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Effective: October 1, 2007 |
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03.55ar1 - Transitional MinnesotaCare (Archive) |
Archived: February 1, 2011 |
Transitional MinnesotaCare was created to move certain people from General Assistance Medical Care (GAMC) to MinnesotaCare. These are adults without children who meet all GAMC eligibility criteria, but do not have a GAMC qualifier. They will be enrolled in Transitional MinnesotaCare for one six-month period at a time, then move to MinnesotaCare at their six-month renewal if they meet all eligibility criteria.
Note: Transitional MinnesotaCare applies only to applicants and enrollees for GAMC with full benefits. Transitional MinnesotaCare is not available to clients who qualify for GAMC Hospital Only (GHO).
To be eligible for Transitional MinnesotaCare, a client must meet all of the following:
l Be an adult age 21 or older with no children under age 21 in the household.
n The client must meet the MinnesotaCare definition of an adult without children.
n GAMC applicants and enrollees who have children under age 21 in the household (i.e., stepparents and parents of children ages 19-20) are not eligible for Transitional MinnesotaCare.
n GAMC applicants and enrollees who are adults with children and are ineligible for GAMC because they do not have a GAMC qualifier must have eligibility redetermined for MinnesotaCare.
l Meet GAMC income and asset requirements.
l Meet GAMC residency, citizenship and immigration status requirements.
l Meet all other GAMC eligibility criteria except having a GAMC qualifier.
Example:
Kevin (age 40) is married and is a stepfather to his wife's children. Kevin applies for health care coverage. He meets GAMC eligibility criteria but does not have a GAMC qualifier.
Action:
Deny GAMC and redetermine MinnesotaCare eligibility (or refer Kevin's application to MinnesotaCare Operations). Kevin is ineligible for Transitional MinnesotaCare because there is a child in the household.
Clients must meet GAMC eligibility criteria at application or renewal to be initially eligible for Transitional MinnesotaCare. However, once approved, enrollees remain eligible even if they report a change in income or assets that would otherwise make them ineligible. Do not close Transitional MinnesotaCare due to any of the following:
l Increases in income.
l Increases in assets.
l Changes in household composition that affect income or assets.
For system instructions for Transitional MinnesotaCare, see MAXIS POLI/TEMP TE11.041 and the MMIS User Manual.
Eligibility factors and links to standard program guidelines are provided below.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
End of Eligibility in Group/Basis.
Relationship to Other Groups/Bases.
Application Process (standard guidelines)
The intent of Transitional MinnesotaCare is to transition GAMC enrollees to MinnesotaCare. However, clients may be eligible for and enrolled in Transitional MinnesotaCare more than once. County agencies may not impede Transitional MinnesotaCare eligibility for clients who reapply and are determined eligible.
Treat new applications from current or former Transitional MinnesotaCare or MinnesotaCare enrollees like all other new applications.
l Consider eligibility for all health care programs, including Transitional MinnesotaCare.
l Contact clients who submit new or duplicate application forms while MinnesotaCare eligibility is pending, or while they are enrolled in MinnesotaCare, to determine whether they wish to reapply or have submitted the forms in error.
See Relationship to Other Groups/Bases below for information about overlap between Transitional MinnesotaCare and MinnesotaCare.
Require a new application any time a former Transitional MinnesotaCare enrollee wants to reapply for MA, GAMC, or Transitional MinnesotaCare. Former Transitional MinnesotaCare enrollees may reapply at any time, including but not limited to:
l After the effective date of Transitional MinnesotaCare closure.
l While MinnesotaCare eligibility is pending.
l After failing to transition to MinnesotaCare after having been determined eligible at renewal.
l After transitioning to MinnesotaCare and then having coverage closed for any reason.
Example:
Tobias was enrolled in Transitional MinnesotaCare, then approved for MinnesotaCare pending awaiting payment at renewal. He failed to pay his initial premium and MinnesotaCare was denied after four months. He later contacts his county agency, requesting health care coverage.
Action:
Require Tobias to complete a new application for a determination of MA, GAMC, or Transitional MinnesotaCare eligibility.
