This manual letter lists new and revised material for the Health Care Programs Manual. Unless otherwise noted, new and revised instructions are effective November 1, 2008.
Eligibility Groups and Bases of Eligibility.
Several sections of Chapter 3 have been updated. Created a new section 03.05.10 - MinnesotaCare Major Program Eligibility Type (MPET).
Citizenship and Immigration Status.
Sections of Chapter 11 on Verification of U.S. citizenship and SAVE are updated.
Chapter 02 - Minnesota Health Care Programs.
Chapter 06 - Client Responsibilities.
Chapter 15 - Third Party Liability (TPL).
Chapter 18 - Deeming Income and Assets.
Glossary - A number of new terms have been added and revised.
Eligibility Groups and Bases of Eligibility
l Section 03 - Eligibility Groups and Bases of Eligibility.
n Revised to clarify the factors that affect an individual’s eligibility for MHCP.
n Deleted references to Medicare Savings Programs and waiver programs. Full information for those items are on the respective pages.
l Section 03.05 - MinnesotaCare Eligibility Groups.
The previous information in this section is replaced with new terminology for describing and defining the four MinnesotaCare eligibility groups. The four eligibility groups are: pregnant women, children under 21, adults with children, and adults without children.
l Section 03.05.05 - Change in MinnesotaCare Eligibility.
”Group” was deleted from the name of this section because it deals with all changes in MinnesotaCare eligibility. Other changes include the following:
n Explains how to redetermine eligibility when an enrollee reports a change between renewals.
n Provides a new definition for the term ”eligibility group”.
n Describes how changes in income, household size, parental status, and age affect eligibility.
n Removes reference to group status and shifts the focus from membership in Group One, Two, Three, or Four to an evaluation of eligibility based on a combination of the client’s eligibility group and household income.
l Section 03.05.10 - MinnesotaCare Major Program Eligibility Type (MPET) (New).
n This new section explains how to determine the major program and eligibility type for a MinnesotaCare applicant or enrollee.
n Adds definition of the term ”MPET”. ”MPET” is the combination of the major program and the eligibility type. MMIS uses the MPET to assign the correct benefit set and Federal Financial Participation (FFP) amount to each enrollee.
l Section 03.15 - Enrollee Becomes Pregnant.
Changes terminology for group status and MPET and provides links to Section 03.05.10.
l Section 03.20 - MinnesotaCare.
In this section and the sections listed below, the Eligibility Group subsection is renamed to MPET (Major Program Eligibility Type), a link is added to section 03.05.10 - MinnesotaCare Major Program Eligibility Type (MPET), and wording changes add clarity and incorporate changes made in previous sections on the MPET terminology.
n Section 03.20.05 - MinnesotaCare for Pregnant Women.
n Section 03.20.10 - MinnesotaCare for Auto Newborns.
n Section 03.20.15 - MinnesotaCare for Children Under 21.
n Section 03.20.20 - MinnesotaCare for Adults With Children.
n Section 03.20.25 - MinnesotaCare for Adults Without Children.
Citizenship and Immigration Status
l Section 11.05 - Verification of U.S. Citizenship.
Clarifies that eligibility cannot be approved until acceptable documentation of citizenship and identity is received. All information about acceptable documentation is in Section 11.05.05.
l Section 11.10.05 - Systematic Alien Verification for Entitlements (SAVE).
n Clarifies not to use SAVE for undocumented or nonimmigrant pregnant women applying for NMED or emergency medical assistance (EMA).
n Adds instructions for using SAVE to obtain sponsorship information and links to 18.05 - Sponsor Verification process.
Chapter 02 - Minnesota Health Care Programs (MHCP)
n Section 02.05 - Hierarchy of Major Programs.
Removes information on the MinnesotaCare major programs. This information is detailed in 03.05.10 - Major Program Eligibility Type (MPET). The focus of Section 02.05 is on the three primary Minnesota Health Care Programs: MinnesotaCare, Medical Assistance, and General Assistance Medical Care.
Chapter 06 - Client Responsibilities
n Section 06.05 - Cooperation.
m Clarifies that clients must cooperate with Medicaid Eligibility Quality Control (MEQC), Payment Error Rate Measurement (PERM) and MinnesotaCare quality reviews as a condition of eligibility. Adds information for how clients claim good cause and eligibility at reapplication.
m Reference to ”other health insurance” are changed to ”other health care coverage” to include any other type of health care coverage or other third party liability.
n Section 07.20.50 - Program Overlap.
Deletes note that refers to group status; provides links to Section 03.05.10.
n Section 08.05 - Renewal Exemptions.
Explains that Refugee Medical Assistance (RMA) enrollees are exempt from six-month renewals.
Chapter 15 - Third Party Liability (TPL)
n Section 15.05 - MinnesotaCare Insurance Barriers.
Clarifies that children under age 21 with income less than 150% FPG and children under age 21 who meet the Children’s Health Plan exception are not subject to MinnesotaCare insurance barriers.
n Section 15.05.15 - Underinsured.
Clarifies that children under age 21 with income less than 150% FPG and children under age 21 who meet the Children’s Health Plan exception may keep other health care and enroll in MinnesotaCare, regardless if the insurance is determined to be ESI.
Chapter 18 - Deeming Income and Assets
n Section 18.05 - Sponsor Deeming.
m Removes definitions from the section; they are available through links to the glossary.
m Removes SAVE and Sponsorship subsection and incorporates it in the Sponsor Verification Process subsection and Section 11.10.05 - Systematic Alien Verification for Entitlements (SAVE).
m Adds instructions to the Sponsor Verification Process subsection for workers to use when requesting sponsor information. The instructions explain what to do when a client is unable to provide a copy of their affidavit of support.
m Adds death of the sponsor or sponsored noncitizen to the changes that may impact eligibility.
n Section 19.25.35 - Trusts.
Clarifies that transfers into a pooled trust by a person age 65 or over must be evaluated for a possible improper transfer.
n Section 19.40.05 - Transfer Penalty Exceptions.
Adds clarifying language to the transfer penalty exception for putting assets into a non-excluded irrevocable trust created after July 1, 2005.
n M - R.
The following terms have been added or revised in this section of the glossary:
m Major Program Eligibility Type (MPET) - new term added.
m Qualifying Work Quarter - revised definition.
m Real Property - revised definition.
n S - Z.
The following term has been added or revised in this section of the glossary:
m Underinsured - revised definition.