MinnesotaCare

3.1.2.3 Periodic Data Matching

Periodic Data Matching (PDM) is a process that uses electronic data sources to identify MinnesotaCare enrollees who may no longer meet eligibility criteria for MinnesotaCare.

Enrollees in MinnesotaCare are subject to data matching using electronic data sources at least once during an enrollee’s 12-month period of eligibility.

The electronic data sources used for periodic data matching provide information about an enrollee’s or household member’s income, Medicare Part A enrollment, or death.

Notification of Discrepant Information

Discrepant information is electronic data that is not consistent with the case information attested to by the enrollee. An enrollee will receive a discrepancy notice only when the information received from an electronic data source indicates the enrollee may no longer qualify for the program in which he or she is currently enrolled.

An enrollee must respond to the discrepancy notice within 30 days from the date on the notice, by mail, in person, or by calling the agency. An enrollee may respond to the discrepancy notice by submitting a response form with confirmed or corrected information. An enrollee who confirms the information on the form is correct must not be required to provide paper verification to resolve the discrepancy.

Extension to Resolve a Discrepancy

An extension of time beyond the 30-day period is available when an enrollee is cooperating with the agency but unable to provide the information needed to resolve a discrepancy before the date of closure. An extension may be granted only upon enrollee request. There is no limit to the number of extensions an enrollee may be granted, if the enrollee is cooperating with the PDM process.

Resolving a PDM discrepancy

Income discrepancy

An income-related PDM discrepancy is considered resolved when the agency receives an attestation of projected annual income for the household from the MinnesotaCare enrollee. No verification is required if the enrollee’s attested projected annual income is the same as the projected annual income listed on the discrepancy notice.
Medicare Part A discrepancy

A Medicare Part A discrepancy is considered resolved when an enrollee confirms having Medicare Part A or attests that he or she does not have Medicare Part A. If an enrollee disputes having Medicare, the agency must check any other available data sources about Medicare enrollment, and if necessary, refer the enrollee to the Social Security Administration (SSA) to update his or her records. The agency cannot require an enrollee to contact SSA before resolving the discrepancy.
Death discrepancy

A death discrepancy is considered resolved when the death is either confirmed or denied by the household. If an enrollee denies the death discrepancy, the agency must resolve the discrepancy and refer the enrollee to SSA to correct his or her records. The agency cannot require an enrollee to contact SSA before resolving the discrepancy.

An enrollee may report changes during the process of resolving their PDM discrepancies. See MHCP Changes in Circumstances for more information.

Failure to Resolve a PDM Discrepancy

A MinnesotaCare enrollee must cooperate with the PDM process as a condition of eligibility. Enrollees who fail to resolve a PDM discrepancy or request an extension within 30 days of the notice are no longer eligible for their current program. The enrollee is not eligible for MinnesotaCare, MA, advanced premium tax credits (APTC) or cost-sharing reductions (CSR) until the enrollee resolves all outstanding discrepancies. An enrollee with an outstanding discrepancy may be eligible to purchase a qualified health plan without a subsidy if he or she meets the eligibility criteria.

A MinnesotaCare enrollee whose eligibility ended due to failure to resolve a PDM discrepancy must resolve the outstanding discrepancy to qualify for MinnesotaCare again. Once the person resolves the outstanding discrepancy, the earliest the person can be eligible for MinnesotaCare is the first day of the month in which the person cooperated with the agency to resolve the PDM discrepancy or reapplied. MinnesotaCare coverage begins the first day of the month after the month in which eligibility is approved and a first premium payment is received, if the person is required to pay a premium. See MinnesotaCare Begin and End Dates for more information.

Legal Citations

Minnesota Statutes, section 256B.0561