This manual letter lists new and revised material for the Health Care Programs Manual. Unless otherwise noted, new and revised instructions are effective April 1, 2008.
Citizenship and Immigration Status - Afghan and Iraqi Special Immigrant Status and Other Updates
This section contains new and revised policy and procedural information for citizenship and immigration status.
There is a new section about Afghan and Iraqi special immigrants. These are Afghan and Iraqi translators who were employed by the U.S. military, and their spouses and unmarried children under age 21.
There is also a new section that adds information about adjustment requirements for other lawfully residing noncitizens. For many of these statuses, workers are advised to refer certain cases to HealthQuest.
Information about SAVE (Systematic Alien Verification for Entitlements) has been updated and expanded, including instructions for using SAVE to request sponsorship information. There are also corresponding glossary updates.
Note: The Health Care Eligibility for Noncitizens guide (DHS-4913) is under review, and will be revised in conjunction with these HCPM updates.
See below for further information.
Chapter 11 - Citizenship and Immigration Status.
Chapter 18 - Deeming Income and Assets.
Updates to Community Spouse Definition
The definition of ”community spouse” has been updated to state that people who receive services through the disability waivers (CAC, CADI, DD and TBI) are not community spouses. This change is effective with receipt of this manual letter. There are also corresponding glossary updates.
Spouses who receive CAC, CADI, DD or TBI services are no longer eligible to receive spousal allocations. Adjust any affected cases at the next renewal.
See below for further information.
Chapter 23 - Long-Term Care and Elderly Waiver.
This manual letter includes a number of other updates and policy clarifications, including revisions to the Method B sections on self-employment and self-support assets, and updated information on the HIV/AIDS programs.
See below for further information.
Chapter 04 - Social Security Administration (SSA) Benefits.
Chapter 13 - State and County Residence Requirements.
Chapter 22 - Standards and Guidelines.
Chapter 30 - Other Related Programs.
Citizenship and Immigration Status - New Afghan and Iraqi Special Immigrant Status and Other Updates
Chapter 11 - Citizenship and Immigration Status
l Section 11, Citizenship and Immigration Status.
In the opening paragraphs, adds an Example; makes minor text changes for clarity; and adds a link to the newly added glossary definition of ”U.S. national.”
Adds information about adjustment for nonimmigrants under ”Definitions” and adds a link to section 11.35, Changes in Immigration Status. Also makes a minor wording change to the definition of immigration status for clarity ("granted to" rather than "conferred on"), and expands the definition of noncitizens for greater emphasis.
Under ”Sponsored Noncitizens,” makes minor text changes to emphasize the link to section 18.05, Sponsor Deeming.
l Section 11.05, Verification of U.S. Citizenship.
Adds an Exception under ”When Must Documentation Be Provided?” for applicants born in Minnesota. These applicants are not required to sign the DHS-4841; instead, they must sign the Minnesota Birth Record Application.
l Section 11.05.15, Cooperation with Documentation Requirements.
Under ”Failure to Cooperate,” adds a Note with instruction to close or deny health care program eligibility for children whose parents fail to cooperate with the citizenship/identify documentation requirement on their behalf.
l Section 11.10, Verification of Immigration Status.
Revises the first sentence of the third paragraph to add the words ”r;the required” before ”verification of immigration status,” and remove the words ”date of entry.” The date of entry may or may not be required (or available), depending on the status.
Under ”Current Verification Not Provided,” adds an Exception for enrollees who document that they have requested verification from USCIS but have not yet received it.
Adds Afghan and Iraqi Special Immigrants to the list of statuses under ”Acceptable Sources of Verification.”
l Section 11.10.05, Systematic Alien Verification Entitlements (SAVE).
Adds a link to section 18.05, Sponsor Deeming, in the introductory paragraph.
Adds new procedural information about primary and secondary verification, and possible follow-up with USCIS, under ”Steps for Using SAVE.”
l Section 11.15, Funding Health Care for Noncitizens.
Adds Notes under ”MinnesotaCare” and ”General Assistance Medical Care (GAMC)” as a reminder that noncitizens with an undocumented or nonimmigrant status are not eligible for MinnesotaCare, GAMC, or GAMC Hospital Only (GHO).
