*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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: September 1, 2011 |
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03.45.35 - Minnesota Family Planning Program (MFPP) |
Archived: June 1, 2016 (Previous Versions) |
The Minnesota Family Planning Program (MFPP) provides coverage of family planning and related health care services for people who are not enrolled in Minnesota Health Care Programs. The program increases access to family planning services for low-income Minnesotans and helps reduce the number of unintended pregnancies.
MFPP eligibility criteria differ from Medical Assistance or MinnesotaCare criteria. Eligibility criteria are described below.
Men and women may be eligible for family planning services through this program if they meet all of the following conditions:
l Are at least age 15 and no older than age 50.
n Children who turn age 15 in the month of application are eligible.
n Enrollees remain eligible through the month in which they turn 50.
l Are not pregnant. If an MFPP enrollee becomes pregnant:
n Advise her that she may be eligible for Medical Assistance (MA) or MinnesotaCare.
n Send a HCAPP and assist her with the application process.
n Close MFPP with ten-day notice.
n Do not act on reports of pregnancy from a third party or contact the third party. Contact the enrollee to confirm the pregnancy.
l Are not enrolled in other MHCP or DHS health services programs, including:
n MA.
n Medical Assistance for Breast/Cervical Cancer (MA-BC).
n Medical Assistance for Employed Persons with Disabilities (MA-EPD).
n Home and community-based waiver programs.
n Transitional MA or Transition Year MA (TMA /TYMA).
n MinnesotaCare.
n Consolidated Chemical Dependency Treatment Fund.
Note: MFPP eligibility does not prevent eligibility in other programs. If a person who is enrolled in MFPP becomes eligible for any other MHCP, close MFPP with a 10-day notice and approve the more beneficial program.
l Are not residents of an institution in which they would be ineligible for federally funded MA. See Living Arrangements for more information.
Meet all additional criteria described in this section.
Not all agencies process MFPP applications at this time. However, agencies should be familiar with the MFPP and how it may impact other MHCP eligibility. Health care program workers should:
l Coordinate coverage between the MFPP and other health care programs as necessary by calling the DHS Family Planning Unit at (651) 431-3480 or (888) 702-9968.
Note: Do not deny a more beneficial program such as Medical Assistance or MinnesotaCare due to current enrollment in MFPP.
l Refer questions about the MFPP to the DHS Family Planning Unit at (651) 431-3480 or (888) 702-9968.
l Provide the Minnesota Family Planning Program Application (DHS-4740) upon request.
l Forward completed MFPP applications to:
Minnesota Department of Human Services.
P.O. Box 64960.
St. Paul, MN 55164-0960.
l Account for administrative activities or directly billable activities associated with the MFPP within the DHS income maintenance or social services random moment time studies. Code time related to the MFPP as you would for any other MA service or program.
Eligibility factors and links to standard program guidelines are provided below.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
Relationship to Other Groups/Bases.
Application Process (standard guidelines)
People apply for the MFPP by:
l Submitting an MFPP application (DHS-4740) to the DHS Family Planning Unit. They can get applications by:
n Calling the DHS Family Planning Unit at (651) 431-3480 (metro) or (888) 702-9968 (outside metro area).
n Downloading/printing an application from the DHS web site.
Note: Do not require the DHS-4740 if an applicant submits an application form designed for a different population, such as the HCAPP. Contact the applicant to gather any missing information.
l Applying with certified providers who can determine and grant presumptive eligibility for MFPP. See Application Process for MFPP for further information.
Eligibility Begin Date (standard guidelines)
The earliest eligibility begin date for ongoing coverage is the first day of the month in which the application was received. The begin date for people determined presumptively eligible is the first day of the month the provider makes the presumptive eligibility determination.
There is no retroactive coverage.
The month of application is the month in which the DHS Family Planning Unit receives a request for MFPP coverage or an MFPP application.
l The request must include the applicant’s name and a means to locate the applicant.
Note: Accept a request to set the date of application that is not signed or dated if it includes the client’s name and a means of locating the person. Obtain the signature during the application process.
l The applicant must submit a completed application within 30 days of the date of the request.
For applicants who apply for ongoing coverage after being approved for presumptive eligibility, ongoing coverage begins the first day of the month following the end of the presumptive eligibility period.
Renewals (standard guidelines)
The eligibility period for the MFPP is 12 months. There are no six-month renewals.
l The DHS-5440 serves as the renewal.
l MMIS mails renewals 14 business days from the end of the month prior to the month the case is scheduled to close.
l The renewal due date is the first day of the month coverage is to end.
l Process the renewal by the last day of the month coverage is to close. This applies both to renewals received by the due date and renewals received after the due date but before the closing date.
Example:
Robin’s MFPP coverage began on April 1, 2007 for the period April 1, 2007 through March 31, 2008. Her renewal due date is March 1, 2008. MMIS mails the renewal and closing notice on February 12, 2008. The completed renewal form is received on February 29.
Action:
Process the renewal by March 31, 2008 to allow continued coverage.
Verify the following:
l Earned and unearned income. See Verification of Income for specific requirements and verification sources.
l Citizenship and immigration status. See Verification of U. S. Citizenship and Verification of Immigration Status.
Social Security Number (standard guidelines)
All applicants and enrollees for ongoing MFPP must apply for or provide a Social Security Number.
Exceptions:
l Applicants being screened for presumptive eligibility.
l Applicants and enrollees who provide convincing evidence that their refusal is based on well-established religious objections.
