*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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: October 1, 2012 |
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06.15 - Applying for Other Benefits |
Archived: June 1, 2016 (Previous Versions) |
Clients who appear to have eligibility for other programs are required to apply for those programs to continue eligibility for Minnesota Health Care Programs (MHCP).
Applying for Other Benefits - MinnesotaCare.
Applying for Other Benefits - MA.
Applying for Other Benefits - Medicare Savings Programs
Applying for Other Benefits - MinnesotaCare
MinnesotaCare clients may be required to apply for Medicare Part A and Part B coverage if it appears that they may be eligible for both programs. See Referrals to Medicare for when to refer the enrollee to apply.
Applying for Other Benefits - MA
Require MA clients to apply for benefits from other programs for which they appear eligible if those benefits would do either of the following:
l Increase their net countable income.
l Help pay their medical expenses.
Note: See Referrals for Social Security Benefits to determine when MA clients are required to apply for RSDI or SSI benefits. See Referrals to Medicare to determine when MA clients are required to apply for Medicare. See When to Refer for RRB Benefits to determine when MA clients are required to apply for Railroad Retirement Board (RRB) benefits. See Referrals to the RRB for Medicare to determine when MA clients receiving RRB are required to apply for Medicare.
Clients must apply for benefits within 30 days of when the worker notifies them of their potential eligibility.
Note: Require people to reapply for benefits lost during an incarceration when they are released from the control of the penal system, including conditional medical releases when the client enters a nursing facility.
l Deny or terminate eligibility if clients fail to apply without .
l Do not require clients to reapply for benefits that were previously denied unless there has been a change in circumstances or eligibility requirements of the benefit program.
Example:
Stefan was recently disabled. He applied for MA and his disability was approved by SMRT. He is MA eligible. Stefan is required to apply for Social Security disability benefits as a condition of ongoing eligibility. His worker requests on August 10 that he apply for these other benefits by September 10. Stefan applies for benefits on August 30. The benefits are denied on September 30 because Stefan failed to follow through with the SSA application process.
Action:
Stefan’s MA eligibility is closed for November, because he did not cooperate with applying for another benefit which would provide him with increased countable income and help pay his medical expenses. The worker closes his eligibility with 10-day notice.
Applying for Other Benefits - Medicare Savings Programs
Require Medicare Savings Program (MSP) clients to apply for benefits from other programs for which they appear eligible only if those benefits would increase the client’s net countable income above the income standard for the program.
Clients must apply for benefits within 30 days of when the worker notifies them of their potential eligibility.
Note: Require people to reapply for benefits lost during an incarceration when they are released from the control of the penal system, including conditional medical releases when the client enters a nursing facility.
l Deny or terminate eligibility if clients fail to apply without good cause.
l Do not require clients to reapply for benefits that were previously denied unless there has been a change in circumstances or eligibility requirements of the benefit program.
Note: MSP enrollees may be required to apply for other benefits that would not increase the client’s net countable income above the program standard if the client applies for MA. See Applying for Other Benefits - MA.
Example:
Jim submits an application requesting MSP coverage only. He reports regular
gift income of $80 per month and that he is disabled. Jim’s application
indicates he may be eligible for Social Security Income (SSI).
Action:
Jim appears eligible for QMB. Do not require Jim to apply for SSI as a
condition of eligibility because the SSI income would not increase Jim’s
net countable income above the QMB income standard.
Two months later, Jim requests MA coverage.
Action:
Jim meets all eligibility requirements for MA. However, because Jim is
seeking MA coverage, he must apply for all benefits that may increase
his net countable income. Approve MA and send a notice to Jim requesting
that he apply for SSI within 30 days. If Jim fails to cooperate, close
MA. Jim remains QMB eligible.