Medical Assistance for Employed Persons with Disabilities

2.3.5.1.2 Premiums

People enrolled in Medical Assistance for Employed Persons with Disabilities (MA-EPD) must pay monthly premiums to establish and maintain eligibility. A premium is based upon:

An American Indian or Alaska Native who has provided verification of American Indian or Alaska Native status is exempt from paying a premium for MA-EPD. The premium exemption begins the first month after the month the verification was received unless the verification was received when the application was processed.

An American Indian is defined as a person who is:

A member of a federally recognized Indian tribe;
Considered by the Secretary of the interior to be an Indian for any purpose; or
Determined to be an Indian under regulations promulgated by the U.S. Secretary of Health and Human Services.

Any formal documentation from a tribe, Indian Health Services (HIS), or the Bureau of Indian Affairs (BIA) that verifies a person is an American Indian is acceptable as verification.

Premium Calculation

MA-EPD premiums are determined by a person's gross countable income (earned and unearned income) and family size. The minimum premium amount is $35 per month.

For individuals with gross income at or below 300% of the Federal Poverty Guidelines (FPG), a sliding scale determines the premium amount.
If income is greater than 300% FPG, the premium is 7.5% of gross income.
For individuals that receive unearned income, an additional fee of 0.5% of unearned income is applied.

The total MA-EPD premium is the combined amount.

An American Indian or Alaska Native who has provided verification of American Indian or Alaska Native status is exempt from paying a premium for MA-EPD. The premium exemption begins the first month after the month the verification was received, unless the verification was received when the application was processed.

An American Indian is defined as a person who is:

A member of a federally recognized Indian tribe;
Considered by the Secretary of the interior to be an Indian for any purpose: or
Determined to be an Indian under regulations promulgated by the U.S. Secretary of Health and Human Services.

Any formal documentation form a tribe, Indian Health Services (HIS), or the Bureau of Indian Affairs (BIA) that verifies a person is an American Indian is acceptable as verification.

An online MA-EPD premium estimator is available. A person’s county or tribal servicing agency is responsible for collecting the initial MA-EPD premium. The Minnesota Department of Human Services (DHS) bills for ongoing MA-EPD premiums monthly.

MA-EPD applicants must pay the initial premium in full within 30 days, before coverage can begin. People can choose which retroactive months they want coverage for, and the months do not have to be consecutive. If the initial premium is not paid within 30 days, MA-EPD eligibility is denied and eligibility is redetermined under all MA bases. An MA-EPD applicant who is denied for failure to pay the premium and who is not eligible for Minnesota Health Care Programs (MHCP) under any basis must reapply to qualify for MA-EPD again.

Gross Countable Income

Gross countable income includes countable earned and unearned income of the person and anyone whose income deems to the person, without any disregards or deductions applied. See the MA for People Who Are Age 65 or Older and People Who Are Blind or Have a Disability (MA-ABD) Countable Income policy for more information.

Excluded Income

The MA-ABD excluded income policy applies to MA-EPD. See the MA-ABD Excluded Income policy for more information.

Deeming

Only the MA-EPD enrollee’s income is counted for adults age 18 and older. No spousal income is deemed to the MA-EPD spouse. Parental income is deemed for MA-EPD applicants and enrollees younger than age 18.

Disregards and Deductions

MA-EPD enrollees do not use standard MA-ABD deductions and disregards, because premiums are calculated using the gross countable income.

The only deduction that applies to the MA-EPD income calculation is the RSDI Cost of Living Adjustments (COLA) disregard. See 2.3.3.3.2.2 MA-ABD Disregards and Deductions for more information about the RSDI COLA disregard.

Family Size

Family size is used to determine premium rates. Family size is determined for each person separately. Family size may be different for each person on an application or in a household.

For MA-EPD enrollees age 21 or older, family size includes the following, if they are living with the person:

Enrollee
Spouse (unless they are enrolled in MA-EPD)
Biological or adopted children younger than age 21, including those who are temporarily absent
Spouse's biological or adopted children younger than age 21, including those who are temporarily absent
Unborn children of the person or their spouse

For MA-EPD enrollees under age 21, family size includes the following if they are living with the person:

Enrollee
Spouse (unless they are enrolled in MA-EPD)
Biological or adoptive parents
Stepparent, if the biological or adoptive parent also lives with the person
Siblings (biological, adopted, or step siblings)
Unborn children of the person, their spouse or their biological, adoptive or stepparents listed above

Premium Payments

The first premium must be paid to the county or tribal agency. Ongoing payments can be made by mail, in person, or online. For more information about MA-EPD premium payments see: How do I pay my MA-EPD premium?

The servicing agency must determine, bill, and collect the initial MA-EPD premium. The initial premium may include premiums for more than one month of coverage. MA-EPD applicants must pay the initial premium in full within 30 days from the date of the Initial Premium Notice (DHS-3547) before coverage can begin. People can choose which retroactive months they want coverage for, and the months do not have to be consecutive.

County and tribal agencies must not open MA-EPD coverage until all months of the initial premium is paid.

If the initial premium is not paid within 30 days from the date of the Initial Premium Notice, MA-EPD eligibility is denied and eligibility is redetermined under all MA bases. An MA-EPD applicant who is denied for failure to pay the initial premium and who is not eligible for Minnesota Health Care Programs (MHCP) under any basis must reapply to qualify for MA-EPD again.

Monthly Premium Invoices

The Minnesota Department of Human Services (DHS) bills for ongoing MA-EPD premiums monthly. DHS will mail a monthly MA-EPD invoice to enrollees after the initial premium payment is received by the county or tribal agency. MA-EPD enrollees receive an invoice every month showing the amount of the monthly MA-EPD premium and the due date. Any past-due amount or credit is not shown on the invoice.

The average anticipated gross monthly countable income is used to calculate the MA-EPD premium amount for the certification period. MA-EPD enrollees have a 12 month certification period.

The actual gross monthly income is used to calculate the MA-EPD premium amount during any retroactive months.

The premium amount is the same for each month of the certification period, because the premium is based on average anticipated income.

MA-EPD premiums must be recalculated at annual renewal.

In between annual renewals, workers must recalculate MA-EPD premiums when

An enrollee reports a change that results in a decreased premium. The decreased premium is effective the first day of the month after the change is reported.
The FPG is increased in January of each year.
Social Security RSDI benefits are increased and the RSDI cost of living adjustment (COLA) disregard ends, effective July 1 each year.

Premium Payment Schedule

Ongoing MA-EPD premiums are due by the fourth day of the month, but can be paid through the last working day of the month. If an MA-EPD enrollee’s coverage is closed due to non-payment of a premium, then in the month after the month in which coverage was closed they must pay a premium for two months to have coverage reinstated. The enrollee’s MA-EPD coverage remains closed if they do not pay a premium for two months to have coverage reinstated. Premiums should be paid on time to avoid a gap in coverage.

Date Invoice Mailed	Date Premium is Due	For Coverage in this Month
December 4	January 4	February
January 4	February 4	March
February 4	March 4	April
March 4	April 4	May
April 4	May 4	June
May 4	June 4	July
June 4	July 4	August
July 4	August 4	September
August 4	September 4	October
September 4	October 4	November
October 4	November 4	December
November 4	December 4	January

Premium Payments

The first premium must be paid to the county or tribal agency. Ongoing payments can be made by mail, in person, or online. For more information about MA-EPD premium payments, see: How do I pay my MA-EPD premium?

Legal Citations

Minnesota Statutes, section 256B.057, subdivision 9