Medical Assistance for Families with Children and Adults

2.2.3.3 Income Limit

To be eligible for Medical Assistance for Families with Children and Adults (MA-FCA) a person’s income must be less than or equal to the applicable income limit. Income limits are based on federal poverty guidelines.

Federal Poverty Guidelines

The U.S. Department of Health and Human Services (HHS) issues federal poverty guidelines (FPG) each year. New guidelines are used beginning each July 1.

These guidelines determine income eligibility for MA-FCA. A person’s applicable income limit is based on many factors, including, but not limited to:

The basis of eligibility for Medical Assistance (MA)
The number of people included in the family size
Whether the person has a medical spenddown for MA

Income Limits for Medical Assistance for Families with Children and Adults

The following income limits determine eligibility for MA -FCA:

Pregnant people: less than or equal to 278% FPG
Infants under 2: less than or equal to 283% FPG
- Children's Health Insurance Program (CHIP) funded MA may be available for infants with income between 275% and 283% FPG who are not enrolled in other health insurance
Children 2 through 18: less than or equal to 275% FPG
Children 19 and 20: less than or equal to133% FPG
Parent and caretaker relatives: less than or equal to 133% FPG
Adults without children: less than or equal to 133% FPG
Transition Year MA (TYMA) second six months: less than or equal to 185% FPG

Auto newborns and former foster children younger than age 26 have no income limit.

See the Minnesota Health Care Programs Income and Asset Guidelines (DHS-3461A) for more information regarding family size and income limits.

Five Percent FPG Disregard

When the person's income is above the income limit, an income disregard equal to 5% FPG is applied. When the person’s income, minus the disregard, is within the income limit, they qualify for MA-FCA. This disregard effectively raises the MA-FCA income limits by 5%.

Safety Net Provision

In certain situations, a person’s income may be greater than his or her income standard for MA-FCA and be less than the MinnesotaCare income standard due to differences in how income is calculated for each program. This results in ineligibility for both programs. This may occur when:

A lump sum is counted in the month received under the MA-FCA income methodology, but counted as part of annual income using the MinnesotaCare income methodology.
Sponsor income is counted in the household income using the MA-FCA income methodology, but not counted in the MinnesotaCare income methodology.
A child younger than age of 19 has income greater than the MA-FCA income limit, but has projected annual income (PAI) less than 100% FPG for MinnesotaCare eligibility. This can happen because MA-FCA and MinnesotaCare have different household composition and family size policies.
Current income is used in the MA-FCA income methodology, but PAI is used for the MinnesotaCare income methodology.

When these situations arise, people are eligible for MA if their PAI is below 100% FPG using the MinnesotaCare income methodology and household composition rules. People whose PAI is equal to or greater than 100% FPG, but equal to or less than 133% FPG using the MinnesotaCare income methodology and household composition rules are eligible for MinnesotaCare.

A person determined eligible for MA under the safety net provision has PAI for the current calendar year below 100% FPG. When a new year begins, they may have a new PAI amount, and may or may not continue to qualify for MA under the safety net provision.

Retroactive Eligibility Under the Safety Net Provision

A person may be eligible for retroactive MA under the safety net provision for up to three months prior to the month of application. If a person enrolled in another Insurance Affordability Program is determined eligible for MA under the safety net provision due to a change in circumstances, MA is available under the safety net provision for up to three months prior to the date the change was reported.

Verification

Because verification of income is required prior to MA eligibility, PAI is a pre-eligibility verification for people who appear to be eligible under the safety net provision. PAI must be verified through an available electronic data source or by paper proof, if electronic data sources are unsuccessful or unavailable.

Legal Citations

Code of Federal Regulations, title 42, section 435.100

Code of Federal Regulations, title 42, section 435.116

Code of Federal Regulations, title 42, section 435.118

Code of Federal Regulations, title 42, section 435.119

Code of Federal Regulations, title 42, section 435.603

Code of Federal Regulations, title 42, section 435.915

Minnesota Statutes, section 256B.056