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, 2008.
Eligibility Groups and Bases of Eligibility.
Several sections of Chapter 3 have been updated.
Clarification in Chapter 7 regarding authorized representatives and eligibility begin dates.
Chapter 15 changes include additional information about TPL and other health care coverage.
Several sections of Chapter 19 have been revised to provide more information about types, availability and verification of liquid assets, reducing assets, and to simplify and clarify policy related to promissory notes, contracts for deed and other property agreements.
MA Payment of Long-Term Care (LTC) Services.
Extensive revisions have been made to Chapter 23, including renaming the chapter, to clarify and provide more comprehensive information about long-term care policies.
Chapter 4 - Social Security Administration (SSA).
Chapter 11 - Citizenship and Immigration Status.
Chapter 13 - State and County Residence.
Glossary - A number of terms have been added and revised.
Eligibility Groups and Bases of Eligibility
l Section 03.25.05 - MA for Pregnant Women.
Adds two types of other health insurance to the Citizenship/Immigration Status subsection: TRICARE (CHAMPUS) and Veteran’s Affairs policy. Pregnant noncitizens who are ineligible for federal funding and who have these types of insurance are not eligible for SCHIP-funded MA.
l Section 03.45.30 - MA for Breast/Cervical Cancer.
Adds exceptions to the insurance barrier that prevents women who have creditable coverage from using the MA-BC basis of eligibility.
l Section 03.50.15 - Legal Factors for GAMC.
n There are significant revisions throughout this section to clarify when people are ineligible for GAMC due to criminal activities. This section explains how to collect information about criminal activities and under what circumstances these criminal activities will make an applicant ineligible for GAMC. Receipt of SSI or RSDI that ended after March 29, 1996, because of drug addiction and alcoholism (DA&A) is no longer a barrier to GAMC enrollment.
n Required Questions for GAMC (DHS-3423) is revised according to the changes in this section and is posted to eDocs.
l Section 07.15.10 - Authorized Representatives.
n Clarifies the roles and responsibilities of an Authorized Representative (AREP), who can and cannot be an AREP, how an AREP is designated, and how long the AREP designation lasts.
n Explains when to accept a designation of Power of Attorney in place of an AREP designation and that the Power of Attorney must specify that the person may represent the applicant or enrollee in the health care application or eligibility process.
l Section 07.20.25 - Eligibility Begin Date.
n Clarifies that people do not have to be eligible in the month of application, but can have eligibility begin later if they meet all eligibility factors by the end of the processing period.
n Adds information that applications must be processed prior to a person’s move to Minnesota if the person is elderly or disabled and cannot live outside of an institution. This is so eligibility can begin on the day he or she moves into the institution.
Third Party Liability (formerly Insurance and Third Party Liability)
l Chapter 15 - Third Party Liability (TPL).
n The title of this section was previously Insurance and Third Party Liability.
n Updates the definition of Third Party Liability (TPL), how TPL affects health care eligibility, clarifies that people must cooperate with identifying potential sources of TPL, and that people must assign their rights to TPL to DHS as a condition of eligibility.
n Information about other health care coverage and newborns moved to section 15.10 - MA and GAMC and Other Health Coverage.
n Adds list of programs that are not considered TPL.
l Section 15.10 - Other Health Care Coverage - MA and GAMC.
n The title of this section was previously MA and GAMC Types of Other Insurance Coverage.
n Clarifies that MA and GAMC do not have insurance barriers to eligibility, but there are certain requirements that must be met for a client to be eligible while concurrently having other health care coverage.
n Updates the list of Other Health Care Coverage and explains how other health care coverage interacts with Newborns, and LTC Insurance.
n Wording changes made throughout this section for clarification.
l Section 15.10.05 - Cost Effective Health Care Coverage - MA and GAMC.
n The title of this section was previously MA and GAMC Cost Effective Insurance.
n Clarifies that MA and GAMC clients are required to maintain or enroll in other health care coverage if it is determined to be cost effective.
n Adds subsection that describes the Special Enrollment Period offered by some employers with group health care coverage.
l Section 15.15 - Non-Health Care Coverage Third Party Liability (TPL).
