This manual letter lists new and revised material for the Health Care Programs Manual. Unless otherwise noted, new and revised instructions are effective October 1, 2007.
Bulletins #06-21-12 and #07-21-04.
Chapter 02 - Minnesota Health Care Programs.
Chapter 03 - Eligibility Groups and Bases of Eligibility.
Chapter 06 - Client Responsibilities.
Chapter 09 - Verification Requirements.
Chapter 28 - Health Care Service Delivery.
Chapter 03 - Eligibility Groups and Bases of Eligibility.
Chapter 13 - State and County Residence Requirements.
Chapter 03 - Eligibility Groups and Bases of Eligibility.
Chapter 11 - Citizenship and Immigration Status.
Chapter 12 - Certification of Disability.
Chapter 17 - Household Composition.
Chapter 22 - Standards and Guidelines.
Chapter 23 - Long-Term Care (LTC) and Elderly Waiver (EW).
Bulletin #06-21-12, New Eligibility Requirements for the GAMC Program and Introduction of a New Transitional MinnesotaCare Program, and Bulletin #07-21-04, Changes and Clarifications to Transitional MinnesotaCare Announced
The following sections were updated with information from bulletin #06-21-12, which was effective September 1, 2006, and bulletin #07-21-04, which was effective May 1, 2007.
l Glossary S-Z.
Adds a definition of Transitional MinnesotaCare. Also adds the disclaimer described in ”Other Updates - Glossary” below.
Chapter 02 - Minnesota Health Care Programs
l Section 02.05 - Hierarchy of Major Programs.
Adds a brief description of Transitional MinnesotaCare under ”General Assistance Medical Care.”
Chapter 03 - Eligibility Groups and Bases of Eligibility
l Section 03 - Eligibility Groups and Bases of Eligibility.
Adds that some adults without children may be eligible for Transitional MinnesotaCare.
l Section 03.20.25 - MinnesotaCare for Adults Without Children.
Adds that some adults without children may be eligible for Transitional MinnesotaCare. Removes the link to bulletin #06-21-12 and adds a link to new section 03.55, Transitional MinnesotaCare under ”Relationship to Other Groups/Bases.”
Also see below for information about updates to this section for bulletin #07-21-06.
l Section 03.50 - General Assistance Medical Care (GAMC).
Updates text and links under ”General Provisions” and ”Related Topics” to link to new section 03.55, Transitional MinnesotaCare.
l Section 03.50.05 - GAMC With Full Benefits.
Updates links and text to link to revised section 03.50.05.05, GAMC Qualifiers, and to new section 03.55, Transitional MinnesotaCare.
Under ”Verification,” removes incorrect language to follow MA Method A asset verification procedures. Adds statement to follow standard GAMC guidelines.
Replaces description of GAMC qualifiers under ”Other Requirements” with a link to section 03.50.05.05, GAMC Qualifiers.
l Section 03.50.05.05 - GAMC Qualifiers.
Changes name of section from ”Transitional MinnesotaCare” (name of new section 03.55) to ”GAMC Qualifiers,” and retains the definition of a GAMC qualifier.
Adds information from bulletin #06-21-12 about when to apply this requirement; how to define ”homeless” for GAMC (see bulletin #07-21-06 below); how to treat potential GAMC qualifiers; when to verify qualifiers; and what to do when a client loses or obtains a GAMC qualifier.
l Section 03.50.10 - GAMC Hospital Only (GHO).
Updates link and text to link to renamed section 03.50.05.05, GAMC Qualifiers.
Under ”Verification,” removes incorrect language to follow MA Method A asset verification procedures. Adds statement to follow standard GAMC guidelines.
l Section 03.55 - Transitional MinnesotaCare.
This new section adds information from bulletin #06-21-12 about the basic eligibility factors and requirements for Transitional MinnesotaCare. This section also includes updated information from bulletin #07-21-04 about application and reapplication requirements; adding a new household member; county agency requirements to administer MinnesotaCare; and overlap between Transitional MinnesotaCare and MinnesotaCare.
l Section 03.55.05 - Renewals for Transitional MinnesotaCare.
