Medical Assistance

2.1.1.2.4 Referral for Other Benefits

As of February 2025, Medical Assistance (MA) enrollees are no longer required to apply for, or attempt to obtain, income benefits as a condition of eligibility.

Social Security benefits

Generally, MA enrollees do not need to apply for Social Security retirement or other retirement benefits to maintain MA eligibility. Applicants or enrollees seeking MA under the Medical Assistance for People Who Are Blind or Have a Disability basis of eligibility who do not have a disability certification from the Social Security Administration (SSA) must apply for Social Security disability benefits in order to be certified disabled by the SSA. This requirement applies even if the applicant or enrollee has a current disability certification from the State Medical Review Team (SMRT). Enrollees must apply within 30 days of when the county, tribal or state servicing agency notifies them of their potential eligibility, unless they can show good cause for not doing so . Good cause is determined on a case-by-case basis by the tribal, county, or state servicing agency.

MA under the TEFRA Option applicants or enrollees are not required to apply for Social Security disability benefits.

Retirement Survivors Disability Insurance

SSA administers Retirement, Survivors and Disability Insurance (RSDI) benefits. RSDI provides a monthly income based on payroll contributions made via Social Security taxes.

The following people, if qualified under a Social Security number having at least 40 work quarters, may be eligible for RSDI:

Retired people who meet SSA age requirements
People certified disabled by SSA
Dependents of a wage earner who is disabled or retired
Dependent survivors of a wage earner who has died

People who are eligible for RSDI may also be eligible for Supplemental Security Income (SSI) if their RSDI payment is less than the SSI income standard.

Supplemental Security Income

SSI is a federal supplemental income program operated by SSA and funded by general tax revenues. It provides monthly cash payments to people aged 65 or older and people certified disabled by SSA, who have little or no income, to help them meet basic needs for food, clothing and shelter. MA enrollees who may be eligible for SSI do not need to apply to continue MA eligibility, unless they need and do not have a current disability determination from SSA.

Medicare

Enrollees who are potentially eligible for Medicare must still apply to maintain MA eligibility. MA will not pay for Medicare-covered services for people who are eligible for, but do not enroll in Medicare Part A without a premium. To be eligible for premium-free Part A on the basis of age, MA enrollees must be age 65 or older.

MA enrollees may be eligible for Medicare under a different basis if they meet one of the following:

Citizens and qualifying non-citizens age 65 or older who pay a Medicare Part A premium
People certified disabled by the SSA receiving RSDI or Railroad Retirement Benefits (RRB) for at least 24 months
Widows or widowers and divorced widows and widowers with a certified disability by SSA and who have been receiving RSDI or RRB benefits for at least 24 months
People with Amyotrophic Lateral Sclerosis (ALS) (Lou Gehrig’s Disease) are entitled to Part A the first month they are entitled to Social Security or RRB benefits with no waiting period
People with End-Stage Renal Disease (ESRD) defined as permanent kidney failure requiring dialysis or a kidney transplant

DHS previously evaluated Medicare premiums for cost-effectiveness, but Medicare premiums are no longer evaluated for cost-effectiveness. People whose premiums were evaluated under the previous policy and determined not cost-effective have good cause for not meeting the requirement to enroll in Medicare if eligible.

Medicare Part A

Medicare Part A is federal hospitalization insurance. People who are eligible for premium-free Medicare Part A may not refuse to apply or turn down this coverage to gain or continue MinnesotaCare or Advance Premium Tax Credit (APTC) eligibility.

Medicare Part B

Medicare Part B is medical insurance. There is a monthly premium for Part B. MA enrollees must apply and maintain Medicare Part B coverage, even if they are required to pay a premium. Medicare Savings Programs (MSP), the Medicare Buy-In and MA-EPD can help eligible clients with premiums and other costs. People who are in an Institution for Mental Diseases (IMD) may also receive help paying for premiums and other costs. People have a wide variety of Medicare-approved plans from which to choose.

MA enrollees enrolled in Medicare Part A are not required to enroll in Medicare Part B or enroll in an MSP if they have primary coverage under an employer group health insurance plan through:

Their own current employment or their spouse's current employment
A parent's current employment where the enrolee is a disabled child (of any age).

Medicare Part D

Medicare Part D is prescription drug coverage. Enrollment in Medicare Part D is not required as a condition of MA eligibility. However, there are specific rules established for clients eligible for Medicare Part D who fail or refuse to enroll in, or opt out of, that program. MA cannot pay any prescription drug costs for eligible Part D beneficiaries regardless of whether or not they are enrolled in Medicare Part D. However, prescription drug bills that are not covered by Medicare can be used to meet a medical spenddown.

Medicare eligible MA and MSP enrollees qualify for a full Extra Help subsidy automatically and must select a Medicare Part D benchmark plan. Medicare beneficiaries of all ages can get free assistance with selecting a Part D plan by calling the Minnesota Aging Pathways at (800) 333-2433.

Railroad Retirement Benefits

The federal Railroad Retirement Board (RRB) administers railroad retirement benefits and Medicare for railroad workers and their families. People who work for a railroad have railroad retirement withheld from their earnings instead of Social Security. If a person has earned enough Social Security credits to receive Social Security benefits as well as railroad retirement benefits, the beneficiary receives the larger of the two.

Retiree benefit amounts are based on the number of years of service. Railroad workers who meet certain service requirements are eligible for:

Retiree benefits
Disability benefits
Dependent benefits for spouses, ex-spouses, and children who meet certain criteria, and
Survivor benefits

RRB eligible MA enrollees at full retirement age must apply for benefits. The railroad worker’s family members must also apply for potential benefits if the railroad worker is currently receiving RRB benefits or was receiving or eligible to receive benefits but is now deceased. People turning age 65 who are receiving railroad retirement benefits must apply for Medicare through the RRB.

Financial Needs

Enrollees, potentially eligible for the following benefits, must apply to maintain MA eligibility.

Minnesota Unemployment Insurance (UI) benefits provide a temporary partial wage replacement to workers who become unemployed through no fault of their own.

Workers’ Compensation provides benefits for people injured or ill from their job.

MA enrollees who are veterans or a spouse of a veteran, using the People Aged 65 or Older, Blind or Disabled basis, living in a long-term care facility, must apply for the federal Veterans’ Aid and Attendance program through the U.S. Department of Veterans Affairs (USDVA).

Exceptions

Enrollees are not required to reapply for benefits that were previously denied unless there has been a change in circumstances or eligibility requirements of the benefit program.

Legal Citations

Code of Federal Regulations, title 42, section 435.608