*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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: November 1, 2012 |
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07.20.30 - Retroactive MinnesotaCare |
Archived: June 1, 2016 (Previous Versions) |
People whose eligibility for MA is closed may be eligible for retroactive MinnesotaCare. Retroactive MinnesotaCare may help pay medical expenses during the time between closure of MA and enrollment in MinnesotaCare.
This policy was designed to eliminate gaps in health care coverage for enrollees moving between programs.
Requirements for Retroactive MinnesotaCare.
Applying for Retroactive MinnesotaCare.
Retroactive MinnesotaCare Notice (DHS-3446).
Non-Timely Retroactive MinnesotaCare Requests.
Retroactive MinnesotaCare and Verifications.
Retroactive MinnesotaCare and Premium Payments.
Retroactive Coverage Services Delivery.
Retroactive Coverage and Adding a Household Member.
Retroactive MinnesotaCare for American Indians.
Retroactive MinnesotaCare Examples.
Requirements for Retroactive MinnesotaCare
Clients must comply with the following requirements to be eligible for retroactive MinnesotaCare:
l Apply for MinnesotaCare within 30 days after the MA closure. See Applying for Retroactive MinnesotaCare.
Remember: Check the MMIS RELG screen to see if there is an MA span of eligibility that will be ending or has ended no more than 30 days before receipt of the application.
Example:
Mary’s MA was closed effective November 1. She submitted an application to MinnesotaCare Operations on November 29. The worker processes the application on December 15.
Action:
Mary is potentially eligible for retroactive MinnesotaCare because her application was received within 30 days of MA termination.
l Return all requested MinnesotaCare verifications by the end of the month following the month in which verifications are requested.
Example:
Aimee’s MA closed April 10, effective May 1, due to excess income. Her county of residence is a MinnesotaCare enrollment site.
Action:
The county worker must determine MinnesotaCare eligibility as well as eligibility for retroactive MinnesotaCare.
The same day, the worker determines Aimee is missing health insurance verification.
Action:
Aimee must return the verifications by the end of May to continue to be considered for retroactive MinnesotaCare.
l Be eligible for ongoing MinnesotaCare.
l Pay the initial and optional (retroactive) MinnesotaCare premiums by the end of the month following the month of premium billing.
Exceptions: Households with one or more American Indian members who have provided verification of their American Indian status are not required to pay premiums for retroactive coverage. See Premium Exemption for Households With an American Indian Member.
Do not require children in households with income equal to or less than 200% FPG to pay premiums for retroactive coverage effective July 1, 2012.
Applying for Retroactive MinnesotaCare
Determine MinnesotaCare eligibility for the following enrollees:
l People whose MA closed due to excess income or assets. If the closing county is:
n A MinnesotaCare enrollment site, determine MinnesotaCare eligibility without requiring a new application.
n Not a MinnesotaCare enrollment site, refer the case to MinnesotaCare Operations for a mandatory MinnesotaCare determination using the most recent renewal form or application. See Shared and Transferred Applications.
l People who submit an application no more than one month after MA ends for a reason other than previously listed.
Retroactive MinnesotaCare Notice (DHS-3446)
Send the Retroactive MinnesotaCare Notice (DHS-3446) to clients who request MinnesotaCare within 30 days of MA termination and are:
l Eligible for ongoing MinnesotaCare and all verifications have been received.
l Pended for more information.
Send the DHS-3446, which explains that the applicant has 30 days from the date of request to submit verifications, along with the Verification Request Form (DHS-3271).
Note: MMIS will not deny retroactive MinnesotaCare for lack of verifications until the end of the month following the request.
Non-Timely Retroactive MinnesotaCare Requests
Send a denial of retroactive MinnesotaCare if the applicant requested retroactive coverage on the HCAPP or by any other written request filed between 30 and 60 days of MA termination.
Note: Consider the applicant to have requested retroactive coverage if the application shows a request for coverage to begin any time before the application date, including the month of application.
No denial notice for retroactive MinnesotaCare is needed if the application was filed less than 30 or more than 60 days after MA termination.
Retroactive MinnesotaCare and Verifications
Applicants pended for more information remain potentially eligible for retroactive MinnesotaCare if they return verifications by the due date and are determined eligible for ongoing MinnesotaCare.
l If applicants return verifications by the due date but the verifications indicate ineligibility, deny ongoing and retroactive MinnesotaCare.
l If verifications are not returned by the due date, MMIS will deny retroactive MinnesotaCare.
Retroactive MinnesotaCare and Premium Payments
Clients must pay the initial and optional (retroactive) MinnesotaCare premiums by the end of the month following the month of premium billing. The Retroactive MinnesotaCare Notice (DHS-3446) explains that the applicant has 30 days from the date of billing to pay the premium.
Note: MMIS will base the optional premium on current household size and income. The premium amount includes all household members eligible for retroactive coverage. Apply the All or Nothing Rule if households request coverage for only some members.
If the initial premium for ongoing eligibility:
l Is received by the end of the month following the billing month:
n MMIS will send the optional premium notice if the household meets all requirements for retroactive coverage.
n The enrollee must pay the optional premium by the end of the month following the optional billing month to receive retroactive coverage.
l Is not received by the end of the month following the billing month:
n MMIS will deny retroactive MinnesotaCare.
n Ongoing MinnesotaCare will remain pending for up to three additional months on MMIS.