This new section adds information from bulletin #06-21-12 about renewal requirements for Transitional MinnesotaCare, including processing the renewal, late renewals, and retroactive MinnesotaCare. This section also includes information from bulletin #07-21-04 about the worker’s role in sending the renewal, and updated information on renewal processing.
Chapter 06 - Client Responsibilities
l Section 06.15 - Applying for Other Benefits.
Adds that Transitional MinnesotaCare clients are not required to apply for other benefits.
l Section 07.05.10 - Application Required.
l Section 07.05.15 - Application Not Required.
Adds new subsections, ”Transitional MinnesotaCare Application Required” and ”Transitional MinnesotaCare Application Not Required,” respectively, which include links to application information related to Transitional MinnesotaCare.
l Section 07.20.30 - Retroactive MinnesotaCare.
Adds that retroactive MinnesotaCare is available to some Transitional MinnesotaCare enrollees.
l Section 07.20.50 - Programs Overlap.
Adds a new subsection, ”MCRE and Transitional MinnesotaCare Overlap.” This subsection adds, from bulletin #07-21-04, that MinnesotaCare and Transitional MinnesotaCare may not overlap, unless the MinnesotaCare case cannot be closed with ten-day notice.
l Section 08.20 - MinnesotaCare Renewals.
l Section 08.25 - MA and GAMC Renewals.
Adds that there are special renewal considerations for Transitional MinnesotaCare enrollees, and includes a link to section 03.55.05, Renewals for MinnesotaCare.
Chapter 09 - Verification Requirements
l Section 09.05 - Mandatory Verifications.
Under ”GAMC Verification Only,” adds that verification is required for GAMC qualifiers that cannot be verified internally through county systems or processes.
l Section 25.05 - MinnesotaCare Premiums.
Adds that county agencies pay the MinnesotaCare premium for Transitional MinnesotaCare enrollees, and includes a link to section 03.55, Transitional MinnesotaCare - Premium Payment by County Agencies.
Chapter 28 - Health Care Service Delivery
l Section 28.05.05 - Benefit Sets by Major Programs.
Adds a new subsection, Transitional MinnesotaCare Benefit Sets, which notes that there are special considerations that determine the benefit set for Transitional MinnesotaCare enrollees, and includes a link to section 03.55, Transitional MinnesotaCare - Covered Services.
Bulletin #07-21-05, DHS Announces Changes to Transfer Penalty Period Begin Date Policy for Medical Assistance (MA) Enrollees Receiving Payment of Long-Term Care (LTC) Services
See Other Updates - Chapter 19 - Assets below for specific information about updates from this bulletin and other updates to transfer policy.
Bulletin #07-21-06, Legislature Enacts Changes to Medical Assistance (MA), General Assistance Medical Care (GAMC), and MinnesotaCare Effective July 1, 2007
The following sections were updated with information from this bulletin, which was effective July 1, 2007.
Chapter 03 - Eligibility Groups and Bases of Eligibility
l Section 03.20.25 - MinnesotaCare for Adults Without Children.
Removes language under ”Residency” that these enrollees must have a fixed address other than a place of public accommodation.
l Section 03.50.05.05 - GAMC Qualifiers.
Adds a new definition of ”homeless” for GAMC.
Chapter 13 - State and County Residence Requirements
l Section 13.15 - State Residence - MinnesotaCare Adults Without Children.
Removes language that these enrollees must have a fixed address other than a place of public accommodation, adds that a fixed address is not required, and adds an example to illustrate this policy.
Also adds a new subsection on verification requirements for clients whose statement of intent to live in Minnesota permanently is inconsistent or questionable.
l Section 20.25.10 - Lump Sum Income.
Under ”MA/GAMC,” notes that prosthetic devices are one type of medical expense that can be an earmarked portion of a lump sum. Also adds an example of how lump sum policy applies to a monetary gift for a prosthetic device.
l Glossary.