Under ”Medical Assistance,” adds a statement to consider Emergency Medical Assistance (EMA) for noncitizens who are otherwise ineligible for MA due to sponsor deeming. Also adds examples to illustrate different circumstances in which noncitizens may be eligible for EMA.
Adds a link to new section 11.35.05, Adjustment Requirements for Other Lawfully Residing Noncitizens, under "Obtaining a Qualified Status."
l Section 11.20.05, Amerasian Immigrants.
Makes minor text changes to the last sentence of the first paragraph for clarity, and adds a link to the glossary definition of ”minor children.”
Updates the required documents and codes under ”Verification Requirements.” The client must provide either a picture I-94 or foreign passport stamped ”processed for I-551” with codes AM1, AM2, AM3, AM6, AM7, or AM8.
l Section 11.20.15, Asylees.
Adds the I-571, Refugee Travel Document, to the documents listed under ”Verification Requirements.” Also corrects the number with which USCIS form I-688B must be annotated. The correct number is 274a.12(a)(5).
l Section 11.20.25, Refugees.
Under ”Verification Requirements,” adds that a copy of the I-765, Application for Employment Authorization, or a receipt from USCIS indicating filing of the application, is an acceptable form of verification for this status. Also corrects the required notation for the I-94. It must be stamped ”refugee” or § 207.
l Section 11.20.35, Withholding of Removal.
Adds information to the introductory section explaining that, while asylees (who have a similar status) may have a choice of immigration status, people must be granted withholding of removal status if they meet the criteria.
Revises the wording under ”Status Adjustment” to clarify that people with this status are not eligible to adjust to LPR status. However, withholding status may be extended by immigration authorities; refer cases with expired status to HealthQuest.
Under ”Verification Requirements,” corrects the first bullet point to state that the order may be from an immigration judge or federal court, and that the order must show a grant of deportation or removal withheld. Adds that a copy of the I-765, Application for Employment Authorization, or a receipt from USCIS indicating filing of the application, is an acceptable form of verification for this status. Also adds detail to the stamp required on the I-94, and adds the I-571, Refugee Travel Document, as another acceptable form of verification of this status.
l Section 11.25, Federally or State-Funded Health Care.
Adds Afghan and Iraqi special immigrants under ”Statuses That May Be Federally or State-Funded.” Also makes minor wording updates to the Note about battered noncitizens for clarity.
Under ”Exemption for Military Service,” adds a Note that self-declaration under penalty of perjury may be accepted pending receipt of acceptable documentation.
l Section 11.25.05, Battered Noncitizens.
Moves the first sentence of the introductory section to the "Who Are Battered Noncitizens?" subsection, and makes minor text changes for clarity.
Replaces the previous text under ”Who Are Battered Noncitizens?” with a revised version for clarity, moves some of the previous text under ”Verification Requirements,” and adds a link to the related information in section 18.05, Sponsor Deeming. There are no policy changes.
Updates the ”Verification Requirements” text to reflect current requirements and procedures. Also adds some of the material previously found under ”Who Are Battered Noncitizens?”, such as the fact that the battery or cruelty must have a substantial connection to the need for health care coverage.
l Section 11.25.10, Lawful Permanent Residents.
Adds that lawful permanent residents may apply for citizenship after living in the U.S. after three years if married to a U.S. citizen, or one year for certain people in the military and veterans.
Updates the "Verification Requirements" to note that earlier versions of the I-551, such as the I-151, may also be accepted. Also adds another acceptable form of verification: certain orders issued by an immigration judge, the Board of Immigration Appeals (BIA), or a federal court. Adds to the last bullet point, "or any other USCIS verification that shows LPR status."
l Section 11.25.20, Afghan and Iraqi Special Immigrants.
This is a new section that adds information about a new immigration status, Afghan and Iraqi special immigrants. These are Afghan and Iraqi translators who were employed by the U.S. military, and their spouses and unmarried children under age 21.
These special immigrants are lawful permanent residents (LPRs) who may be eligible for MA with FFP or Refugee Medical Assistance (RMA) for six months, if Afghan, or eight months, if Iraqi, following their date of entry into the U.S. See the section for further information about status adjustment and verification requirements.
l Section 11.30, State-Funded Health Care.
