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
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
Assumption of Liquidity
We added the statement “that has a value in real currency or acts as a substitute for real currency” after Virtual currency to clarify what it is.
2.5.4.4.1 Program for People Living in Institutions for Mental Diseases (IMD) Medicare
Medicare Reimbursement
We clarified who may be eligible for the Medicare Savings Program (MSP) while residing in an IMD along with a distinction between federally funded and state-funded enrollees.
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.”
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
Under the Adults section, fourth bullet point down
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.
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 #20-21-01 DHS Announces a Change in Service Delivery for Medical Assistance Applicants and Enrollees Temporarily Absent from Minnesota
- Bulletin #21-21-08 DHS Explains Treatment of RentHelpMN Assistance and Child Tax Credit Payments for Minnesota Health Care Programs
- Bulletin #22-21-05 DHS Explains Treatment of Minnesota’s Public Program Frontline Worker Payments
- Bulletin #23-21-07 DHS Clarifies MA Eligibility Policy and Coverage Suspension for People who are Incarcerated
- Bulletin #23-21-12 DHS Cancels Unpaid MinnesotaCare Premiums and Temporarily Waives Premiums for all Enrollees
- Bulletin #23-21-15 DHS Revises the MHCP Application, Renewal and Supplement Forms for Certain Populations
- Bulletin #23-21-18C Corrected #23-21-18: DHS Announces a Simplified Renewal Process for Certain MA-ABD Enrollees
- Bulletin #23-21-24 DHS Announces Medical Assistance for Former Foster Care Youth
- 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 #20-21-04, DHS Explains Treatment of Federal Coronavirus Aid, Relief, and Economic Security Act Payments for Minnesota Health Care Programs
- Bulletin #20-21-05, DHS Explains Treatment of Federal Pandemic Unemployment Compensation Payments for Minnesota Health Care Programs
- Bulletin #20-21-06, DHS Explains Treatment of State, Local and Tribal COVID-19 Relief 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 #20-21-13, DHS Announces a Change to Processing PARIS Interstate Matches for MHCP Enrollees During the COVID-19 Public Health Emergency
- Bulletin #20-21-14, DHS Explains Treatment of Coronavirus Response Payments under the Consolidated Appropriations Act, 2021, for Minnesota Health Care Programs
- 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.