Adds a disclaimer to the first page of each Glossary section (in the format that is available from the Table of Contents) that these definitions are intended for general reference. For complete policy information, users should refer to the relevant section(s) of the manual.
Under ”Glossary M-R,” also updates the definition of marriage to include some common law unions from other states.
Chapter 03 - Eligibility Groups and Bases of Eligibility
l Section 03.45.10 - Refugee Medical Assistance (RMA).
Adds under ;Income Guidelines” that refugee resettlement grants are treated as lump sum income.
l Section 07.05.15 - Application Not Required.
Clarifies under ”MCRE Application Not Required” that when people who are denied or closed on MA or GAMC request MinnesotaCare within 11 months of the application date, eligibility for MinnesotaCare should be determined using any application or renewal form completed by the enrollee, rather than ”any form.” Also clarifies that counties that are not MinnesotaCare enrollment sites must send the most recent application or renewal to MinnesotaCare Operations. It is not necessary to send both.
l Section 08.10 - Renewal Forms.
l Section 08.25.05 - Processing MA/GAMC Renewals.
Removes references to the obsolete CAF Recertification Form (DHS-3217).
Chapter 11 - Citizenship and Immigration Status
l Section 11.20.25 - Refugees.
Adds under ”Funding Source” that refugee resettlement grants are treated as lump sum income.
Chapter 12 - Certification of Disability
l Section 12.05 - Social Security Administration (SSA) Disability Determinations.
Adds a statement under "When SSA Benefits End" to highlight current policy for disabled noncitizens who lose SSI eligibility after being in the U.S. for seven years. Like other MA enrollees who lose SSA benefits for reasons not related to disability, these noncitizens should be referred to SMRT. They maintain their MA eligibility while the SMRT determination is pending.
Chapter 17 - Household Composition
l Section 17 - Household Composition.
Under ”Household Composition Basics,” updates the definition of marriage to include certain common law unions from other states.
The transfer sections of this chapter have been revised to include information from bulletin #07-21-05, ”DHS Announces Changes to Transfer Penalty Period Begin Date Policy for Medical Assistance (MA) Enrollees Receiving Payment of Long-Term Care (LTC) Services,” which was effective July 1, 2007. These sections also include other policy clarifications and updates that were conveyed via teleconferences and a follow-up Question and Answer (Q & A) document posted on the DHS CountyLink website on February 2, 2007.
Please review the summary below carefully since several sections contain new policy.
l Section 19.40 - Transfers.
Adds information on when failure to take action to obtain income or assets is not considered an uncompensated transfer.
Changes the name of subsection ”What is the Penalty for an Improper Transfer?” to ”What is the Transfer Penalty?” In general, the term ”improper transfer” is replaced in the manual with terms such as ”uncompensated transfer” and ”r;transfers resulting in a transfer penalty.”
Moves material on demonstrating that a transfer was not made exclusively to establish or maintain MA eligibility to new section 19.40.05.05, Transfers Made for Purposes Other Than to Qualify for MA.
l Section 19.40.05 - Transfer Penalty Exceptions.
Revises the effective date for the elimination of the exemption for transfers of less than $200 in a given month. The policy applies when people request MA payment of LTC services on or after September 12, 2006. Previous instructions stated the policy applied to requests made on or after July 1, 2006. This change was previously conveyed via teleconference and the Q&A document.
Removes the subsection on ”MA Spousal Asset Transfers” because the information is either covered elsewhere or has been moved to section 19.40.50, Archived Transfer Information.
l Section 19.40.05.05 - Transfers Made for Purposes Other Than to Qualify for MA.
New section with expanded information and examples on how clients can demonstrate that a transfer was done exclusively for a purpose other than to obtain or maintain eligibility for MA payment of LTC services.
l Section 19.40.10 - Date of Transfer.
Clarifies material on transfers into annuities and trusts.
l Section 19.40.15 - Lookback Period.
