*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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: April 1, 2013 |
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03.55 - Healthy Minnesota Contribution Program |
Archived: June 1, 2016 (Previous Versions) |
The Healthy Minnesota Contribution Program requires adults without children who have income equal to or greater than 200% FPG, but less than or equal to 250% FPG, to receive a defined contribution to purchase health insurance in the private market rather than paying a premium for the MinnesotaCare benefit set.
All MinnesotaCare eligibility requirements for adults without children apply to the Healthy Minnesota Contribution Program except where noted below.
Eligibility factors and links to standard program guidelines are provided below.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
MinnesotaCare Major Program and Eligibility Types (MPETs).
Relationship to Other Groups/Bases.
Application Process (standard guidelines)
Follow standard MinnesotaCare guidelines.
The Healthy Minnesota Contribution Program eligibility begin date is the first day of the month following the month in which eligibility is determined.
An enrollee must choose, apply for, and be approved for private or Minnesota Comprehensive Health Association (MCHA) health insurance within four calendar months of approval of the Healthy Minnesota Contribution Program. Enrollees who do not purchase coverage by the end of the four-month period must reapply for Minnesota Health Care Programs if they want coverage.
Example:
Morgan was determined eligible for the Healthy Minnesota Contribution Program effective October 1.
Action:
Morgan must choose, apply for, and be approved for private or MCHA health insurance by January 31 to have coverage.
Renewals (standard guidelines)
Healthy Minnesota Contribution Program enrollees must renew eligibility every 12 months. Enrollees who move from MinnesotaCare to the Healthy Minnesota Contribution Program without a break in eligibility retain the same renewal date.
Example:
Scott is a MinnesotaCare enrollee with a December 31 redetermination date. His renewal is processed on December 7 and his income is now above 200% FPG. He meets all other eligibility requirements.
Action:
Close Scott's MinnesotaCare eligibility effective January 31 and approve Healthy Minnesota Contribution Program eligibility effective February 1. The redetermination date will remain December 31 as there is no break in eligibility.
Example:
Nick is a MinnesotaCare enrollee with a December 31 redetermination date. His MinnesotaCare coverage ends August 31. He contacts the agency to reapply on October 2 and reports income at 215% FPG.
Action:
Approve Nick for the Healthy Minnesota Contribution Program with an eligibility begin date of November 1. His redetermination date is October 31.
Follow standard MinnesotaCare guidelines.
Social Security Number (standard guidelines)
Follow standard MinnesotaCare guidelines.
Follow standard MinnesotaCare guidelines.
Residency (standard guidelines)
Follow standard MinnesotaCare guidelines.
Other health care coverage that is a barrier to MinnesotaCare eligibility is also a barrier to eligibility for the Healthy Minnesota Contribution Program.
Note: Health Insurance coverage purchased with a monthly defined contribution amount must be entered as TPL in MMIS if the enrollee subsequently becomes eligible for MA or MinnesotaCare during a month there is an overlap of coverage.
Example:
On November 2 Haley, a Healthy Minnesota Contribution Program enrollee, reports she is no longer employed and that she has zero income. Haley indicates she has a need for MA to begin in the month of November.
Action:
Close Haley's Healthy Minnesota Contribution Program eligibility November 30. Based on the information provided, she is eligible for MA. Approve MA effective November 1 and add the health insurance policy purchased with the Healthy Minnesota Contribution Program monthly defined contribution as TPL in MMIS.
Household Composition (standard guidelines)
Only adults without children are eligible for the Healthy Minnesota Contribution Program. Use a household size of one or, for people who are married and living with a spouse, a household size of two.
Note: The All or Nothing Rule does not apply because the private health insurance coverage is purchased individually.
All Healthy Minnesota Contribution Program enrollees have a major program of BB and an eligibility type of M1.
Asset Guidelines (standard guidelines)
The asset limit for the Healthy Minnesota Contribution Program is:
l $10,000 for a household of one.
l $20,000 for a household of two or more.
