Minnesota Health Care Programs

Eligibility Policy Manual

Welcome to the Minnesota Department of Human Services (DHS) Minnesota Health Care Programs Eligibility Policy Manual (EPM).The manual contains the official DHS eligibility policies for the Minnesota Health Care Programs including Medical Assistance and MinnesotaCare. It does not provide procedural instructions or system information. Minnesota Health Care Programs policies are based on the state and federal laws and regulations that govern the programs. See Legal Authority section for more information. See the Legal Authority section for more information.

Updates

Beginning June 1, 2023 policy clarifications and policy additions are announced through an Email Subscription. Anyone can sign up to receive the Email Subscription.

Recent Updates

March 25, 2024March 25, 2024

 

2.3.5.1.2 Medical Assistance for Employed Persons with Disabilities (MA-EPD) Premiums and Cost Sharing

We removed Cost Sharing from the title of this policy. We also added clarification that “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.”

2.3.3.2.3 Medical Assistance for People Who Are Age 65 or Older or People Who Are Blind or Have a Disability Excluded Assets

Excluded Assets Regardless of Identifiability

Frontline Worker Payments made under Minnesota’s 2022 Frontline Worker Payments law was added to this section to incorporate bulletin #21-21-05 DHS Announces a Change to MAGI Methodology for Medical Assistance and MinnesotaCare.

4.2.1.1 Medicare Savings Programs (MSP) Applications

In the Application Forms subsection, we clarified Agencies must make an MSP determination for Medical Assistance (MA) enrollees enrolled in Medicare at application, renewal, or at a change in circumstance. An MA enrollee is not required to contact the agency to apply for an MSP.

 

February 16, 2024February 16, 2024

 

2.3.3.1 Medical Assistance for People Who Are Age 65 or Older and People Who Are Blind or Have a Disability Household Composition and Family Size

Under the Adults section, fourth bullet point down (i.e., stepchildren) was added.

2.3.5.4.1 Medical Assistance for Employed Persons with Disabilities Medicare

We changed the Medicare Part B Reimbursement section to Payment for Medicare Part B Premiums.

In the last paragraph of this section, we clarified Medical Assistance for an Employed Person with a Disability (MA-EPD) enrollees not eligible for the Qualified Medicare Beneficiary (QMB) program or Specified Low-Income Medicare Beneficiary (SLMB) program, with income at or below 200% FPG, the Medicare Part B premium must be processed and reimbursed by the county or tribal servicing agency.

2.1.1.2.1.3.2 Medical Assistance Medical Support

We revised the Good Cause section of this page to clarify what good cause is, how it is determined, and to include information about an enrollee's right to appeal the good cause committee's decision.

 

January 19, 2024January 19, 2024

 

2.3.5.3.2 Medical Assistance for Employed Persons with Disabilities (MA-EPD) Income

We added this section to include MA-EPD income policy.

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We clarified the Medical Assistance for People Who Are Age 65 or Older or People Who Are Blind or Have a Disability (MA-ABD) Shared Ownership policy and how to determine the asset value of a joint bank account.

We removed section 2.3.3.2.4.1.1 MA-ABD Shared Ownership and moved the information into:

We added the following new sub-headings:

  1. •  Jointly Owned Liquid Assets
    •  Assumption Dispute
    •  Dispute Outcome
    •  Effects on LTC Eligibility
    •  Other Jointly Owned Assets

We added the Shared Ownership of Personal Property sub-heading.

We removed section 2.3.3.2.4.1 MA-ABD Availability of Countable Assets and combined this information into section 2.3.3.2.4 MA-ABD Countable Assets.

We also developed Information about Joint Bank Accounts (DHS-8511) for use with this policy clarification.

 

January 12, 2024January 12, 2024

We incorporated information from Bulletin #23-21-16 DHS Clarifies Requirement to Redetermine Medical Assistance Eligibility Under All Bases Before Closure as it applies to the Medical Assistance (MA) for Northstar Kinship Assistance (NKA), Foster Care (FC) and Northstar Adoption Assistance (NAA) into the following EPM sections.

Appendix C

We updated this appendix with the Medicare cost sharing amounts for the 2024 benefit year. 

Appendix F

We updated the IRS mileage rate for 2024.

December 1, 2023December 1, 2023

Appendix F

We revised standards and guidelines in Appendix F that become effective January 1, 2024

2.3.3.4.2 Medical Assistance for People Who Are Age 65 or Older and People Who are Blind or Have a Disability Health care Expenses

Types of Health Care Expenses

We clarify that “once medical necessity is established, enrollees are not required to submit a new Medical Need form for the same expense in subsequent six-month periods.”

 

We incorporated the following policy changes from Bulletin #23-21-13 DHS Clarifies Medical Assistance Eligibility Policy for when a Disability Certification Ends.

2.1.1.2.4 Medical Assistance (MA) Referral for Other Benefits

We added a person may need to appeal a denial of certification of disability with other programs in order to maintain a basis of eligibility for MA.

2.3.2.1 Medical Assistance for People Who Are Age 65 or Older and People Who Are Blind or Have a Disability

We separated the Beginning and Ending Bases of Eligibility section into two sections labeled Begin Dates and End Dates. We also clarify "If a person is receiving MA with a blind or disabled basis with a certification of disability by SMRT and then is found not disabled by SSA, the SSA determination supersedes the SMRT determination and the blind or disabled basis ends." 


DHS discontinued the use of manual letters to announce policy clarifications and policy additions effective June 1, 2023. You can see a list of manual letters published between June 1, 2016 to June 1, 2023 in the EPM
Archive Manual Letters. As of June 1, 2023 this home page is no longer archived, since it does not contain eligibility policy.

Bulletins

DHS bulletins provide information about policy changes and direction to county and tribal health and human services agencies and other DHS business partners. According to DHS policy, bulletins more than two years old are obsolete. Anyone can subscribe to the Bulletins mailing list.

A DHS Bulletin supersedes information in this manual until incorporated into this manual. The following bulletins have not yet been incorporated into the EPM:

COVID-19 Emergency Bulletins: These bulletins announce temporary policy modifications, which supersede policies in this manual, during the COVID-19 emergency. Because these bulletins provide temporary guidance, they will not be incorporated into this manual.

Prior versions of EPM sections are available upon request. This manual consolidates and updates eligibility policy previously found in the Health Care Programs Manual (HCPM) and Insurance Affordability Programs Manual (IAPM). Prior versions of policy from the HCPM and IAPM are available upon request.

Contact Us

Direct questions about the Minnesota Health Care Programs Eligibility Policy Manual to the DHS Health Care Eligibility and Access (HCEA) Division, P.O. Box 64989, 540 Cedar Street, St. Paul, MN 55164-0989 or fax (651) 431-7423.

Health care eligibility workers must follow agency procedures to submit policy-related questions to HealthQuest.

Legal Authority

Many legal authorities govern Minnesota Health Care Programs, including but not limited to:

  • Title XIX of the Social Security Act;
  • Titles 26, 42 and 45 of the Code of Federal Regulations;
  • Minnesota Statutes chapters 256B and 256L, and
  • Certain federal regulations from the Centers for Medicare & Medicaid Services (CMS).

Each topic in the EPM includes applicable legal citations at the bottom of the page.

DHS has made every effort to include all applicable statutes, laws, regulations and other presiding authorities; however, erroneous citations or omissions do not imply that there are no applicable legal citations or other presiding authorities. The EPM provides program eligibility policy and should not be construed as legal advice.

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EPM Updates

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