Simplifies the wording under ”Emergency Medical Assistance (EMA)” and adds a link to section 11.15, Funding Health Care for Noncitizens, where a more complete explanation about EMA is already given.
l Section 11.30.05, Other Lawfully Residing Noncitizens.
Adds several references and links to new section 11.35.05, Adjustment Requirements for Other Lawfully Residing Noncitizens in the introductory paragraph.
Replaces the subsection "Verification Requirements" with a new subsection, "Status Descriptions and Verification Requirements." This new subsection reformats the existing information that describes each status and its verification requirements, and updates and expands the verification requirements for many statuses. This includes the addition of new acceptable documents for some statuses, such as a copy of form I-765, Application for Employment Authorization, or a receipt from USCIS indicating filing of application. Also adds that, for some statuses, any verification from the immigration authorities or other authoritative documents that indicates the pertinent status may be accepted.
l Section 11.35, Changes in Immigration Status.
Revises and expands the introductory section for clarity, and adds general material about adjustment for refugees and asylees that was previously found in the "Becoming a U.S. Citizen" subsection.
Under "Cooperating with USCIS," revises and adds material to emphasize current requirements for adjustment of status, and adds a link to new section 11.35.05, Adjustment Requirements for Other Lawfully Residing Noncitizens. Also replaces the Exception for Micronesians and Marshall Islanders, which is already included in section 11.30.10.05, with a general statement to refer to the specific manual section for a given status for adjustment requirements.
Replaces the words "living in the United States" with "maintaining an LPR status" to reflect current naturalization policy under "Becoming a U.S. Citizen." Moves general material about adjustment for refugees and asylees from this subsection to the introductory section.
Makes minor text changes for clarity and modifies the Note to accurately reflect federal guidelines under "Adjusting to LPR Status (Entered U.S. With Federally Funded Status)."
l Section 11.35.05, Adjustment Requirements for Other Lawfully Residing Noncitizens.
This is a new section that adds information about requirements for adjustment of status for other lawfully residing noncitizens. Many clients in this group may have involved or complex circumstances, such as why they were granted the status or whether extension of the status is possible. Refer questions about such cases and those with expired status to HealthQuest.
Chapter 18 - Deeming Income and Assets
l Section 18.05, Sponsor Deeming.
Updates both terms under ”Definitions.”
n Updates and expands the definition of ”qualifying work quarters” to include the term ”work credits," which is used by the Social Security Administration, and adds a link to the SSA website.
n Revises the definition of ”sponsor” for clarity and to delete the reference to sponsorship by a church, organization, or group. Public and private agencies are not considered sponsors for health care program eligibility. Also incorporates a reference to USCIS form I-864, Affidavit of Support.
Under ”Who Has A Sponsor?”, makes multiple updates to the text and format throughout the subsection to reflect current policy and procedures. Revises the list of when a sponsored noncitizen is no longer considered sponsored to include "Become a naturalized citizen," and add "work credit" terminology to "Earn 40 qualifying work quarters." Modifies the Note to add information about counting a spouse or parent’s work quarters, or credits, to meet the 40 qualifying work quarters requirement. Also revises and expands the Shawn Example to illustrate qualifying for an exemption from sponsor deeming due to work credits earned by a parent.
Adds a new subsection, ”SAVE and Sponsorship Information,” which adds material about using SAVE to request sponsorship information.
Modifies and expands the Maria Example under ”Sponsor Deeming Exclusions” to more specifically describe current policy.
Under ”Sponsor Verification,” adds information about steps to take if the sponsor fails to respond to the Sponsor Letter (DHS-3453).
Adds another item under ”Sponsor Deeming Changes” that should be acted on for the next available month: if the client qualifies as a battered noncitizen.
Updates to Community Spouse Definition
l Section 19.45 - Asset Assessments.
Updates the definition of ”community spouse” to match the new glossary definition.
Chapter 23 - Long-Term Care and Elderly Waiver
l Section 23.15 - Determining Community Spouse.
