*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
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Effective: November 1, 2012 |
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03.20.15 - MinnesotaCare for Children Under 21 |
Archived: June 1, 2016 (Previous Versions) |
Children may be eligible for MinnesotaCare (MCRE) as part of this eligibility group for the month of birth through the month of their twenty-first birthday.
Note: For children ages 0-1 whose mothers were enrolled in MinnesotaCare or Medical Assistance (MA) for the month of birth, see MinnesotaCare for Auto Newborns.
For children under 21 who qualify for MinnesotaCare as a child who resided in foster care or a juvenile residential correctional facility on their 18th birthday, see MinnesotaCare for Certain Children Exiting Foster Care or a Residential Juvenile Correctional Facility.
Eligibility factors and links to standard program guidelines are provided below.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
MinnesotaCare Major Program Eligibility Type (MPET).
Relationship to Other Groups/Bases.
MMIS Instruction to Approve Eligibility for Children with Household Income Greater than 275% FPG.
Application Process (standard guidelines)
People under 18 who do not live with a parent, relative caretaker, foster parent, or legal guardian may apply on their own behalf. This includes minor caretakers and minors without children.
Note: All clients age 18 or older may apply on their own behalf. However, if clients ages 18-20 live with a parent or relative caretaker, they are generally not considered a separate household. See Who May Apply and Determining Household Size for MinnesotaCare for further information.
Follow standard MinnesotaCare guidelines. See Adding a Household Member for eligibility begin date guidelines for some special situations, such as newly adopted children.
Renewals (standard guidelines)
Follow standard MinnesotaCare guidelines.
Follow standard MinnesotaCare guidelines.
Social Security Number (standard guidelines)
Do not require SSNs for:
l Children eligible as auto newborns through the month of their first birthday.
l Newly adopted children of any age until the next renewal.
Children under 21 who are U.S. citizens or lawfully present noncitizens may qualify for:
l MinnesotaCare with Federal Financial Participation (FFP) if they are Minnesota residents and meet all other MinnesotaCare criteria.
l State-funded MinnesotaCare if the child becomes incarcerated while enrolled in MinnesotaCare. If he or she remains incarcerated at next renewal, close MinnesotaCare. See Correctional Facilities for more information.
Noncitizen children who are undocumented or who have a temporary nonimmigrant status (such as students or tourists) are not eligible for MinnesotaCare but may be eligible for Emergency Medical Assistance. Nonimmigrant children who are legally admitted to the United States on a long term basis may qualify for MinnesotaCare.
Use the Systematic Alien Verification for Entitlements (SAVE) system to validate the immigration status of eligible noncitizen applicants and enrollees.
See Funding Health Care for Noncitizens and Undocumented and Nonimmigrant People for further information about immigration status and federal funding.
Children under 21 who are citizens or lawfully present noncitizens must follow citizenship verification requirements or immigration status requirements.
Note: Children previously enrolled in either MA or MinnesotaCare as an auto newborn are exempt from citizenship verification requirements.
Residency (standard guidelines)
Follow standard MinnesotaCare guidelines.
Insurance barrier requirements differ depending on whether a child has income at or below 200% FPG.
Generally, most insurance barriers are not applied to:
l Children with income equal to or less than 200% FPG.
l Children under age 21 who meet the Children’s Health Plan exception. These are children who were enrolled in the Children's Health Plan (CHP) on or before June 30, 1993, and who have maintained continuous enrollment .
See MinnesotaCare Insurance Barriers.
Household Composition (standard guidelines)
Children whose custody alternates equally between separated or divorced parents are considered part of both parents' households; however, the child can only be enrolled on one parent's case.
Children under age 18 who would otherwise be included in their parents' household must be excluded from the parents’ case and opened on their own case if they are emancipated minors. See Determining Household Size for MinnesotaCare.
See MinnesotaCare Major Program Eligibility Type (MPET) for information on determining a child's MPET.
Asset Guidelines (standard guidelines)
Exclude the value of assets for all children under age 21.
Do not deem sponsor's assets for households that include a child under age 21 who is applying for or enrolled in MinnesotaCare.
