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
September 20, 2024September 20, 2024
We incorporated Bulletin #20-21-01 DHS Announces a Change in Service Delivery for Medical Assistance Applicants and Enrollees Temporarily Absent from Minnesota into the following pages. This change incorporates information that health care services will be delivered through fee-for-service rather than managed care when a person is temporarily absent for the state for more than 30 days.
1.4.4 Minnesota Health Care Programs (MHCP) Temporary Absence
2.2.4.1 MA-FCA Health Care Delivery
2.2.2.1.2 MA-FCA Basis of Eligibility
Eligibility Begin Date
We clarified that a pregnant person must be eligible for MA in the month the pregnancy ends to receive the 12-month postpartum period. People determined retroactively eligible for MA as a pregnant person are entitled to the 12-month postpartum period.
September 10, 2024September 10, 2024
1.2.6 Minnesota Health Care Programs (MHCP) Signature
Special Circumstances
We clarified the MHCP Signature applies to applications, renewals and other MHCP eligibility forms, except for the Authorization to Obtain Financial Information (DHS-7823) form.
2.1.2.2.2 Medical Assistance (MA) Immigration Status
MA Eligibility for Noncitizen Children under Age 21 and Pregnant People
We included additional clarification that undocumented and DACA pregnant people are ineligible for MA.
Qualified Immigration Statuses Without a Five-Year Waiting Period
We updated the dates for the Ukrainian and Afghan parolees.
Equity Value of an Automobile
We clarified JD Power or Kelley Blue Book should be the source used to verify vehicle values.
2.3.5.1.3 Medical Assistance for Employed Persons with Disabilities (MA-EPD) Work Requirements
We clarified Employment Income requirements for Wage, Self-Employment, and Seasonal Employment income.
August 28, 2024August 28, 2024
We incorporated Bulletin #23-21-24 DHS Expands Medical Assistance for Former Foster Care Youth with this new page.
2.2.3.5. MA-FCA Income Verification
Educator Expenses
We updated the maximum anticipated adjustment for the self-attestation amount to $300 for one educator and $600 when both spouses are educators.
Appendix F Standards and Guidelines
Utility Allowance
We update the amounts for the following allowances:
- Utility allowance
- Electricity allowance
- Telephone allowance
The updated amounts become effective October 1, 2024.
Excluded Assets Regardless of Identifiability
We updated the list of excluded assets to include: Consolidated Appropriations Act (CAA) recovery rebate payments, Coronavirus Aid, Relief, and Economic Security (CARES) Act payments, COVID-19 Relief Payments, and RentalHelpMN Assistance.
2.3.3.2.4 MA-ABD Countable Assets
Shared Ownership of Countable Assets
We moved the following information from EPM section 2.3.3.2.4.1.1 MA-ABD Shared Ownership, which is now retired.
A jointly owned asset is unavailable when all of the following criteria are met:
- The permission of a joint owner is required to sell or dispose of the asset;
- The joint owner is not a member of the household or financially responsible relative whose assets are deemed to the person; and
- The joint owner refuses to allow the sale or disposal of the asset.
2.3.5.4.1 MA-ABD for Employed People with a Disabilities (EPD) Medicare
Payment for Medicare Part B Premiums
We clarified policy to include two new forms.
MA-EPD enrollees who become newly eligible for agency reimbursement of their Medicare Part B premiums must receive the Eligible for Manual Reimbursement for Medicare Part B Premiums for MA-EPD Enrollees Form (DHS-8555).
MA-EPD enrollees who become newly ineligible for agency reimbursement of their Medicare Part B premiums must receive the Ineligible for Manual Reimbursement for Medicare Part B Premiums for MA-EPD enrollees Form (DHS-8556).
In the following EPM sections we clarified the eligibility requirements for people with Medical Assistance for Families and Children with a Spenddown basis who request payment for long-term care services (MA-LTC) while in a long-term care facility (LTCF).
- 1.3.1.5 Minnesota Health Care Programs (MHCP) Notices
- 2.2.3.6 Medical Assistance for Families with Children and Adults (MA-FCA) Medical Spenddown
- 2.4.2 Medical Assistance for Long-Term Care Services (MA-LTC) Financial Requirements
- 2.4.2.1 MA-LTC Asset Eligibility for a Long-Term Care Spouse
- 2.4.2.4 MA-LTC Long-Term Care Facility Services
- 2.4.2.5 MA-LTC Income Calculations
2.3.6 Medical Assistance Under the TEFRA Option
We removed the reference to EPM section 2.3.6.1.2 TEFRA Parental Fees
We incorporated the name change of the Asset Validation System to the Asset Verification Service announced in Bulletin #24-21-03 DHS Explains Electronic Verification of Certain Assets into the following EPM sections.
- 1.3.2.1 Minnesota Health Care Programs (MHCP) Change in Circumstances
- 1.3.2.4 MHCP Inconsistent Information
- 2.3.1 Medical Assistance for People Who Are Age 65 or Older or People Who Are Blind or Have a Disability (MA-ABD) General Requirements
- 2.3.1.1 MA-ABD Mandatory Verifications
- 2.3.1.2 MA-ABD Asset Verification Service (AVS)
- 2.3.1.3 MA-ABD Authorization to Obtain Information
- 2.3.5.1.1 Medical Assistance for Employed Persons with Disabilities (MA-EPD) Mandatory Verifications
- 2.4.2.1.1 MA-LTC Asset Assessment for Planning Purposes
- 4.2.1 Medicare Savings Programs (MSP) General Requirements
2.1.1.2.3 Minnesota Health Care Programs Cost Sharing
We incorporated DHS Bulletin #23-21-21 DHS Eliminates Parental Fees for Children Receiving MA under the TEFRA Option and HCBS Waivers. Parental Fees for Children receiving MA under the TEFRA Option and HCBS Waivers.