Exception: Do not require a new application at renewal when a Transitional MinnesotaCare enrollee is ineligible for MinnesotaCare. Use the renewal to determine MA, GAMC, or Transitional MinnesotaCare eligibility. See Renewals for Transitional MinnesotaCare for more information.
Eligibility Begin Date (standard guidelines)
Follow standard GAMC guidelines.
Renewals (standard guidelines)
Transitional MinnesotaCare is available for only one six-month certification period at a time. At renewal, enrollees are expected to move to MinnesotaCare.
See Renewals for Transitional MinnesotaCare for more information.
Verifications (standard guidelines)
Follow standard GAMC guidelines.
Social Security Number (standard guidelines)
Follow standard GAMC guidelines.
Citizenship/Immigration Status (standard guidelines)
Follow standard GAMC guidelines.
Residency (standard guidelines)
Follow standard GAMC guidelines.
Insurance and Benefit Recovery (standard guidelines)
Transitional MinnesotaCare enrollees are required to cooperate with the Benefit Recovery Section (BRS) for potential third party liability (TPL). Notify BRS of all health coverage policies in effect for Transitional MinnesotaCare enrollees by recording the applicable information in the TPL subsystem on MMIS.
Transitional MinnesotaCare enrollees are not required to pursue potential cost effective insurance or apply for other benefits that may become available to them while they are enrolled. Applicants must meet GAMC requirements to be eligible. However, once approved, they remain eligible even if they have new insurance or benefits available to them.
Household Composition (standard guidelines)
Follow MA/GAMC policies for adding a new household member when adding a new spouse to a Transitional MinnesotaCare enrollee's household. If the spouse does not have children under age 21 living in the household and meets all other eligibility factors:
l Add the spouse to the household the month following the month of entry.
l Interrupt the certification period, and begin the new certification period in the first full month the spouse is in the household.
l Do not extend the Transitional MinnesotaCare enrollee's eligibility due to the change in the certification period. The Transitional MinnesotaCare renewal continues to be due for the same month it was due in the original certification period.
l Determine eligibility for the spouse if health care coverage is requested.
n If the new spouse is eligible for Transitional MinnesotaCare, that eligibility is for a full six-month period, regardless of when the original Transitional MinnesotaCare enrollee moves to MinnesotaCare.
n Although the new spouse's income and assets do not affect the current Transitional MinnesotaCare enrollee's eligibility, to be eligible for Transitional MinnesotaCare, the new spouse must meet all GAMC eligibility criteria, including income and asset requirements with spousal deeming.
Example:
Ned is enrolled in Transitional MinnesotaCare with a certification period of January through June. Ned reports he married Lori in April. Lori requests health care coverage for May, and is eligible for Transitional MinnesotaCare.
Action:
Add Lori to the household for May, the first full month she is in the household. Interrupt the January through June certification period. The new certification period is May through October.
m Approve Lori's Transitional MinnesotaCare for May through October.
m Ned's Transitional MinnesotaCare renewal is still due for his July eligibility. For the new certification period, approve Ned's May and June eligibility, and fail eligibility for July through October.
In June, when Ned's renewal for July is processed, he is determined eligible for MinnesotaCare.
Action:
Approve MinnesotaCare for Ned pending awaiting payment. Do not interrupt Lori's certification period.
Note: If Ned was determined eligible for MA, GAMC, or Transitional MinnesotaCare at renewal (instead of MinnesotaCare), interrupt Lori's certification period and begin a new certification period for July through December for the household. However, any increases in income or assets do not affect Lori's eligibility; she remains eligible for Transitional MinnesotaCare through October.
If the new spouse has children under age 21 living in the household, the enrollee is no longer eligible for Transitional MinnesotaCare. Add the new spouse and children to the household for the month following the month of entry, and:
1. Evaluate eligibility for MA.
2. If there is no MA eligibility:
n Complete a MinnesotaCare eligibility determination if your agency is a MinnesotaCare enrollment site.
n Otherwise, follow your agency's procedures to transfer the case for a MinnesotaCare eligibility determination.
