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500.20 Post-Eligibility for MinnesotaCare |
Effective: January 1, 2014 |
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500.20.05 MinnesotaCare Begin and End Dates |
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Eligibility, enrollment and coverage begin dates are separate concepts for MinnesotaCare.
Eligibility refers to when a person meets the program eligibility requirements.
Enrollment refers to when a person who has been determined eligible for MinnesotaCare pays an initial premium and enrolls in a managed care plan.
Coverage begin date refers to the date a person can receive covered services paid through MinnesotaCare.
An eligible person who enrolls in MinnesotaCare has coverage effective on the first day of the month following the month the premium payment is received, or following the month a determination of eligibility is made if the person is not subject to a premium payment. The full premium payment must be received by noon on the last working day of the month for eligibility to begin the first day of the following month. In order to begin coverage for family members subject to a premium payment, the full premium for all eligible family members must be paid by the deadline. Partial premium payments are accepted but coverage will not begin until the full household premium is paid.
In most cases, coverage ends for enrollees deemed ineligible at the end of the month following a 10-day advance notice of closure. In some situations, a 10-day advance notice is not required before closing coverage.
The coverage end date for households whose income exceeds 200% of federal poverty guidelines (FPG) is the last day of the month following the month the household is determined ineligible.
In order to maintain enrollment in MinnesotaCare, an eligible person must pay the monthly premium no later than noon on the last business day of the current month. If the premium is not paid by this date, the person is disenrolled from MinnesotaCare beginning the first day of the next month.
MinnesotaCare enrollees who are disenrolled for failure to pay a premium can reinstate coverage by paying the current month's and the next month’s premiums no later than the 20th day in the month of disenrollment. If the reinstatement amount is paid, MinnesotaCare coverage is reinstated back to the date coverage closed. Reinstated enrollees will receive health care services on a fee-for-service basis for any month they are not enrolled in a managed care plan.
People disenrolled for nonpayment may choose to resume coverage on the first day of the following month of disenrollment rather than reinstate coverage back to the date of closure. If a single payment is received, coverage is not reinstated, but will begin on the first day of the next available month.
Minnesota Statutes, section 256L