For MFPP clients who declare they are U.S. citizens:
l Do not require documentation of citizenship and identity for presumptive eligibility.
l Enrollees must document citizenship and identity for ongoing MFPP eligibility. See Citizenship Verification Requirements for additional information.
For MFPP clients who are noncitizens:
l Immigration status is not required for presumptive eligibility.
l Enrollees must have an immigration status that qualifies them for federally funded MA for ongoing MFPP eligibility.
Residency (standard guidelines)
Minnesota residents who meet the requirements in State Residence for MA and MinnesotaCare meet the state residence requirements for the MFPP.
MFPP applicants and enrollees may ”opt out” of providing information on other health insurance if they have concerns that reporting the information would violate their privacy.
Note: The MFPP will not pay for prescription drugs covered under the Medicare prescription drug benefit. People who are eligible for Medicare must enroll in a Part D plan to have prescription drugs covered.
For applicants and enrollees who ”opt out” of providing health insurance information, the DHS Benefit Recovery Section (BRS) will not:
l Require the provider to bill the other health insurance.
l Seek reimbursement from any other health insurance.
l Include these enrollees on the ”finder file” that runs a data match for finding potential unreported TPL.
l Create a recovery case for MFPP if MHCP opens retroactively for a period when MFPP was active.
l Send a Medical Services Questionnaire.
l Include information on other health insurance on the DHS eligibility verification systems (EVS/MN-ITS).
For applicants and enrollees who provide complete information on other health insurance, submit the information to BRS following standard guidelines. Consider an applicant or enrollee who provides partial or incomplete information about other health insurance to have opted out.
Exception: The MFPP will not reimburse cost effective health care coverage premiums. Do not submit any policies to BRS for a cost effectiveness determination.
Household Composition (standard guidelines)
For adults age 21 and over, follow MA Adult’s Household Size to determine household size for all MFPP applicants and enrollees.
For children under age 21 do not count parents and siblings in the child’s household size for the MFPP.
Follow these steps to calculate countable income.
1. Evaluate countable and excluded income using MA Method A.
2. Calculate countable income.
a. For unvarying earned and unearned income:
l Multiply monthly income by 12.
l Multiply semi-monthly income by 24.
l Multiply biweekly income by 26.
l Multiply weekly income by 52.
b. For varying income expected to be received throughout the year, determine an annual amount using the information on the application and income verification. See Determining Countable Income for MA, Step 6.
Also see Seasonal Income and MA Self-Employment Income.
Follow MA Income Deeming and MA Sponsor Deeming.
Exception: Do not deem the income of a spouse, parent or sponsor to applicants and enrollees under age 21.
There is no asset limit for the MFPP.
Annual income must be equal to or less than 200% FPG.
Deductions/Disregards (standard guidelines)
Do not apply any earned or unearned deductions or disregards. Use gross countable income.
There are no spenddown or premium provisions for the MFPP.
Covered Services (Prepaid MHCP Manual)
The MFPP covers family planning services and supplies, including:
l Family planning-related office visits.
l Birth control prescriptions, devices and supplies.
l Sterilizations.
l Diagnosis and treatment of some sexually transmitted diseases (STDs) found during a family planning visit.
l Diagnosis of HIV/AIDS found during a family planning visit.
The MFPP does not cover:
l Abortions.
l Infertility treatment.
l Family planning services provided in an inpatient setting.
l Treatment of HIV/AIDS.
l Immunizations and vaccines.
Service Delivery (Prepaid MHCP Manual)
All MFPP services are provided through a fee-for-service delivery system.
MFPP enrollees must report changes in circumstances within ten days of the change.
Enrollees who fail to report a change that would have resulted in ineligibility for the MFPP are subject to a 12-month ineligibility period beginning with the date of disenrollment.
Exception: Do not apply a 12-month ineligibility period for failure to report a pregnancy within ten days.
Do not act on changes in income and household composition between renewals, unless the enrollee failed to report the change at renewal.
Do not refer minor MFPP enrollees to the IV-D Agency for medical support.
l Adult MFPP applicants and enrollees whose children are enrolled in MA or MinnesotaCare must cooperate with medical support requirements for the children as a condition of their own MFPP eligibility.
l If a caretaker enrolled in the MFPP fails to cooperate with medical support for an MA- or MinnesotaCare-enrolled child, the IV-D agency will notify the child’s MA or MinnesotaCare worker. The MA or MinnesotaCare worker must contact the DHS Family Planning Unit to coordinate closing the caretaker’s MFPP coverage.
People lose MFPP eligibility when they:
l Become pregnant.
l Die.
l Fail to submit a renewal before the closing date.
l Enroll in another MHCP or DHS health services program.
n Close MFPP with ten-day notice. The person may be open on the MFPP and the other program until MFPP can be closed.
l Lose Minnesota residency.
l Reach age 50. Eligibility ends the month after the month of the 50th birthday.
l Enter an institution, such as an IMD or correctional facility, where they are ineligible for federal funding.
l Are no longer citizens, nationals, or immigrants with a status eligible for federal funding.
l Voluntarily request closure.
Relationship to Other Groups/Bases (standard guidelines)
See Programs Overlap for information on the limited situations in which MFPP coverage may overlap with other health care programs.
MA-BC may be available to enrollees diagnosed with breast or cervical cancer through a MFPP certified provider that participates in the Sage Screening Program.