*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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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25.10.30 - MA-EPD Premium Exemption for American Indians |
Archived: June 1, 2016 |
Effective July 1, 2009, American Indians are exempt from paying MA-EPD premiums. A person must verify his or her American Indian status in order to be exempt from paying an MA-EPD premium.
Determining Eligibility for the Premium Exemption.
Initiating the Premium Exemption.
Determining Eligibility for the Premium Exemption
An individual who has verified his or her American Indian status is exempt from paying MA-EPD premiums.
Complete the following steps to determine if a person is eligible for the premium exemption:
1. Review the application to determine if the applicant may be an American Indian. If it appears that the applicant is an American Indian based on information contained in the application or the applicant reports that he or she is an American Indian, request verification of American Indian status by sending the DHS-3271.
Note: Verification of American Indian status is not an eligibility requirement. Do not pend or delay approval of MA-EPD eligibility while waiting for the verification.
2. Approve eligibility, including eligibility for any retroactive months, if the applicant meets all eligibility requirements and
a. has verified his or her American Indian status. Initiate the premium exemption. Cancel the approval notice in MAXIS and manually issue the Medical Assistance for Employed Persons with Disabilities (MA-EPD) Approval Notice for American Indians (DHS-6260C). This notice informs the client that they are eligible for MA-EPD with no premium payment.
Enter the following case note into MAXIS:
“MA-EPD AMERICAN INDIAN PREMIUM EXEMPTION EFFECTIVE MM/DD/YYYY.”
OR
b. has paid the initial premium and any applicable retroactive premiums. The applicant may pay the MA-EPD premium while obtaining verification of American Indian status so that coverage can begin. See MA-EPD Premiums for information.
If the applicant 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 client provides verification of American Indian status, initiate the premium exemption beginning the following month and refund MA-EPD premiums paid for any coverage months beginning July 2009 or later.
3. Review the case to determine if the applicant’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 applicant is eligible for coverage for any months since July 2009 in which the sole reason for denial or closing was due to non-payment of premiums.
Review all cases at renewal to determine if the enrollee is an American Indian. No further action is required if the enrollee is currently exempt from paying premiums due to his or her American Indian status.
Take the following actions if, based on information on the renewal form or the last application, the enrollee may be an American Indian and is not currently exempt from paying premiums:
1. Determine if the enrollee has previously submitted verification of American Indian status.
2. If the case contains verification that the enrollee is an American Indian, initiate the premium exemption and refund any premiums paid for coverage months July 2009 and forward.
3. Manually issue the Medical Assistance for Employed Persons with Disabilities (MA-EPD) Approval Notice for American Indians (DHS-6260C). If this is the first renewal with verified American Indian status, also send the Medical Assistance for Employed Persons with Disabilities (MA-EPD) Premium Exemption for American Indians (DHS-6260B). This notice informs the client that he or she has been identified as an American Indian.
4. If the case does not contain verification that the enrollee 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.
Note: For enrollees who verify American Indian status between renewals, issue the Medical Assistance for Employed Persons with Disabilities (MA-EPD) Premium Exemption for American Indians (DHS-6260B).
5. Enter the following case note into MAXIS:
“MA-EPD AMERICAN INDIAN PREMIUM EXEMPTION EFFECTIVE MM/DD/YYYY.”
Initiating the Premium Exemption
Send the following SIR webmail message to dhs.made@state.mn.us with “MA-EPD American Indian No Premium” in the subject line:
(Client name and PMI #) is a verified American Indian exempt from paying premiums. Eligibility for MA-EPD has been approved in MAXIS and MMIS. Do not open premium billing. Reimburse any MA-EPD premiums this enrollee has paid for coverage months of July 2009 and forward.
Send the following SIR webmail message to dhs.made@state.mn.us with “MA-EPD American Indian No Premium” in the subject line:
(Client name and PMI #) is a verified American Indian exempt from paying premiums. Reimburse any MA-EPD premiums this enrollee has paid for coverage months of July 2009 and forward.
Do not count MA-EPD refunds as income in the month received by the enrollee.