Medical Assistance

2.1.4.2 Qualifying Health Care Coverage

As of January 2014, people must have qualifying health care coverage, qualify for a coverage exemption, or make an individual shared responsibility payment upon filing a federal income tax return. The Individual Health Coverage Mandate is a provision of the Affordable Care Act.

Medical Assistance (MA) is qualifying health care coverage and meets the federal individual responsibility requirement. Qualifying health care coverage is also called minimum essential coverage (MEC).

Medical Assistance enrollees receive a Form 1095-B from the Minnesota Department of Human Services (DHS). Form 1095-B verifies health care coverage and is used to report individual health coverage to taxpayers and the IRS. An individual who maintains continuous health care coverage throughout the year is not liable for the individual shared responsibility payment.

More information regarding the individual responsibility mandate is located at MNsure.

MA with a Spenddown – Hardship Exemption

MA with a spenddown is not considered qualifying health coverage by the federal government and does not meet the federal individual responsibility requirement. No Form 1095-B is sent to MA with a spenddown enrollees.

People enrolled in MA with a spenddown can apply for a hardship exemption from the shared responsibility payment from the Federal Health Insurance Marketplace at HealthCare.gov. The HealthCare.gov website does not specifically list the exemption for MA with a spenddown. The request for an MA with a spenddown exemption must be described on the Application for Exemption from Shared Responsibility Payment for Individuals who Experience Hardships. A Confirmation of Medically Needy Coverage in Minnesota Medical Assistance, available from the Minnesota Department of Human Services, must be included.

Other Minnesota Health Care Programs

The following Minnesota Health Care Programs (MHCP) are not considered qualifying health coverage by the federal government and does not meet the federal individual responsibility requirement. No Form 1095-B is sent to these enrollees.

Emergency Medical Assistance (EMA)
Medicare Saving Programs (MSP)
Minnesota Family Planning Program (MFPP)

Legal Citations

Code of Federal Regulations, title 26, section 1.5000A

Code of Federal Regulations, title 26, section 1.5000A-2

Code of Federal Regulations, title 26, section 1.5000A–3

Code of Federal Regulations, title 26, section 6055

Code of Federal Regulations, title 45, section 155.605