To be eligible for the Healthy Minnesota Contribution Program, adults without children must have income equal to or greater than 200% FPG, but less than or equal to 250% FPG.
Deductions/Disregards (standard guidelines)
Follow standard MinnesotaCare guidelines.
Healthy Minnesota Contribution Program enrollees do not pay MinnesotaCare premiums.
The Healthy Minnesota Contribution Program provides a monthly defined contribution amount to help pay private or MCHA health insurance premiums. The defined contribution amount is determined by applying a sliding fee scale based on the enrollee's income, household size and age. The defined contribution amounts are calculated in MMIS.
DHS pays the monthly defined contribution amount directly to the private insurance company or MHCA for the plan the enrollee purchased. The enrollee must pay the additional amount directly to the private health insurance company or to MCHA if the premium is more than the monthly defined contribution amount. If the premium is less than the monthly defined contribution amount, the remaining amount is not available to the enrollee.
Healthy Minnesota Contribution Program enrollees receive services provided by the health insurance plan they choose to purchase. There are no direct medical services provided by the Healthy Minnesota Contribution Program.
Covered services, cost sharing, disenrollment for premium nonpayment, appeal rights, complaint procedures and the effective date of coverage are determined by the health insurance plan purchased by the enrollee. Refer Healthy Minnesota Contribution Program enrollees to their private or MHCA health insurance plan for help with these issues.
Do not enroll Healthy Minnesota Contribution Program enrollees in a MinnesotaCare managed care plan or issue a Minnesota Health Care Programs identification card. Service delivery is governed by the terms of the health insurance plan the enrollee purchases.
Certain disabled adults without children must apply for MA. Refer to MinnesotaCare for Disabled Adults Without Children for more information.
Termination from the Healthy Minnesota Contribution Program is effective the first day of the calendar month following the month for which the health insurance coverage was terminated because the enrollee:
l failed to pay their portion of the health insurance premium; or
l voluntarily terminated private or MCHA health insurance coverage and did not enroll in other private or MHCA health insurance during the same month.
Note: Enrollees who are terminated from the Healthy Minnesota Contribution Program due to failure to pay premiums or for voluntary termination cannot reenroll in the Healthy Minnesota Contribution Program for four calendar months.
Enrollees and applicants whose income decreases below 200% FPG are not subject to a four-month penalty period if they request, and are eligible for, premium-based MinnesotaCare. Eligibility is possible the first day of the month after Healthy Minnesota Contribution Program eligibility is terminated.
Enrollees whose income increases above 250% FPG are not eligible for an extra month of Healthy Minnesota Contribution Program eligibility. Enrollees may choose to pay the full premium for their private health insurance when Healthy Minnesota Contribution Program eligibility ends. If they choose to do so, they will not be eligible for MinnesotaCare. See Relationship to Other Groups/Bases for information regarding MinnesotaCare enrollees who report an income increase equal to or greater than 200% FPG.
In some situations, people may receive overlapping Healthy Minnesota Contribution Program and MinnesotaCare or MA for a limited period.
Redetermine eligibility for Healthy Minnesota Contribution Program enrollees who report a change in their circumstances and have a change in their basis of eligibility, such as reporting a pregnancy or a child moves into the home.
Note: Pregnant women are not eligible for the Healthy Minnesota Contribution Program and should be enrolled in MA or MinnesotaCare if all eligibility requirements are met. Contact the MMIS User Services Help Desk for assistance when a woman reports she is pregnant.
Determine eligibility for the Healthy Minnesota Contribution Program for MinnesotaCare enrollees who report an increase in income equal to or greater than 200% FPG. MinnesotaCare enrollees are eligible for an extra month of MinnesotaCare coverage if they meet all other eligibility requirements. Close MinnesotaCare effective the last day of the month after the month the increase in income is reported.
Follow standard MinnesotaCare guidelines.
Note: When determining the Healthy Minnesota Contribution Program overpayment, consider only the used amount as indicated on the RHMC screen in MMIS.