n The title of this section was previously Third-Party Liability (TPL).
n This section provides examples of TPL that are not health care coverage.
n Clarifies that Non-Health Care Coverage TPL is not an insurance barrier to MinnesotaCare eligibility. However, as a condition of eligibility, people must cooperate with providing TPL information to Benefit Recovery.
n Wording changes and clarifications added throughout this section.
l Section 19.25.05 - Liquid Assets.
n The title of this section was previously Cash, Accounts, Securities.
n The content of this section has been completely revised. This section now discusses types and availability of liquid assets.
l Section 19.25.20 - Promissory Notes, Contracts for Deed and other Property Agreements.
n The title of this section was previously Contracts for Deed and Property Agreements.
n This section has been revised to provide policies that apply to promissory notes, in addition to contracts for deed and other property agreements.
n Significant revisions and clarifications are made throughout this section.
l Section 19.35 - Excess Assets.
n This section is condensed to refer readers instead to sections with policy relating to the specific health care program.
n Clarifies that clients who have excess assets may their reduce assets in order to qualify for health care.
l Section 19.35.10 - MA and GAMC Excess Assets.
n Formatting and wording changes have been made throughout this section.
n Clarifies that applicants must receive notice that informs them they have excess assets, and must reduce assets before the end of the processing period to be eligible.
n Lists types of verifications clients can submit as proof they reduced their assets.
MA Payment of Long Term Care (LTC) Services
Significant revisions have been made to most of Chapter 23. Many sections are archived as information was reorganized and moved into other sections. The remaining revised sections are renumbered for consistency, with explanations provided on the archived pages.
l Chapter 23 - MA Payment of Long-Term Care (LTC) Services.
n This chapter is renamed from Long-Term (LTC) and Elderly Waiver (EW) Services and explains the eligibility requirements for people who apply for or receive MA payment of LTC Services. The name has been changed to encompass the eligibility requirements for Home and Community-Based Disability Waivers, including CAC, CADI, TBI and DD.
n Clarifies that people who meet eligibility criteria for MA payment of LTC services may be obligated to contribute income towards the cost of LTC services they receive and the amount of their contribution is based either on a LTC income or community income calculation. These calculations determine if a person has a LTC spenddown, a medical spenddown, a combination LTC/medical spenddown or a waiver obligation.
n Adds definition of LTC services.
n Adds information about specific eligibility requirements in order for MA to pay for LTC services and links to the areas of the manual that expand on that criteria, including home equity, treatment of annuities and transfer penalties.
n Removes the list of LTC forms from this section. Forms are linked where appropriate when discussed in relation to eligibility.
n Removes overview of EW. EW is covered in HCPM 03.40.25, Elderly Waiver (EW).
l Section 23.05 - Long-Term Care Consultation (LTCC).
Formerly 23.20 - The name of this section remains the same with some rewording and additional information provided.
l Section 23.10 - Determining Which Income Calculation to Use.
n Formerly 23.25 - Choosing Appropriate Income Calculation.
n This section provides information to determine if a community income calculation or a LTC income calculation is used to calculate the amount a person must contribute toward the cost of LTC services.
n An explanation of the Special Income Standard (SIS) for the EW program is added.
l Section 23.15 - LTC Income Calculation.
n Formerly 23.40.
n The focus on this page is now when to begin and end the LTC Income Calculation and how to determine retroactive eligibility prior to receipt of LTC services.
l Section 23.15.05 - LTC Countable Gross Income Determination.
n Formerly 23.40.05 – LTC Income.
n The name was changed to be more descriptive and includes the information needed to determine countable gross income in the LTC income calculation.
l Section 23.15.10 - Deductions from LTC Countable Gross Income.
n Formerly 23.40.15 - LTC Medicare Premiums.
n This new section provides information on the application of all allowable deductions and clarifies the order in which they must be applied in the LTC income calculation. This information was previously in several sections of Chapter 23, which have now been archived.
n Incorporates bulletin #08-21-09, Revised Criteria for Home Maintenance Needs Allowance Deduction in Medical Assistance (MN) Long-Term Care Facility Income Calculation.
l Section 23.15.10.05 - Community Spouse Allocation.
n Formerly 23.40.30 - LTC Community Spouse Allocation.
n Lists the specific steps to take for calculating the Community Spouse allocation.
n Clarifies when not to deduct to the community spouse allocation.
l Section 23.15.10.10 - Family Allocations.
n Formerly 23.40.40 - LTC Family Allocations.
n This section lists specific steps for the family allocation calculation.
l Section 23.20 - LTC Spenddowns and Waiver Obligations.
n Formerly 23.45.
n This section was expanded to include information about LTC spenddowns, waiver obligations, and combination LTC/medical spenddowns, as well as interaction with Medicare Part A payments.
