jamal, who is 12. Layla submits copies of their green cards with the application. They are both Lawful Temporary Residents. They meet all other MA eligibility criteria.
Action:
Approve MA with FFP for Jamal, as he is a lawfully present noncitizen child. Approve state-funded MA for Layla. Because Layla has a parent basis of MA eligibility, and she is not a qualified noncitizen, she cannot be enrolled in MA with FFP.
See the Medical Assistance Immigration Status and Eligibility Table for more information and systems coding.
Residency (standard guidelines)
Follow standard MA guidelines.
When new MA coverage is requested for a child (including infants under age two), ask the parent or caretaker about health insurance that may be available to the child and pursue cost-effective insurance premium payments if appropriate.
l If you are unable to reach a parent or caretaker by phone, mail the Minnesota Health Care Programs Health Insurance Information form (DHS-1922B) with the Request for Information (DHS-3271).
l Record all pertinent information in case notes.
Note: Do not deny or close the child's eligibility if the parent or caretaker fails to cooperate.
Household Composition (standard guidelines)
Follow policy in Determining Household Size for MA.
Use Method A for income.
Asset Guidelines (standard guidelines)
There is no asset limit for children under age 21.
l Ages 0 to 2: 280% FPG.
l Ages 2 through 18: 150% FPG.
l Ages 19 and 20: 100% FPG.
MA for children ages 0 to 2 with income at or below 275% FPG is funded with MA federal financial participation (FFP). MA for children ages 0 to 2 with income above 275% and at or below 280% FPG is funded by CHIP if the child has no other health coverage. If the child has other health coverage, MA is paid with state-only funds.
DHS sorts the expenditures for children ages 0 to 2 into the correct funding sources based on their income level and the presence or absence of other health coverage. No action or special coding is required.
Noncitizen children under age 21 are not subject to sponsor deeming. Do not apply sponsor deeming when determining eligibility for noncitizen children applying for or enrolled in MA. Do not require a copy of the Affidavit of Support or verification of sponsor income or assets when determining MA eligibility for children.
Sponsor deeming requirements apply effective the month following the child's 21st birthday. Request the Affidavit of Support and verification of sponsor's income and assets when redetermining eligibility prior to the child's 21st birthday.
l Ages 0 to 2: Work expense deduction for pregnant women and infants.
l Ages 2 through 18:
l Ages 19 and 20:
n 17% earned income disregard.
Spenddowns (standard guidelines)
Children under age 21 with excess income may be eligible by spending down to 100% FPG. Redetermine net income for children ages 0 through 18 using the:
l 17% earned income disregard.
Children under age 21 do not have co-payments or dental limits.
Managed care unless otherwise excluded.
Children with non-custodial parents may need a medical support referral. See Medical Support for more information.
A parent of a child who receives MA and whose income is not deemed to the child may be liable for parental fees. See Parental Fees for more information.
Redetermine eligibility for children and parents or caretakers when:
l An automatic newborn turns 1.
l Child turns 2. The child’s income standard is reduced from 280% FPG to 150% FPG. Also, different earned income deductions now apply.
l Child turns 18. The child may no longer meet the definition of dependent child, which may affect the parent/caretaker’s eligibility.
l Child turns 19. The child will no longer meet the definition of dependent child, which may affect the parent/caretaker’s eligibility. Further, the child’s income standard is reduced from 150% FPG to 100% FPG.
l Child turns 21. The client no longer meets the child under 21 basis of eligibility for MA.
See Change in Basis of Eligibility for more information.
A child in any of the age groups who is receiving inpatient hospital services on their first, second, 19th, or 21st birthday, is eligible to remain on MA until the end of the hospitalization if they meet all other eligibility criteria.
A child residing in an inpatient psychiatric hospital on their 21st birthday is eligible to remain on MA until their 22nd birthday or until they are discharged, whichever date occurs first.
Children under 21 who are blind or disabled may be able to choose which basis of eligibility to use.
Exception: Children who are eligible under the TEFRA option, or who receive services through the CAC, CADI, DD, or BI waiver programs must use a blind or disabled basis of eligibility.
Determine MA eligibility for General Assistance (GA) recipients who are ages 18-20.
Also consider MinnesotaCare for Children Under 21.
When the client is eligible for more than one basis of eligibility, help the client choose the most beneficial basis. See Multiple Bases of Eligibility.
Workers who have contact with families during the application process are encouraged to inform families that the Child and Teen Checkups Program (C&TC) is an MA benefit, and that the county C&TC agency will contact them with more information.