Medical Assistance

2.1.1.2.1.3.2 Medical Support

The Medical Assistance (MA) program requires parents or relative caretakers to help provide health care for their children. When both parents live with the child, this requirement is generally met by deeming the parents’ income to the child. When one parent does not live with the child, a referral for medical support may be required.

Medical support is health insurance coverage or cash payments that a parent, who is not living with the child, provides or is court-ordered to provide to meet the medical needs of their child. For MA eligibility, the parent or relative caretaker who lives with the child is required to cooperate with medical support referral requirements for children younger than age 19 on MA.

Assignment of Rights and Cooperation

A parent or relative caretaker assigns the child’s right to medical support by signing a paper or online health care application or renewal form.

County, tribal or state servicing agencies are required to mail a medical support referral packet to the parent or relative caretaker. The MA enrolled parent or relative caretaker must return the form within 30 days of the date on the referral packet. Regardless of whether the forms are returned or not, the county, tribal or state servicing agency must initiate a referral to the county or tribal child support agency, also called the IV-D agency.

For medical support, cooperation may include:

Establishing paternity
Establishing an order for medical support, or enforcing an existing order
Providing information about non-custodial parents
Forwarding any medical support payments received directly from the non-custodial parent to the Department of Human Services (DHS)

A pregnant person, or a parent or relative caretaker who is pregnant, is not required to cooperate with medical support for the child she is expecting or for any other child during pregnancy or during the 12 month postpartum period.

Non-Cooperation

The county or tribal child support office determines non-cooperation with medical support requirements and notifies the county, tribal or state servicing agency. The parent or relative caretaker’s MA coverage is closed with 10-day notice.

If MA is closed for non-cooperation, MA coverage cannot be reopened until the parent or relative caretaker cooperates with medical support requirements. If the parent or relative caretaker cooperates, MA may reopen the first day of the month in which cooperation occurs.

The MA coverage of a child, or of anyone without the legal ability to assign rights, is not impacted by non-cooperation with medical support requirements, such as the non-cooperation of a parent or relative caretaker.

Good Cause

A parent or relative caretaker may ask to be exempt from cooperating with child support as part of the medical support requirements when they believe cooperating could reasonably result in physical or emotional harm to the parent, relative caretaker, or child, or would otherwise be detrimental to the child. This is called “claiming good cause.” A parent or relative caretaker can claim good cause at any time by completing and submitting the Client Statement of Good Cause on the Cooperation with Child Support form (DHS-2338). Parents and relative caretakers who are referred to medical support must be notified in writing of their right to claim good cause. Information about good cause is included in the medical support referral packet sent to parents and relative caretakers who are referred to medical support. A person with an active good cause claim, including someone who is awaiting the good cause committee’s decision, is cooperating with medical support requirements. When a participant of the Safe at Home program (SAH) requests good cause, the good cause committee must review and officially approve the request without requiring additional information. A person may withdraw a claim of good cause at any time in the process.

Each county has a good cause committee that reviews good cause requests. The committee includes representatives from: the Minnesota Family Investment Program (MFIP), Medical Assistance, child support, and Child Care Assistance Program (CCAP). If a person claiming good cause is also a recipient of Tribal Temporary Assistance for Needy Families (Tribal TANF), the county's good cause committee and the Tribal TANF Agency make a joint decision regarding good cause claims, and the Tribal TANF agency’s decision must prevail. Upon request, the good cause committee must assist the person in gathering any evidence requested.

Good cause claims must be redetermined by the good cause committee annually. If a household with an approved good cause claim moves to another county, the review date for the good cause exemption remains one year from the date it was approved by the good cause committee at the original agency.

The county must share the evidence between agencies upon request from the parent or relative caretaker.

A person whose good cause claim is denied has the right to appeal the decision. See EPM 1.3.1.1 for more information about appeals. A person who has submitted a request for appeal of the good cause committee’s decision or who is awaiting the outcome of their appeal is cooperating with medical support requirements. A person whose good cause claim is denied and does not appeal, or does appeal but the appeal is denied, must begin to cooperate with child support to satisfy MA medical support requirements.

When Medical Support Referrals are Made

A medical support referral is made when a child younger than age 19 resides with one parent or a relative caretaker, both the child and the parent or relative caretaker are eligible for MA, and none of the Referral Not Required criteria below applies.

Referral Not Required

A medical support referral is not made in any of the following circumstances:

One parent in a two-parent household has a temporary absence. Refer to Section 1.4.4 Minnesota Health Care Programs Temporary Absence for more information.
Only a child, and not a parent or relative caretaker, is enrolled in MA.
The parent is deceased.
The parent or relative caretaker is pregnant or in the 12 month postpartum period.
The parent is a minor child under age 18 or is an emancipated minor.
The child receives Northstar Adoption Assistance.
The child receives Northstar Foster Care or Kinship Assistance.
A parent is involuntarily out of the household because he or she is being detained by U.S. Immigration and Customs Enforcement (ICE) or is waiting for immigration authorization from U.S. Citizenship and Immigration Services (USCIS) from outside of the United States.

Voluntary Referral

A parent or relative caretaker may request voluntary medical support or child support referral services from the county or tribal IV-D agency when a referral for MA eligibility purposes is not required. The county or tribal IV-D agencies can assist people in getting the medical or child support referral services.

Legal Citations

Code of Federal Regulations, title 42, section 433.145

Code of Federal Regulations, title 42, section 433.146

Code of Federal Regulations, title 42, section 433.147

Code of Federal Regulations, title 42, section 433.148

Code of Federal Regulations, title 42, section 435.610

Minnesota Statutes, section 256.741

Minnesota Statutes, section 256B.056, subdivisions 6 and 8