Adds the CAC, CADI, DD and TBI waivers to the last bullet in the subsection ”Community Spouse” to match the revised glossary definition.
Clarifies that a community spouse may be eligible for Minnesota Health Care Programs but may not receive MA payment of LTC services.
Modifies the last two bullets under ”No Community Spouse” to conform to the new definition.
l Section 23.40.30 - LTC Community Spouse Allocation.
Updates the third bullet in the introductory section to state that an allocation is not allowed for a spouse who receives services through the CAC, CADI, DD or TBI waivers.
Under ”Ending the Community Spouse Allocation,” changes the bullet ”The spouse enters an LTCF or begins receiving EW services” to ”The spouse enters an LTCF or begins receiving waiver services."
l A-F.
Updates the community spouse definition to state that people who receive services through the CAC, CADI, DD or TBI waivers are not community spouses.
l M-R.
Updates the definition of "qualifying work quarters" in conjunction with the updates to section 18.05, Sponsor Deeming.
l S-Z.
Updates the definition of "sponsor" in conjunction with the updates to section 18.05, Sponsor Deeming. Also adds the definition of ”U.S. nationals,” which was previously published in bulletin #06-21-09, ”Citizenship and Identity Documentation Requirements for Certain Minnesota Health Care Programs Applicants and Enrollees.”
Chapter 04 - Social Security Administration (SSA) Benefits
l Section 04.45.05 - MA/GAMC and Medicare Part D.
Under ”Benefit Change Notice,” changes two bullets to reflect current MMIS User Services Help Desk procedures. The MMIS User Services Help Desk sends the notice to the enrollee with a copy to the worker via interoffice mail, and enters a brief case note.
Chapter 13 - State and County Residence Requirements
l Section 13.05.15 - Adoption Assistance.
l Section 13.05.20 - Foster Care.
Changes the section names to ”Adoption Assistance - State Residence” and ”Foster Care - State Residence” to distinguish them from the same-named sections in chapter 3. There are no content changes to these sections.
l Section 19.10.05 - Self-Employment Excluded Assets.
Revises the first paragraph to clarify that this section applies only to self-employment assets, not to other self-support exclusions allowed under Method B.
Removes the definition section because the term ”capital asset” is not used in the section, and the term ”operating asset” is used only once with a glossary link to the definition.
Revises the Glenda and Carlos Examples under ”Types of Self-Employment Assets” to highlight the difference in how the assets are treated.
Replaces the third bullet under ”MA Method B and GAMC” with new language that clients must provide a statement identifying self-employment assets to be excluded.
Adds that a client must provide a statement to exempt self-employment assets that are not currently in use due to circumstances beyond the client’s control. Previously, a written statement was required only if the client requested to extend the exemption beyond one year due to disability.
l Section 19.10.10 - Self-Support Excluded Assets.
Clarifies in the first paragraph that self-employment is one type of self-support. Under ”MinnesotaCare, Method A and GHO,” clarifies that the self-employment exclusions are the only self-support provisions that apply to these programs.
Under "MA Method B and GAMC,” removes the initial paragraph because the information applies to self-employment assets and is covered in that section.
Replaces the link to the glossary definition of PASS plans with a link to What is PASS? in another section.
Adds a subheading for ”Personal Property Used to be Employed by Another” and adds that the client must provide a statement to exclude equipment used in employment.
Adds under ”Personal Property Used to be Employed by Another” and ”Non-Income Producing Self-Support Assets” that a client must provide a statement to exempt assets that are not currently in use due to circumstances beyond the client’s control. Previously, a written statement was required only if the client requested to extend the exemption beyond one year due to disability.
Makes minor text edits throughout the section and moves an example to more closely follow the bullet it illustrates.
Chapter 22 - Standards and Guidelines
l Section 22.30 - IRS Mileage Rate.
Adds a column for the lower rate used to reimburse clients and people with a vested interest for transportation costs under access service plans and for medical transportation costs used to meet a spenddown. The higher rate applies to self-employment, volunteer drivers and appeal reimbursement.
Chapter 30 - Other Related Programs
l Section 30.10 - Medical Needs.
Updates the section on HIV/AIDS programs with current information on those programs.