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Effective: November 1, 2008 |
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03.05.10ar1 - MinnesotaCare Major Program Eligibility Type (MPET) (Archive) |
Archived: July 1, 2009 |
All MinnesotaCare enrollees are assigned to a major program and an eligibility type. The combination of the major program and the eligibility type is called the MPET . MMIS uses the MPET to assign the correct benefit set and Federal Financial Participation (FFP) amount to each MinnesotaCare enrollee.
This section explains how to determine the MPET. For further information about system coding, see the MMIS User Manual.
MinnesotaCare has five major programs. MMIS uses a system code for each major program. The major program and eligibility type codes help MMIS identify the correct benefit set and the FFP amount for each enrollee.
To assign the correct major program, first determine the applicable eligibility group. Next, determine if the applicant or enrollee is a citizen or a noncitizen who qualifies for federal funding. Assign the applicant or enrollee to one of the following major programs:
l Major program LL.
Children under 21 and pregnant women who are either:
n U.S. citizens, or
n Noncitizens who qualify for federally funded health care coverage.
l Major program KK.
Children under 21 and pregnant women who are noncitizens who do not qualify for federally funded health care coverage.
l Major program FF.
Parents and relative caretakers who are either:
n U.S. citizens, or
n Noncitizens who qualify for federally funded health care coverage.
l Major program JJ.
n All legal guardians and foster parents, and
n Parents and relative caretakers who are noncitizens who do not qualify for federally funded health care coverage.
l Major program BB.
All adults without children.
l Major program XX.
Non-pregnant parents and relative caretakers, legal guardians, and foster parents with income above 275% FPG.
The eligibility type is an alpha-numeric system code that further identifies the enrollee, allowing MMIS to correctly assign benefit sets and federal funding amounts. To assign the eligibility type you will need to know the enrollee’s eligibility group and income.
Note: For children you will also need to know whether the child meets the Children’s Health Plan exception. Children meet the exception if they were originally enrolled in the Children's Health Plan (CHP) on or before June 30, 1993, and have maintained continuous enrollment .
The MinnesotaCare eligibility types are:
l Children 0 to age 21 (major program LL or KK).
n I1 - Infants to age 2 with income at or below 150% FPG.
n I2 - Infants to age 2 with income above 150% FPG.
n C1 - Children ages 2 to 21:
m with income at or below 150% FPG, or
m who meet the Children's Health Plan exception described above.
n C2 - Children ages 2 to 21 with income above 150% FPG.
l Pregnant women (major program LL or KK).
n P1 - Pregnant women under age 21 with income at or below 150% FPG.
n P2 - Pregnant women who are:
m under age 21 with income above 150% FPG, or
m age 21 and over.
l Non-pregnant adults with children (major program FF or JJ).
n A2 - Non-pregnant adults with children who meet the major program criteria for:
m Program FF, and have income above 200% and at or below 275% FPG.
m Program JJ, and have income above 175% and at or below 275% FPG.
n M2 - Non-pregnant adults with children who meet the major program criteria for:
m Program FF, and have income at or below 100% FPG.
m Program JJ, and have income at or below 175% FPG.
m Program XX, parents and relative caretakers, legal guardians, and foster parents with income above 275% FPG.
n A4 - Non-pregnant adults with children who meet the major program criteria for program FF, and have income above 175% and at or below 200% FPG.
n M4 - Non-pregnant adults with children who meet the major program criteria for program FF, and have income above 100% FPG and at or below 175% FPG.
l Adults without children (major program BB).
n M1 - Non-pregnant adults without children with income at or below 200% FPG.
Note: The numeral in the eligibility type refers to the ”group number” (not to be confused with the eligibility group). The group number is not important on its own, except as a shorthand way to describe children who are exempt from some insurance barriers, e.g., Group One children.
See the following sections for further information:
MinnesotaCare for Pregnant Women.
MinnesotaCare for Auto Newborns.
MinnesotaCare for Children Under 21.
MinnesotaCare for Adults With Children.