Archived Chapter 23 sections
The following sections of Chapter 23 are archived as of October 1, 2008. Policy Information from these sections is covered in other sections of the HCPM as noted:
n Section 23.05 - Elderly Waiver.
Elderly Waiver is explained in 03.40.25 - Elderly Waiver (EW).
m Special Income Standard (SIS) EW information from this section was folded into 23.10 - Determining Which Income Calculation to Use.
n Section 23.10 - Continuous LTC-EW Period.
Continuous LTC-EW Period is explained in:
m 19.45 - Asset Assessments.
m Glossary definition for Continuous LTC/EW Period.
n Section 23.15 - Determining Community Spouse.
A Community Spouse is defined and explained in:
m 19.45 - Asset Assessments.
m 19.45.05 - Asset Assessment Determination.
m 19.45.10 - Spousal Asset Determination.
m 23.10 - Determining Which Income Calculation to Use.
m Glossary definitions for Community Spouse and LTC Spouse.
n Section 23.30 - Beginning or Ending LTC Income Calculation.
Beginning or ending LTC income calculation is explained in:
m 23.10 - Determining Which Income Calculation to Use.
m 23.15 - LTC Income Calculation.
n Section 23.30.05 - LTCF/SIS-EW No Community Spouse.
Determining eligibility for LTCF or SIS EW with no community spouse is explained in:
m 23.10 - Determining Which Income Calculation to Use.
m 23.15 - LTC Income Calculation.
n Section 23.30.10 - LTCF, EW With Community Spouse.
Determining eligibility for LTCF or EW with a community spouse is explained in:
m 23.10 - Determining Which Income Calculation to Use.
m 23.15 - LTC Income Calculation.
n Section 23.35 - LTC/EW Household Size.
Household Size is explained in:
m 17.05.05 - Exceptions to MA/GAMC Household Size.
m 23.10 - Determining Which Income Calculation to Use.
n Section 23.40.10 - LTC Excluded Income.
Excluded Income is covered in:
m 23.15.05 - LTC Countable Gross Income Determination.
m 20.05 - Excluded Income.
n Section 23.40.20 - LTC Needs Allowance.
Applying LTC needs allowances - including clothing and personal needs, veteran’s improved pension, home maintenance needs, and SIS-EW Maintenance needs are covered in:
m 23.15.10 - Deductions from LTC Countable Gross Income.
n Section 23.40.25 - LTC Guardianship Fees.
Guardianship Fees are covered in:
m 23.15.10 - Deductions from LTC Countable Gross Income.
n Section 23.40.30.05 - Allocation Allowances.
Community spouse and family allocations are covered in:
m 23.15.10 - Deductions from LTC Countable Gross Income.
n Section 23.40.30.10 - Community Spouse Allocation Example.
Community Spouse allocation examples are included in:
m 23.15.10 - Deductions from LTC Countable Gross Income.
n Section 23.40.35 - LTC Court-Ordered Child Support.
Court-ordered child support deductions are covered in:
m 23.15.10 - Deductions from LTC Countable Gross Income.
n Section 23.40.45 - Health Insurance Premium Deduction for Long-Term Care (LTC).
Health insurance premium deductions, including dental and LTC insurance, are covered in:
m 23.15.10 - Deductions from LTC Countable Gross Income.
n Section 23.40.50 - LTC Medical Expense Deduction.
Medical expense deductions, including co-payments and remedial care expense, are covered in:
m 23.15.10 - Deductions from LTC Countable Gross Income.
n Section 23.40.55 - LTC SSI Deduction.
