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

November 27, 2024November 27, 2024

We incorporated policy from Bulletin #23-21-21 DHS Eliminates Parental Fees for Children Receiving MA under the TEFRA Option and HCBS Waivers into the following EPM sections.

2.3.6 MA under the TEFRA Option
2.3.6.1.2 MA under the TEFRA Option Parental Fees (This page was removed.)

2.3.3.2.7.2 MA-ABD Retirement Funds

We clarified that retirement plans that have been converted into an income stream that pays periodic payments can only be excluded when the plan does not allow for other withdrawals in addition to the income stream.

Appendix F Standards and Guidelines

We revised standards and guidelines in Appendix F that become effective January 1, 2025.

November 15, 2024November 15, 2024

We incorporated policy from Bulletin #23-21-28 DHS Announces Key MHCP Eligibility Policies during the Unwinding Period into the following EPM sections.

3.2.3.2 Employer Sponsored Coverage

Affordability Standard for Employer-Sponsored Coverage

We updated the employee’s portion of the annual premiums to not exceed 9.02 percent of the annual household income to be considered affordable.

November 1, 2024 November 1, 2024

2.1.2.3 Medical Assistance County Residency

County of Service

We clarified the county of service is responsible for case management after an application has been processed and eligibility has been determined, along with the specific actions this includes. The county of service is determined based on where an enrollee lives. However, applications submitted through METS, the servicing agency is assigned by METS when eligibility is pending or approved.

2.3.3.3.2.3 Medical Assistance for People Who Are Age 65 or Older and People Who Are Blind or Have a Disability Excluded Income

We removed Consumer Support Grant (CSG) payments from the list of excluded income and replaced it with the Community First Services and Supports (CFSS) payments.

We also included Long-Term Services and Supports workforce incentive payments under the Minnesota Care Force Incentive program to the list.

2.4.2.5 Medical Assistance for Long Term Care Income Calculations

Waiver Obligation

We removed the waiver obligation may be adjusted retroactively without providing 10-day notice.

Appendix H Lawfully Present Noncitizens

We clarified the definition of noncitizens who are considered lawfully present for the purpose of Minnesota Health Care Programs (MHCP) eligibility determinations.

This update also incorporates federal guidance, effective November 1, 2024, making technical adjustments to the list of immigration statuses and circumstances that defines noncitizens who are considered lawfully present.

October 21, 2024October 21, 2024

We incorporated policy from Bulletin #24-21-03 DHS Explains Electronic Verification of Certain Assets for Minnesota Health Care Programs into the following EPM sections.

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.

2.3.3.2.7.7 Medical Assistance for people Who Are Age 65 and Older, Who Are Blind or Have a Disability (MA-ABD) Automobiles and Other Vehicles Used for Transportation

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

2.2.2.1.3 Medical Assistance for Families with Children and Adults (MA-FCA) Former Foster Care Youth Basis of Eligibility

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.

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.

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.