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Effective: December 1, 2006 |
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07.20.25ar1 - Eligibility Begin Date (Archive) |
Archived: August 1, 2008 |
The date eligibility begins depends on several factors, including:
l The date of application.
l Premium payment (if applicable).
l Whether or not retroactive coverage is requested or available.
l The date all eligibility factors have been met.
See Applications for Inmates for information on the begin date for a client who applies for health care before being released from incarceration.
Eligibility Begin Date - MCRE.
Eligibility Begin Date - MA-BC.
Eligibility Begin Date - MA-EPD.
Eligibility Begin Date - GAMC.
In most cases, people cannot be open on more than one health care program in the same month. See Programs Overlap for more information on exceptions to this policy.
If people are open on another program and request a new program:
l Ensure that the applicant understands they cannot remain open on both programs and that their coverage may change.
l The begin date of the new program must be coordinated with the closing date of the first program. See Shared and Transferred Applications.
For MinnesotaCare (MCRE), the eligibility begin date is the first day of the month following the month in which the agency receives the initial premium payment.
Note: The payment must be received by noon on the last working day of the month for eligibility to begin the following month.
For people who are hospitalized on the date coverage would otherwise begin, coverage begins the day after the person is discharged from the hospital.
For MA, the eligibility begin date is different for the following coverage requests:
l Retroactive eligibility requested:
The earliest possible begin date is the first day of the month three months before the month of application.
n People must meet all of the eligibility factors, including having an MA basis of eligibility, in each of the retroactive months.
n Determine eligibility for each month in the retroactive period for which people request coverage.
n People may be eligible for some but not all months in the retroactive period.
Example:
Georgia, age 23, applies for MA on March 25. She is a pregnant woman, and does not have a disability. Her estimated date of conception is February 15. She is requesting retroactive coverage to December.
Action:
Georgia cannot have retroactive coverage for December or January because she does not have an MA basis of eligibility and GAMC does not allow retroactive coverage. February is the earliest possible month of MA eligibility as a pregnant woman because it is the month she conceived.
Georgia is not eligible for December and January. Determine MA eligibility beginning in February.
n If any household members have pending, but not active, MCRE spans during the retroactive months, they may be eligible for MA for those months. Notify the MCRE representative when you approve MA.
l Retroactive eligibility not requested:
The begin date of eligibility is the first day of the month of application or the date all eligibility factors are met, whichever is later.
n People do not have to be eligible in the month of application.
n Eligibility may begin at a later date if the applicant meets all eligibility factors by the end of the processing period.
Example:
Elmer applies for MA on November 25. He will be 65 on December 10. He has countable assets of $2500. He has no medical bills for November and does not wish to reduce to $1000 for GAMC eligibility. He is requesting MA effective December 1.
Action:
Elmer does not meet an MA basis for November, however he does in December because he is turning 65 years old. Approve the November 25 application effective December 1 if Elmer meets all eligibility factors.
Eligibility Begin Date - MA-BC
The earliest date of eligibility for Medical Assistance for Breast and Cervical Cancer (MA-BC) is the later of either:
l Three months before the date of application.
Note: Women who are granted presumptive eligibility for MA-BC must be found eligible for ongoing MA-BC before retroactive eligibility is granted.
l The first day of the month in which the woman was screened for MA-BC.
Eligibility Begin Date - MA-EPD
For Medical Assistance for Employed Persons with Disabilities (MA-EPD) follow Eligibility Begin Date – MA to determine the possible eligibility begin date.
l Eligibility cannot be approved for people until the premium is paid.
l Applicants requesting retroactive coverage must pay the premium for each retroactive month before coverage can be approved for that month. See MA-EPD Premiums.
The earliest possible begin date for GAMC is the later of either:
l The date of application.
l The date all eligibility factors are met.
Note: For GAMC Hospital Only (GHO) eligibility factors must include an inpatient hospital admission.
Other information to check when processing an application for GAMC:
l Retroactive coverage is not available for GAMC or GHO.
l People do not have to be eligible for full GAMC or GHO in the month of application. Eligibility may begin at a later date if the applicant meets all eligibility factors by the end of the processing period.
l People with planned hospitalizations, such as elective surgery, may apply for GHO up to 45 days in advance. Do not approve coverage until you confirm that the admission has taken place.
l People who met an MA basis of eligibility in any of the three months before the month of application may be eligible for retroactive MA coverage in those months.
Example:
Eleanor applies for health care on March 25. She is requesting retroactive coverage to December. She lives with her daughter, Amy, who turned 18 on December 10 and is not in high school.
Action:
Eleanor met an MA parent basis of eligibility in December since Amy met the definition of a dependent child.
Eleanor does not have an MA basis beginning in January. Determine MA eligibility for December only.
Determine GAMC eligibility beginning March 25. Eleanor is not eligible for January, February, or March 1-24 coverage because she did not meet an MA basis in those months and GAMC does not allow coverage before the date of application.