Special SSI deduction is covered in:
m 23.15.10 - Deductions from LTC Countable Gross Income.
n Section 23.45.05 - Long-Term Care Spenddowns.
LTC Spenddown information is covered in:
m 23.20 - LTC Spenddowns and Waiver Obligations.
n Section 23.45.10 - Waiver Obligations.
Waiver obligations are covered in:
m 23.20 - LTC Spenddowns and Waiver Obligations.
n Section 23.45.15 - Combination LTC/Medical Spenddowns.
Combination LTC/Medical Spenddowns are covered in:
m 23.20 - LTC Spenddowns and Waiver Obligations.
n Section 23.45.20 - Designated Provider Option - LTC/EW.
Designated provider option is covered in:
m 23.20 - LTC Spenddowns and Waiver Obligations.
m 24.10.05.10 - Designated Provider.
n Section 23.50 - LTC, EW and Assets.
m Information about calculating asset eligibility and excess assets formerly included in this section is covered in Chapter 19 - Assets.
m Information about Lump Sums that was provided in this section is covered in 20.25.10 – Lump Sum Income.
n Section 23.55 - LTC, EW and Transfers.
Transfers are covered in 19.40 - Transfers.
Chapter 04 - Social Security Administration (SSA)
n Section 04.15 - Supplemental Security Income (SSI).
m Revises and updates eligibility criteria for SSI.
m Adds statement to clarify that SSI payments for people expected to reside in a medical institution for a full calendar month or more are usually reduced to $30 a month except in certain circumstances.
m The 1619 (a) and 1619 (b) Social Security Status subsection is revised to delineate the differences between 1619 (a) and 1619 (b) more clearly.
m Clarifies that although SSI recipients have a basis of eligibility for MA, they are not automatically eligible for MA and a separate eligibility determination is required.
m Wording changes and clarification added throughout section.
Chapter 11 - Citizenship and Immigration Status
n Section 11.05.05 - Acceptable Documentation of U.S. Citizenship and Identity.
m Clarifies the citizenship documentation hierarchy process. Stresses that it is important to progress through the documentation hierarchy as quickly as possible and not delay eligibility, if the client is cooperating.
m Adds detailed explanation of when to accept Affidavits as proof of U.S. Citizenship, and clarifies the process for requesting proof of citizenship from clients who are born or were previously enrolled in MA in another state.
Chapter 13 - State and County Residence
n Section 13.05 - State Residence for MA/MinnesotaCare Families.
Note added to the Moving to Minnesota – MA subsection that informs agencies to process a person’s application prior to them moving to Minnesota if the person is elderly or disabled and cannot live outside of an institution.
n Section 20.35 is being archived.
n A - F.
The following terms have been added or revised in this section of the glossary:
m Certificate of Deposit (CD) - new term added.
m Combination LTC/Medical Spenddown - new term added.
m Community Spouse - clarifies that a spouse who is separated from an LTC client is still a community spouse.
m Cost-Effective Coverage - new term added.
m Cost-Sharing - A spenddown is not considered cost-sharing so this was deleted from the definition.
n G - L.
The following terms have been added or revised in this section of the glossary:
m Group Health Care Coverage - new term added.
m Guardianship Account - new term added.
m Individual Health Care Coverage - new term added.
m Liquid Assets - revised definition.
m Long-Term Care Facility (LTCF) - revised definition to more specifically identify facilities considered LTCF.
m Long-Term Care (LTC) Services - new term added to identify eligible services.
m Long-Term Care (LTC) Spenddown - new term added for clarification.
n M - R.
The following terms have been added or revised in this section of the glossary:
m Medical Spenddown - new term added for clarification.
m Other Health Care Coverage - new term added for better understanding of other coverage.
m Payer of Last Resort - new term added for clarification.
m Power of Attorney - revised, more specific definition.
m Promissory Note - expanded definition for clarity.
m Property Agreement - new term added.
m Reverse Mortgage - new term added.
n S - Z.
The following terms have been added or revised in this section of the glossary:
m Spenddown - revised definition deletes reference to cost-sharing because this does not have the same meaning and adds types of spenddowns.
m Time Deposits - new term added.