*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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: March 1, 2011 |
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25.05.40 - Premium Exemption for Households with an American Indian Member |
Archived: June 1, 2016 |
Effective July 1, 2009, households with one or more American Indian members enrolled are exempt from paying MinnesotaCare premiums. The MinnesotaCare household is exempt from paying a monthly premium if any eligible household member verifies his or her American Indian status. The household is not exempt from paying MinnesotaCare premiums if the American Indian member(s) is ineligible for MinnesotaCare or enrolled in a different Minnesota Health Care Program.
Determining Eligibility for the Premium Exemption.
Reinstating Previously Closed MinnesotaCare Cases.
Retroactive Coverage for American Indians.
Initiating the Premium Exemption.
Adding a New Member to the Household.
Determining Eligibility for the Premium Exemption
A household is eligible for the premium exemption in any month that one or more household members have verified their American Indian status and are enrolled in MinnesotaCare.
Complete the following steps to determine if a household is eligible for the premium exemption:
1. Review the application to determine if anyone applying for MinnesotaCare may be an American Indian. If it appears that any household member may be an American Indian based on information contained in the application or the household reports there is an American Indian household member, request verification of American Indian status by sending the DHS-3271. Only one enrolled household member must verify American Indian status to exempt the entire household from paying premiums.
Note: Verification of American Indian status is not an eligibility requirement. Do not pend or delay approval of MinnesotaCare eligibility while waiting for the verification of American Indian status.
See Reinstating Previously Closed MinnesotaCare Cases if the household was previously been enrolled in MinnesotaCare on and after July 1, 2009.
2. Approve eligibility if the verification of one or more household member’s American Indian status is provided and initiate the premium exemption.
3. Approve the household awaiting payment if the household is determined eligible for MinnesotaCare without pending for other verifications but has not yet provided proof of American Indian status. The household may pay their MinnesotaCare premium while they are obtaining verification of American Indian status so that coverage can begin.
If the household has not provided verification within 60 days send a second notice requesting return of the verification allowing an additional 30 days. No further action is required if the verification is not returned.
Note: Once the household provides verification of American Indian status, initiate the premium exemption and refund past premiums if applicable.
4. The effective date of MinnesotaCare coverage for eligible households who include one or more American Indians is the first day of the month following eligibility approval, if American Indian status has been verified. For eligible households who have not yet verified the American Indian status of at least one household member, the effective date of coverage is the first day of the month following receipt of the initial premium payment.
Example:
Bill and his family apply for MinnesotaCare in January. On the application, Bill has identified himself as an American Indian. The application includes all necessary verifications including verification that Bill is an American Indian. All members of the household are eligible for MinnesotaCare.
Action:
Approve MinnesotaCare coverage for February. Follow procedures to initiate the premium exemption.
Example:
Jenny and her family apply for MinnesotaCare in January. On the application Jenny has identified herself as an American Indian. The application includes all necessary verifications to determine MinnesotaCare eligibility and all members of the household are eligible for MinnesotaCare but verification of Jenny’s American Indian status has not been provided.
Action:
Approve all household members pending awaiting payment. Request verification of Jenny’s American Indian status by sending the DHS-3271. MinnesotaCare coverage will be effective the month following the month that Jenny either pays the MinnesotaCare premium or provides verification of her American Indian status. Refund any premiums that Jenny pays for months prior to the months she provides verification of her or another household member’s American Indian status.
Review all cases at renewal to determine if any enrolled household member appears to be an American Indian. No further action is required if the household is currently exempt from paying premiums and the household still includes at least one member who has verified his or her American Indian status.
Take the following actions if the household appears to include an American Indian member and is not currently exempt from paying premiums:
1. Determine if the household has previously submitted verification of American Indian status for any enrolled household member.
2. If the case contains verification that one or more household members are American Indians, initiate the premium exemption and refund any premiums paid for coverage months July 2009 and forward.
3. If the case does not contain verification that any household member is an American Indian, request verification of American Indian status by sending the DHS-3271. If the renewal is pending for other verifications, continue pending the renewal. If no other verification is needed, approve the renewal. The household can continue paying premiums until verification is provided. The household may provide verification at any time. Once the household provides verification, initiate the premium exemption and refund any premiums paid for coverage months July 2009 and forward.
4. Enter the following case note in MMIS along with the name of the household member who is a verified American Indian: “MINNESOTACARE AMERICAN INDIAN PREMIUM EXEMPTION EFFECTIVE MM/DD/YYYY”.
Reinstating Previously Closed MinnesotaCare Cases
Households with American Indian members whose MinnesotaCare coverage was cancelled for nonpayment of premiums effective June 30, 2009, or later may be eligible to have their coverage reinstated. Follow the instructions below to reinstate MinnesotaCare coverage for households who included an American Indian and were cancelled for nonpayment of premiums on or after June 30, 2009.
Review the case to determine if the household’s coverage was denied or closed due solely to non-payment of premiums for any coverage months beginning with July 2009 through the month the current application was filed. The household is eligible for coverage for any months since July 2009 in which the household included an American Indian household member and the sole reason for denial or closing was due to non-payment of premiums.
l Presume that households are eligible to have their coverage reinstated back to the effective date of cancellation if coverage ended solely due to nonpayment of premiums.
l Do not approve eligibility prospectively in the following circumstances:
n The current household income exceeds the income limit;
n The household does not currently include an American Indian eligible for MinnesotaCare;
n Household members have or had health care coverage and do not meet an exception to the MinnesotaCare other health coverage barriers. See MinnesotaCare Other Health Care Coverage Barriers for more information; or
n The household moved out of state since their coverage ended.