3. Close Transitional MinnesotaCare with ten-day notice.
Eligibility Method (standard guidelines)
Follow standard GAMC guidelines.
Asset Guidelines (standard guidelines)
Applicants must meet standard GAMC asset requirements. However, once approved, enrollees remain eligible even if they report a change in assets that would otherwise make them ineligible.
Income Guidelines (standard guidelines)
Applicants must meet standard GAMC income requirements. However, once approved, enrollees remain eligible even if they report a change in income that would otherwise make them ineligible.
Deductions/Disregards (standard guidelines)
Like GAMC, no deductions or disregards are allowed for Transitional MinnesotaCare. Applicants must meet standard GAMC guidelines.
Spenddowns/Premiums (standard guidelines)
Spenddowns
Like GAMC, there are no spenddown provisions for Transitional MinnesotaCare.
Premium payment by county agencies
County agencies are required to pay the MinnesotaCare sliding scale premiums for the Transitional MinnesotaCare managed care months of coverage, until the six-month renewal.
Note: There is no MinnesotaCare premium charged for the fee-for-service GAMC benefit months of Transitional MinnesotaCare eligibility. See Covered Services below for more information about managed care and fee-for-service months.
DHS bills county agencies monthly for the premium amount.
n The billing is sent to counties at the beginning of each month for enrollees covered in the current month.
n DHS will not provide refunds or credits for Transitional MinnesotaCare premiums. This includes premiums charged due to eligibility errors, or for enrollees who are subsequently determined eligible for retroactive Medical Assistance.
n The county agency's obligation to pay the premium ends at the end of the six-month Transitional MinnesotaCare certification period.
The county agency may choose to continue to pay MinnesotaCare premiums for former Transitional MinnesotaCare enrollees, or for any county resident enrolled in MinnesotaCare. The county agency must:
n Be listed as the provider in the MMIS Financial Control Subsystem.
n Appear as the ’Premium Mailing Name’ and ’Address’ in the MMIS Recipient Subsystem.
n Contact the MMIS User Services Help Desk for assistance when setting up the county agency as payer of MinnesotaCare premiums. See the MMIS User Manual sections on Case Entry and MMIS Screens - RREP.
Covered Services (Prepaid MHCP Manual)
Transitional MinnesotaCare enrollees' covered services will be determined by their method of health care service delivery.
New health care program applicants and current fee-for-service GAMC enrollees who are determined eligible for Transitional MinnesotaCare will have a change in covered services during the six-month Transitional MinnesotaCare period. They will receive:
l The full GAMC benefit set through a fee-for-service delivery system from the effective date of Transitional MinnesotaCare coverage until the effective date of enrollment in a managed care health plan (also referred to as a managed care organization (MCO)).
l The MinnesotaCare Basic Plus One benefit set effective with their managed care health plan enrollment. This is similar to the GAMC benefit set, but includes additional copays for some services and a $10,000 limit on inpatient hospital benefits.
Current GAMC enrollees who are already enrolled in a managed care health plan and are determined eligible for Transitional MinnesotaCare:
l Remain enrolled in the same managed care health plan.
l Switch from the GAMC to the MinnesotaCare Basic Plus One benefit set effective with the start of their Transitional MinnesotaCare eligibility.
Enrollees are advised of their covered services on the Minnesota Health Care Programs Benefit Summary (DHS-3860). This form is sent with eligibility notices to new enrollees.
Service Delivery (Prepaid MHCP Manual)
All Transitional MinnesotaCare enrollees are required to enroll in a managed care health plan.
l Transitional MinnesotaCare enrollees will have their choice of GAMC managed care health plans that are available in their county of residence.
Note: GAMC enrollees who are enrolled in a health plan and move to Transitional MinnesotaCare at renewal will remain enrolled in their health plan but will receive the MinnesotaCare Basic Plus One benefit set beginning the first month of Transitional MinnesotaCare eligibility.
l At the end of the Transitional MinnesotaCare eligibility period, eligibility is redetermined for MinnesotaCare. For clients who are determined eligible for MinnesotaCare:
n A MinnesotaCare managed care enrollment packet is automatically issued by mail when MinnesotaCare coverage is approved on MMIS as pending awaiting payment.
n In some counties, enrollees will have a wider choice of managed care plans available to them under MinnesotaCare.
n Health plan enrollment will begin the next available month after the MinnesotaCare premium is received.