Changes the section title from ”Look Back Period” to ”Lookback Period.” This change occurs throughout the transfer subchapter.
Rearranges text to provide clarification on MA lookback periods.
l Section 19.40.20 - Purchases as Transfers.
Combines instructions on determining the uncompensated value of life estates and promissory notes from section 19.40.25, Determining Uncompensated Value, with material in this section.
Adds that the determination of actuarial soundness for promissory notes, loans and mortgages is based on the principal portion of the payments only. Revises some of the instructions and an example to reflect this.
Adds text that clarifies that purchase of a life estate in another’s home on or after July 1, 2006, must be evaluated as a possible uncompensated transfer even if the purchaser lives in the home for more than 12 months.
l Section 19.40.25 - Determining Uncompensated Value.
Replaces material on determining the uncompensated value of life estates and promissory notes with references and links to section 19.40.20, Purchases as Transfers, where the information is now located.
Adds instructions on determining the uncompensated value of transferred income.
Adds examples on how to determine compensation in the form of care or services.
l Section 19.40.30 - Determining Transfer Penalty.
Revises and reorders the steps to determining the transfer penalty to better distinguish between calculating the penalty for fractional transfers versus partial penalty months.
Clarifies that, for transfers made on or after February 8, 2006, all uncompensated transfers made during the lookback period are added together to determine a single penalty period. This applies to fractional transfers as well as to transfers in excess of the appropriate SAPSNF.
Clarifies that the SAPSNF to use is the one in effect on the date of the client’s most recent initial or renewed request for MA payment of LTC services. This could be the most recent application, renewal or Request for Payment of LTC Services (DHS-3543). This clarification was originally conveyed via teleconference and the follow-up Q & A.
l Section 19.40.35 - Applying Transfer Penalty.
Revises and reorganizes the subsection ”MA - When Does Transfer Penalty Begin?” to reflect the changes for enrollees who made transfers on or after February 8, 2006, that were reported or discovered on or after July 1, 2007. These changes were previously announced in bulletin #07-21-05.
l Section 19.40.40 - Multiple Transfers.
Adds a step under MA for multiple transfers made on or after February 8, 2006, and changes the last example to match the new instructions. This procedure was previously clarified in the teleconference Q & A.
l Section 19.40.50 - Archived Transfer Information.
Moves material from section 19.40.05, Transfer Penalty Exceptions, on one-time spousal transfers allowed when a spouse resided in an LTCF before October 1, 1989, to this section.
l Section 20.05.05 - Program Provisions for Excluded Income.
Changes the words ”Exclude household provisions made directly to members of the clergy” to ”Exclude housing provided directly to members of the clergy” to clarify the policy.
l Section 20.25 - Types of Income.
Adds a link to new section 20.25.60, Refugee Resettlement Grants.
l Section 20.25.45 - Interest and Dividends.
Removes incorrect statement about excluding the interest portion of payments on contracts for deed and promissory notes and adds these payments to the list of interest payments counted as unearned income under ”MA Method B.”
l Section 20.25.60 - Refugee Resettlement Grants.
This new section adds policy on how to treat refugee resettlement grants for health care program eligibility.
Chapter 22 - Standards and Guidelines
l Section 22.45 - Long-Term Care (LTC) Allowances.
Updates the phone standard from $25 to $24. This standard is used in spousal allocations instead of the standard utility allowance when the spouse is not responsible for heating or cooling costs. There is no change to the $75 standard allowed for electricity in these cases.
Workers should identify and update budgets for those affected when processing an application or processing renewals on or after October 1, 2007. This change was first announced in MAXIS e-mail 7378813 dated September 19, 2007.
Chapter 23 - Long-Term Care (LTC) and Elderly Waiver (EW)
l Section 23.40.45 - Health Insurance Premium Deduction for LTC.
Changes the name of the section from ”LTC Insurance Premium Deduction” to ”Health Insurance Premium Deduction for LTC” to clarify that this deduction applies to premiums for health insurance, and not long-term care insurance, policies.