Medical Assistance

2.1.4.1 Begin and End Dates

Overview

Medical Assistance (MA) eligibility and coverage are separate concepts:

Eligibility refers to when a person meets the MA eligibility rules.
Coverage refers to when a person can receive MA benefits.

MA begin and end date policy also applies to Medicare Savings Programs (MSP) and the Minnesota Family Planning Program (MFPP).

Generally, MA eligibility and coverage begin and end dates are the same. However, there are situations where eligibility and coverage do not begin or end on the same day. Differences are explained on the policy pages for the types of MA listed below. The eligibility and coverage begin and end dates may not be the same in the following situations:

When an MA enrollee received coverage for a month they were not eligible for MA, an overpayment may exist. See the MHCP Overpayment policy for more information.

Eligibility Begin Date

MA eligibility begins the first day of the month that a person meets the program eligibility rules. It can begin no earlier than the first day of the month of application, if a person does not request retroactive coverage or is not eligible for retroactive coverage. Retroactive coverage can begin no earlier than the first day of the month, three months before the month of application. People must meet all eligibility requirements in each retroactive month to have coverage in that month, and people may be eligible for some but not all months prior to the month of application.

If a request for an eligibility determination does not require a new application, the month the request for coverage is received is the application month.

When an enrollee is eligible under a new basis, eligibility begins the first day of the month the required supplemental form is submitted. See EPM section 1.3.2.1 MHCP Change in Circumstances for more information.

Generally, people who meet all eligibility requirements at any time during a month are eligible for the entire month. The exceptions are:

When a person is born, eligibility can begin no earlier than the date the person was born.
When a person moves to Minnesota, eligibility can begin no earlier than the date the person became a Minnesota resident.
When a person is approved for a spenddown, eligibility begins the date the person meets their spenddown.

Coverage Begin Date

MA coverage begins the same date MA eligibility begins.

Eligibility End Date

When an MA enrollee reports a change in circumstances that results in the loss of MA eligibility, the MA eligibility generally ends on the last day of the month in which the change occurred. The exceptions are:

When an MA enrollee dies, eligibility ends the date the person died.
When the change occurred too late in the month to send a 10-day advance notice, MA eligibility ends the last day of the month following the month in which the change occurred.
When an MA enrollee reports a change in circumstance that maintains MA eligibility but results in a beneficial or adverse action, the existing MA eligibility ends the day before the new eligibility begins.
Eligibility ends, with a 10 day advance notice, if the enrollee fails to provide the requested supplemental form and any additional information required to complete a redetermination for all possible programs within the required time frame. See EPM section 1.3.2.1 Change in Circumstances for more information.

Coverage End Date

MA coverage ends if an MA enrollee no longer meets the eligibility requirements or becomes incarcerated.

Coverage End Date due to Ineligibility

When a MA enrollee reports a change in circumstance that results in the loss of MA eligibility, MA coverage ends the last day of the month for which advance notice can be given. Generally, 10-day advance notice is needed to end MA coverage. See the MHCP Notices policy for specific situations that require less than 10-day advance notice.

Coverage End Date due to Change in Basis

When a MA enrollee is eligible under a new basis, coverage under the current basis ends the last day of the month, prior to the start of eligibility under the new basis.

When a MA enrollee fails to provide the requested supplemental form and any additional information required to complete a redetermination, coverage ends the last day of the month for which advance notice can be given. See EPM section 1.3.2.1 Change in Circumstances for more information.

Coverage End Date due to Incarceration

When a MA enrollee is incarcerated in a state prison, county detention facility, or city jail the enrollee must report the incarceration. MA coverage ends the date of incarceration.

Legal Citations

Code of Federal Regulations, title 42, section 431.213

Code of Federal Regulations, title 42, section 435.907

Code of Federal Regulations, title 42, section 435.915

Code of Federal Regulations, title 42, section 435.916

Minnesota Rules, part 9505.0110

Minnesota Rules, part 9505.0015, subpart 5

Minnesota Rules, part 9505.0085

Minnesota Statutes, section 256B.04

Minnesota Statutes, section 256B.08

Minnesota Statute 256B.056, subd.7

Minnesota Statute 256B.061