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

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." 

November 17, 2023November 17, 2023

3.2.3.2 MinnesotaCare Employer-Sponsored Coverage

Family Affordability Standard

We decreased the employee’s portion of the annual premiums for family coverage to not exceed 8.39 percent from 9.12 percent of their annual household income for the tax year to be considered affordable. 

 

2.3.5.1.3 Medical Assistance for Employed Persons with Disabilities Work Requirements

Verification of Employment Income

We clarified employment income must be verified at application, at six months, and at renewal.

We also added, “only verification of employment income is required when the premium is recalculated at six months. Verification of assets is not required unless the enrollee reports a change in assets.”

 

October 25, 2023October 25, 2023

1.2.3 Minnesota Health Care Programs Date of Application

Paper Application

We revised this section to clarify the application date for applications completed by certified assisters is “the date the certified assister enters in the “application date” box in Appendix C.”

2.1.1.2.1.3 Medical Assistance Third Party Liability Other Health Care Coverage

We clarified applying for other benefits that may help pay for pay for the applicant or enrollees health care also includes:

  • Cooperation with completing the Work Injury Report (WIR) when the person has had a work-related injury. 
  • Cooperation with completing the Accident Injury Report (AIR) when the person has had a motor-vehicle related accident.

2.1.1.2.1.3.3 Medical Assistance Other Third Party Liability Accidents and Injuries

We clarified documentation an enrollee must complete when possible TPL coverage is identified also includes:

  • a Work Injury Report (WIR) when there is a work-related accident or injury.
  • an Accident Injury Report (AIR) (DHS-7336-ENG) when there is a motor-vehicle related accident or injury.

2.4.2.2 MA-LTC Long-Term Care Partnership Insurance

We incorporate the policy changes from Bulletin #23-21-03 DHS Changes Evaluation Process for Long-Term Care Partnership (LTCP) Policies. For people who believe they may have a qualified LTCP policy, the county or tribal servicing agency must request verification of whether the policy is a qualified LTCP policy directly from the person or the person’s authorized representative.

September 29, 2023September 29, 2023

2.2.3.5 Medical Assistance for Families with Children and Adults (MA-FCA)

Income Discrepancies

We clarified income that was not reported and the electronic data source reports income above the enrollee’s income limit, the agency cannot approve MA-FCA eligibility.

We also clarified when a person has no income with the following statement: “When an applicant has attested to having zero income, or no source of income, and an electronic data source indicates the applicant has income, this is considered a discrepancy if the amount of the income indicated by the data source is above the enrollee’s MA income limit. If the amount of the income provided by the data source is at or below the enrollee’s MA income limit, there is no income discrepancy, since both the applicant’s attested income and the electronic data indicate the person has income at or below the MA limit.”

Federal Tax Adjustments

We made minor adjustments to the IRS forms and line-item references on those forms.


September 8, 2023September 8, 2023

2.4.2.3.1 Home and Community-Based Services Waivers for People with Disabilities

We clarified that MA-NAA, MA-NKA, and MA-FC enrollees should continue to use their respective basis of eligibility when requesting a HCBS waiver. We also removed “the parents of children who are eligible for one of the HCBS waiver programs may need to pay a parental fee.”

 

2.4.2.4 Medical Assistance for Long-Term Care Services Long-Term Care Facility Services

We clarified “people who are enrolled in MA-EPD and meet the LTC Eligibility Factors use the MA-ABD income methodology and are subject to MA-EPD asset limits.”

 

2.3.5.3 Medical Assistance for Employed Persons with Disabilities Financial Eligibilityy

We clarified income must be greater than $65 per month on average for the six-month period used at application and renewal from wages or self-employment earnings to be eligible.


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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