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300.10.10 Financial Eligibility for Medical Assistance for Families With Children and Adults |
Effective: January 1, 2014 |
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300.10.10.05 Income Standards for Medical Assistance for Families With Children and Adults |
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Minnesota’s Insurance Affordability Programs (IAPs) consider income in determining eligibility, benefit set, spenddown and premium amounts. To be eligible for most programs a person’s income must be less than or equal to the appropriate income standard. Income standards and calculations vary by program and by a person’s basis of eligibility. Income standards are based on federal poverty guidelines.
Federal poverty guidelines (FPG) are issued by the U.S. Department of Health and Human Services (HHS) each July.
These guidelines determine income eligibility for IAPs. A person’s applicable income standard is based on many factors, including, but not limited to:
The basis of eligibility for Medical Assistance (MA)
The number of people included in the household size
Whether the person has a medical spenddown for MA
The following income standards determine eligibility for MA for Families with Children and Adults:
Pregnant women: less than or equal to 278% FPG
Infants under 2: less than or equal to 283% FPG
Children 2 through 18: less than or equal to 275% FPG
Children 19 through 20: less than or equal to133% FPG
Parent and caretaker relatives: less than or equal to 133% FPG
Adults without children: less than or equal to 133% FPG
There are circumstances in which people with income greater than their MA income standard may still qualify for the program if they meet an exception. People who meet the following exceptions are eligible for MA if they meet all other eligibility requirements.
An additional 5% FPG disregard is applied to the actual FPG percentage of pregnant women, infants, children younger than age 21, parents and relative caretakers, and adults without children when the applicant's income standard and the 5% FPG disregard allow the person to qualify for MA for Families with Children and Adults.
In certain situations, a person’s income may be greater than his or her income standard for MA for Families with Children and Adults and be less than MinnesotaCare, resulting in ineligibility for both programs. This may occur when:
a lump sum is counted in the month received under the MAGI-based income methodology, making a person ineligible for MA for that month; however, it is counted over a 12-month period using the MAGI income methodology making the person ineligible for MinnesotaCare.
sponsor income is counted in the household income using the MAGI-based income methodology, making a person ineligible for MA; however, sponsor income is excluded using the MAGI income methodology, making the person ineligible for MinnesotaCare.
a child under the age of 19 has income greater than 275% FPG using the MAGI-based income methodology, and has income less than 100% FPG using the MAGI income methodology; making the child ineligible for MA and MinnesotaCare.
To prevent any inadvertent gaps in coverage that may result from the situations described above, an exception exists which allows a person to be eligible for MA. When these situations arise, the person's income is recalculated using the MAGI income methodology, and then compared to the applicable MA income standard. If the person's income is within the applicable MA income standard, he or she is eligible for MA.
Medical Assistance for Families with Children and Adults Income Methodology
Minnesota Health Care Programs Income and Asset Guidelines DHS-3461A
Minnesota Statutes, section 256B.056
Code of Federal Regulations, title 42, section 150.350
Code of Federal Regulations, title 42, section 155.305
Code of Federal Regulations, title 42, section 435.603
Code of Federal Regulations, title 42, section 435.100
Code of Federal Regulations, title 42, section 435.116
Code of Federal Regulations, title 42, section 435.118
Code of Federal Regulations, title 42, section 435.119
Federal Register, Vol. 78, No. 16, (January 24, 2013), page 5183