Medical Assistance for Employed Persons with Disabilities

2.3.5.1.2.1 Good Cause for Non-Payment of Ongoing Premiums

An enrollee who is unable to pay their ongoing MA-EPD premium due to circumstances beyond their control may request good cause for non-payment of a monthly premium.

Good cause is defined as circumstances beyond a person's control or not reasonably foreseeable resulting in the enrollee being unable or failing to pay the premium when it was due. Life events that cause unexpected expenses include, but are not limited to, the following:

Natural disasters
Illness
Job loss

Family emergency
Unexpected home or car repair

Good cause must be requested before the enrollee’s coverage is closed for failure to pay the premium. DHS determines whether good cause exists based on the evidence provided by the enrollee to support their claim.

Good cause will not be granted for:

non-payment of an initial premium, including any retroactive months.
a month in which the premium has already been paid.

choosing to pay other regular or anticipated expenses instead of the premium.

Requesting Good Cause

An enrollee must request good cause using the MA-EPD Good Cause Application (DHS-6939). To submit the MA-EPD Good Cause Application, the enrollee can:

Submit the form electronically,
Fax to 651-431-7563, or

Mail to DHS MA-EPD Good Cause, P.O. Box 64967, Saint Paul, MN 55164-0967. This address is for MA-EPD Good Cause Applications only. Do not mail premium payments to this address.

Enrollees can get help to complete the form by calling Disability Hub MN at 866-333-2466.

DHS provides the person with written notice of the good cause decision within 30 days. People may request an appeal if they do not agree with a good cause decision. See the MHCP Appeals policy for more information.

Legal Citations

Minnesota Statutes, section 256B.057, subdivision 9