All county agencies are required to:
l Determine MinnesotaCare eligibility for Transitional MinnesotaCare enrollees who submit a renewal form at the end of the six-month transition period.
Exception: MinnesotaCare Operations will continue to administer cases when the spouse of a Transitional MinnesotaCare enrollee is active on a MinnesotaCare case administered by MinnesotaCare Operations at the time of the Transitional MinnesotaCare renewal. Contact MinnesotaCare Operations and request MinnesotaCare, including retro coverage, be opened on the existing case.
l Provide ongoing MinnesotaCare case maintenance indefinitely for enrollees who move from Transitional MinnesotaCare to MinnesotaCare. Continue to administer the MinnesotaCare case as long as the enrollee is enrolled in MinnesotaCare without a lapse in coverage.
Example:
Justine applies for health care coverage in County B, a Type One MinnesotaCare enrollment site, and is determined eligible for Transitional MinnesotaCare. At renewal, she is determined eligible for MinnesotaCare.
Action:
County B maintains Justine's ongoing MinnesotaCare case because she moved directly from Transitional MinnesotaCare to MinnesotaCare.
End of Eligibility in Group/Basis
Transitional MinnesotaCare is available for only one six-month certification period at a time. At renewal, enrollees are expected to move to MinnesotaCare.
Exception: Transitional MinnesotaCare may continue into a new certification period only if the certification period is interrupted. See Household Composition above for more information.
Relationship to Other Groups/Bases (standard guidelines)
If MinnesotaCare clients submit a new application and are determined eligible for Transitional MinnesotaCare while they are enrolled in MinnesotaCare, close their MinnesotaCare coverage before opening Transitional MinnesotaCare. Transitional MinnesotaCare cannot overlap with MinnesotaCare coverage.
Exception: If the MinnesotaCare case cannot be closed with ten-day notice, Transitional MinnesotaCare may be approved to overlap with MinnesotaCare for only one month.
l Cancel MinnesotaCare effective the end of the current month plus one.
l Approve Transitional MinnesotaCare effective the first day of the current month plus one.
Example:
Renee is enrolled in MinnesotaCare. The county agency receives a new health care application from Renee on June 22. The county worker contacts Renee, who indicates she wants to apply to see if she is eligible for health care coverage without a premium; if so, she wants to cancel her MinnesotaCare coverage. Renee meets all GAMC eligibility criteria, except for having a GAMC qualifier.
Action:
Close MinnesotaCare effective July 31 (the end of the current month plus one) because there is not time to provide Renee with ten-day notice for June 30. Approve Transitional MinnesotaCare effective July 1.
Determine MinnesotaCare eligibility for clients who are adults with dependent children who meet GAMC eligibility criteria but do not have a GAMC qualifier.
Redetermine eligibility for Transitional MinnesotaCare enrollees who report a change that makes them eligible for Medical Assistance (MA) or GAMC. This includes gaining a basis of eligibility for MA, or obtaining a GAMC qualifier. See GAMC Qualifiers - Obtaining a GAMC Qualifier for more information.
Example:
Kasha is enrolled in Transitional MinnesotaCare, and is turning age 65 next month.
Action:
Close Transitional MinnesotaCare and determine MA eligibility for Kasha. If Kasha is eligible for MA, adequate notice is sufficient for closing Transitional MinnesotaCare, since MA is more beneficial for Kasha.
Example:
Xiong is enrolled in Transitional MinnesotaCare. On October 25, he reports that he will have health insurance from his employer beginning next month (November). Since having other health insurance is a GAMC qualifier, he now meets all GAMC eligibility criteria.
Action:
Close Transitional MinnesotaCare effective October 31, and approve GAMC effective November 1. Ten-day notice is not required.