If the optional premium:
l Is received before the due date:
n MMIS will approve retroactive MinnesotaCare from the date that MA closed to the date ongoing MinnesotaCare began.
n Enrollees must accept retroactive coverage for all months in this period.
Example:
Henry’s MA ended June 30. He is determined eligible for MinnesotaCare in July and pays his initial premium on August 15. His optional premium of $80 for each month (July and August) for retroactive MinnesotaCare coverage is sent the same day.
Action:
Henry must pay the entire $160 optional premium if he wants retroactive coverage. He cannot choose to pay $80 and get retroactive coverage for only one month.
l Is not received by the due date:
n MMIS will deny retroactive MinnesotaCare.
n Ongoing MinnesotaCare remains active.
Retroactive Coverage Service Delivery
Coverage during the retroactive period will be fee-for-service.
MMIS will generate a letter informing enrollees that coverage during the retroactive period will be fee-for-service.
Note: Enrollees who received services during the retroactive period should contact the provider and ask the provider to bill the state directly.
Retroactive MinnesotaCare and Adding a Household Member
Household members who are added to an active case after losing MA do not have to pay a premium for retroactive coverage. See Adding a Household Member.
Retroactive MinnesotaCare for American Indians
To be exempt from MinnesotaCare premiums for the retroactive period, one or more American Indian household members who have verified their American Indian status must enroll or be enrolled in MinnesotaCare for the retroactive period.
Households with one or more American Indians who wish to be exempt from premiums for the retroactive period must provide verification of their American Indian status by the end of the month following the month of the initial premium billing. If they cannot provide the verification within the required timeframe, the household may pay the initial, retroactive, and ongoing premiums to begin coverage, while they gather the required verification. Once the household verifies that an enrolled member of the household is an American Indian, refund past premiums paid and exempt the household from future premiums.
Contact the MMIS User Services Help Desk via web form if the household is eligible for retroactive MinnesotaCare and the premium exemption. The Help Desk will manually adjust these cases in order to activate the retroactive coverage.
Example:
Carol’s TYMA ends effective July 1 and she is not eligible for ongoing MA because of excess income. Her county of residence is a MinnesotaCare enrollment site. The county worker must determine eligibility for Carol at the time of her MA closure because she is being closed due to excess income. All required information and verifications are available to determine MinnesotaCare eligibility.
Action:
Carol and her children are eligible for MinnesotaCare. The worker approves the case as pending awaiting payment on July 6 and sends Carol the DHS-3446. Carol must pay her initial premium by the end of August (the month following the month of approval) to be considered for retroactive MinnesotaCare.
Carol’s initial premium is received on July 23. Ongoing MinnesotaCare will begin August 1.
Action:
MMIS computes Carol’s retroactive premium for July and sends the optional premium notice on July 25. Carol must pay the optional premium by the end of August to have coverage for July.
Example:
Colleen submits a HCAPP to MinnesotaCare Operations on July 10.
Action:
Check the MMIS RELG screen - Colleen’s MA ended June 30. She meets the requirement of requesting MinnesotaCare within 30 days of MA termination. The MinnesotaCare worker learns that Colleen’s MA closed because she failed to return her renewal.
Colleen does not provide verification of her reported income with her HCAPP. An attempt to verify the income electronically is unsuccessful. Pend the case for more information and send the DHS-3446 with the request for income information. Colleen must return the verifications by the end of August to be considered for retroactive MinnesotaCare.
The worker receives the verifications on August 3 and determines that Colleen is eligible.
Action:
Approve the case as pending awaiting payment. Colleen’s initial premium payment must be received by the end of September to qualify for retroactive MinnesotaCare.
Colleen’s initial premium is received on September 7. Ongoing MinnesotaCare will begin October 1.
MMIS computes the retroactive premium amounts for July, August and September and sends the optional premium notice on September 8. Colleen must pay the retroactive premiums by the end of October to have coverage for the retroactive months. She may not pay for only one or two months in the retroactive period.
If Colleen does not pay the optional premium for the three retroactive months by the end of October, MMIS will deny retroactive MinnesotaCare. Ongoing MinnesotaCare will remain active if current premiums are paid.
Example:
Jane’s MA ends on June 30 for herself and her daughter Jill. They are determined eligible for MinnesotaCare on July 10. They meet all requirements for retroactive MinnesotaCare. MMIS computes the retroactive premium for both Jane and Jill.
Jane contacts her worker and says she wants retroactive coverage only for Jill. Jane did not have any bills since MA ended.
Action:
The worker contacts the MMIS User Services Help Desk to request an adjustment. MMIS will not generate a replacement premium notice. The worker informs Jane of the retroactive premium amount for Jill only.
Example:
MA was closed effective June 30 for Amy and her son, Adrian. They are determined eligible for MinnesotaCare in July. The worker notices that Amy indicated on her application that she is an American Indian.
Action:
Approve MinnesotaCare for Amy and Adrian pending awaiting payment for August and enter a retroactive span for the month of July. Send the Retroactive MinnesotaCare (DHS-3446) and request verification of American Indian status by sending the DHS-3271.
Two weeks after requesting verification of American Indian status, Amy submits a tribal ID card.
Action:
Exempt Amy and Adrian from retroactive and ongoing premiums.