If one or more members of the household are currently ineligible for MinnesotaCare due to the reasons stated above, reinstate eligibility from the date of cancellation for nonpayment to the end of the month in which the household member(s) became ineligible and deny prospective eligibility. A verbal or written statement from the client concerning the above information is sufficient. Do not request verification.
Confirm the current household composition to ensure that only eligible household members are reinstated. Only reinstate coverage for household members who cancelled for nonpayment. Do not open retroactive coverage for persons who joined the household after closure. Update the case as necessary including case notes.
Contact the MMIS User Services Help Desk to have coverage reinstated for the appropriate months. Complete your agency’s appropriate web form or use the “MMIS Help Desk MinnesotaCare Request” web form available on SIR. Specify who the enrolled American Indian is and provide the Help Desk with the months that should be reinstated. After Help Desk staff have taken the appropriate actions they will notify the worker. The response will instruct the worker to send the DHS-6260 to the household. Keep a copy of the notice in the case file.
Help Desk staff will:
l Reinstate coverage and process any refund. The reinstatement process may take up to seven business days to complete and clients may not appear eligible in MMIS during this time.
l Update the case redetermination date to three months from the start of ongoing coverage to facilitate the system-generated mailing of a renewal application to the household.
l Case note actions taken and respond to the submitted web form notifying the worker the process is complete. The response will instruct the worker to send the DHS-6260 to the household. Keep a copy of the notice in the case file.
After completing the refund and premium exemption process, clients will appear eligible in MMIS without a break in coverage.
Enrollees whose MinnesotaCare coverage is reinstated will have fee-for-service coverage for past months through the current month and will be enrolled in a managed care plan for the next available month. Send the Fee-for-Service Coverage Notice (DHS-3403) to the household. The notice explains how enrollees can get reimbursed for past medical expenses they may have incurred.
Households with one or more American Indian members that wish to be exempt from premiums for the retroactive period must provide verification of their American Indian status within the current premium payment timelines. See Retroactive MinnesotaCare for more information.
Initiating the Premium Exemption
Contact the MMIS User Services Help Desk to initiate the premium exemption. Complete your agency’s appropriate web form or use the “MMIS Help Desk MinnesotaCare Request” web form available on SIR. Specify who the enrolled American Indian is and provide the Help Desk with the begin date of the exemption.
Adding a New Member to the Household
Follow current policies and procedures for adding new members to the MinnesotaCare household. See Adding a Household Member for additional information.
If the household is not already exempt from premiums and it appears that the new household member may be an American Indian, request verification of their American Indian status by sending the DHS-3271. Exempt the household from paying premiums beginning with the month that the new household member’s American Indian status is verified.
If the new American Indian member has not yet verified his American Indian status when coverage begins, do not initiate the premium exemption until the household member’s American Indian status is verified. Once the verification is received, initiate the premium exemption and refund any premiums paid since the American Indian member joined the household.
Example:
Tom is enrolled in MinnesotaCare as a single adult. In May, he calls his worker to report he was recently married and would like to add his wife Melissa to his coverage. Tom also reports that Melissa is an American Indian.
Action:
Request verification of Melissa’s American Indian status along with any other verifications needed to determine Melissa’s eligibility.
On May 16, Melissa returns all needed information except verification of her American Indian status. Melissa meets all eligibility requirements.
Action:
Approve eligibility effective June 1.
On June 5, Melissa sends in a copy of a letter from the BIA verifying she is an American Indian.
Action:
Contact the MMIS User Services Help Desk to initiate the premium exemption for Tom and Melissa beginning with July coverage and to refund the premium payment they made for June.
The premium exemption continues as long as any household member with verified American Indian status resides in the MinnesotaCare household and remains enrolled.
If the household reports that the enrolled American Indian has left the household and another enrolled household member is an American Indian and submitted verification, continue the exemption. If another enrolled household member is an American Indian but did not provide verification, request verification of American Indian status by sending the DHS-3271. Allow the household 60 days to submit verification. If the household fails to submit verification within that time, send a second request and allow an additional 30 days to return the verification. If the household has not verified American Indian status of another member after the 30 days, end the exemption for the next available month.
If there is no other enrolled American Indian member in the household, end the premium exemption the month after the change occurs. Send the American Indian MinnesotaCare Premium Exemption Ending (DHS-6260A) to inform the household the premium exemption is ending and that they are responsible for paying premiums for the following month.
Note: If the American Indian moves to a new MinnesotaCare case, the premium exemption will begin on that new case as long as the client continues to meet all other eligibility requirements.
Contact the MMIS User Services Help Desk to have premiums refunded for the appropriate months. Complete your agency’s appropriate web form or use the “MMIS Help Desk MinnesotaCare Request” web form available on SIR. Specify who the enrolled American Indian is and provide the Help Desk with the months that should be refunded.
Do not count MinnesotaCare refunds as income in the month received. Refunded amounts that are retained by the household are counted along with other countable assets at the time of the next renewal.