Effective July 1, 2023, DHS will no longer assess a parental fee for TEFRA and for children accessing HCBS disability waivers.
2.5.3.2 Emergency Medical Assistance (EMA) Non-Financial Eligibility
EMA Renewal
We clarified EMA should remain open, even when the medical emergency has ended.
Appendix F Standards and Guidelines
We updated the amounts for the following allowances:
- Basic Shelter Allowance
- Minimum Monthly Income Allowance
- Home Maintenance Allowance
- Special Income Standard for Elderly Waiver Maintenance Needs Allowance
- Remedial Care Expense
- Statewide Average Payment for Skilled Nursing Facility
The updated amounts become effective July 1, 2024
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:
- Bulletin #23-21-07 DHS Clarifies MA Eligibility Policy and Coverage Suspension for People who are Incarcerated
- Bulletin #23-21-18C Corrected #23-21-18: DHS Announces a Simplified Renewal Process for Certain MA-ABD Enrollees
- Bulletin #23-21-25 DHS Revises the Application for Health Coverage and Help Paying Costs and Supplement Form
- Bulletin #23-21-27 DHS Implements Continuous Medical Assistance Eligibility for Children Under Age 19
- Bulletin #23-21-28 DHS Eliminates the Asset Limit for MA for Employed Persons with DIsabilities
- Bulletin #24-21-01 DHS Explains Certain MA Enrollees Must Provide Verification of Assets at Renewal
- Bulletin #24-21-02 DHS Implements Individual-Level Eligibility Renewals for Medical Assistance and MinnesotaCare
- Bulletin #24-21-03 DHS Explains Electronic Verification of Certain Assets for Minnesota Health Care Programs
- Bulletin #24-21-04 DHS Clarifies Minnesota Health Care Programs Income and Asset Verification Policies for Certain People
- Bulletin #24-21-05C Corrected #24-21-05: DHS Announces Minnesota Health Care Programs Post-Unwinding Eligibility Policies
- Bulletin #24-21-06 DHS Modifies Ex Parte Renewal Process for MA-ABD and MSP Enrollees
- Bulletin #24-21-07 DHS Resumes Monthly Premiums for Certain MinnesotaCare Enrollees for July 2024 Coverage
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.
- Bulletin #20-21-02, DHS Announces Temporary Policy Changes to Minnesota Health Care Programs During the COVID-19 Peacetime Emergency
- Bulletin #20-21-03, DHS Announces Medical Assistance for COVID-19 Testing of Uninsured Individuals
- Bulletin #20-21-05, DHS Explains Treatment of Federal Pandemic Unemployment Compensation Payments for Minnesota Health Care Programs
- Bulletin #20-21-10, DHS Announces Updates to Temporary Policies for Minnesota Health Care Programs during the COVID-19 Public Health Emergency
- Bulletin #23-21-12 DHS Cancels Unpaid MinnesotaCare Premiums and Temporarily Waives Premiums for all Enrollees
- Bulletin #20-21-13, DHS Announces a Change to Processing PARIS Interstate Matches for MHCP Enrollees During the COVID-19 Public Health Emergency
- Bulletin #21-21-02, DHS Explains Treatment of Coronavirus Response Payments under the American Rescue Plan Act of 2021, for MHCP
- Bulletin #21-21-03, DHS Explains Treatment of PUA and PEUC for Minnesota Health Care Programs
- Bulletin #21-21-04, DHS Explains Redetermination and Closure of MHCP for Enrollees Not Validly Enrolled due to Fraud or Agency Error
- Bulletin #21-21-06 DHS Announces MinnnesotaCare Premium Reductions for 2021 and 2022
- Bulletin #21-21-07 DHS Explains Redetermination and Closure of MHCP for Enrollees Not Validly Enrolled due to Abuse
- Bulletin #22-21-11 DHS Announces Temporary Policy to Accept Minnesota Address Updates on USPS Returned Mail for Minnesota Health Care Programs
- Bulletin #23-21-05 DHS Announces Temporary Policy to Accept Contact Information Updates from MCOs for MHCP
- Bulletin #23-21-08 DHS Announces Key MHCP Eligibility Policies during the Unwinding Period
- Bulletin #23-21-09 DHS Announces the Resumption of Minnesota Health Care Programs Annual Eligibility Renewals
- Bulletin #23-21-14 DHS Explains Transition from COVID-19 Temporary MA-EPD Policies to Standard MA-EPD Policies
- Bulletin #23-21-17 DHS Explains Handling Renewal-Related Returned Mail During the Unwinding Period
- Bulletin #23-21-19 DHS Announces Temporary Asset Disregard and Other Asset Policies for Certain MHCP Enrollees
- Bulletin #23-21-20 DHS Announces Temporary Changes to Deadlines for Medical Assistance and MinnesotaCare Eligibility Appeals
- Bulletin #23-21-26 DHS Implements Mitigation Plan 2.0 and Clarifies Post Renewal Policies
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.
EPM Subscription
After you set up an account, you will have the opportunity to scroll down to select Minnesota Health Care Programs Eligibility Policy Manual, which will provide an update or all sections, or you can select which individual sections of the EPM you want to be notified when an update occurs.You can change your subscriber preferences at any time by logging into your account.