Do not consider income to be a barrier to MinnesotaCare eligibility for children under 21. Children are eligible for MinnesotaCare regardless of their household income as long as they meet all other eligibility criteria. However, there are two MinnesotaCare family income standards to consider for children:
l Children with household income greater than 275% FPG will pay the maximum MinnesotaCare premium. See Premiums below.
l Also determine if income is less than or equal to 200% FPG. For children who do not already meet the Children’s Health Plan exception noted above, this standard affects Insurance barriers, as noted above.
Do not deem sponsor's income for households that include a child under age 21 who is applying for or enrolled in MinnesotaCare
Deductions/Disregards (standard guidelines)
Follow standard MinnesotaCare guidelines.
There are three types of premiums for children:
1. Zero premiums. Children with income equal to or less than 200% FPG and children who qualify for MinnesotaCare for Certain Children Exiting Foster Care or a Residential Juvenile Correctional Facility do not pay a monthly premium.
2. Sliding scale premiums. Children with household income greater than 200% FPG, but equal to or less than 275% FPG pay a sliding scale premium based on household size, income, and number of household members covered.
3. Maximum premiums. Children with household income greater than 275% FPG pay the maximum MinnesotaCare premium based on the number of children enrolled. See MinnesotaCare Premium Amounts for maximum premium amounts.
See Premiums for further information.
MMIS will not cancel infants under age two for failure to pay premiums. See Forgiving Premiums. MMIS will cancel other household members who fail to pay their premiums without good cause.
Make a request to forgive the portion of the past due payments attributed to an infant under age two for covered months in the past at any of the following times:
l The other household members wish to re-enroll or reapply after a break in coverage.
l The household wishes to add new members or new coverage for existing household members.
l When the infant turns age two.
Note: Do not make a request to forgive payments attributed to the infant at any time other than those listed above, or payments for future months.
If a child under 21 is pregnant, treat her as part of the MinnesotaCare for pregnant women eligibility group for purposes of premium requirements.
Covered Services (Prepaid MHCP Manual)
Children under 21 are eligible for the same benefits as MA enrollees with minor exceptions. They are not subject to deductibles, co-payments, or the service limitations that apply to some adults.
Follow standard MinnesotaCare guidelines.
Caretakers (other than foster parents) of children under 21 must cooperate in establishing paternity and obtaining medical support for the children unless they show good cause . Children's eligibility is not affected by a caretaker's failure to cooperate. See Medical Support.
Note: Do not require pregnant women under age 21 to cooperate with medical support. See Pregnant Women and Newborns. There are also specific considerations for some children who do not live with a parent or caretaker; see Minor Child Lives Apart From Both Parents.
When children turn 21, their eligibility must be re-evaluated. See Change in MinnesotaCare Eligibility for further information.
l MMIS will create monthly worker messages to identify infants who are turning two in the current month for whom a premium payment has not been made.
l Before billing in the month of the infant's second birthday, make a request to forgive the infant's portion of any unpaid premiums that were not previously forgiven. This includes the infant's unpaid premiums through the month in which the child turns two.
For information about premium payments for children under age 21 who are pregnant, see MinnesotaCare for Pregnant Women.
See MinnesotaCare for auto newborns or special provisions applying to children born to a woman enrolled in MinnesotaCare.
Also consider MA for Children Under 21.
Workers who have contact with families during the application process are encouraged to inform families that the Child and Teen Checkups Program (C&TC) is a MinnesotaCare benefit, and that the county C&TC agency will contact them with more information.
Children enrolled in MinnesotaCare who turn age 21 must be screened for MA for adults without children and must be referred for MA if they appear to qualify.
Follow current policy and procedures to establish and approve eligibility on a new MinnesotaCare case for a MinnesotaCare child who turns age 21. Review the most recent application or renewal on file and other information known about the client to determine whether he or she may quality for MA for adults without children. Follow current policy to determine eligibility for MA or to transfer the application to the appropriate agency for a complete MA determination. Send the Notice to Apply for Medical Assistance (DHS-3404).
Track the case for 60 days from the first day of the month in which coverage could begin on the new MinnesotaCare case while MA eligibility is determined. Deny or cancel MinnesotaCare for the next available month if the client fails to complete and cooperate with the MA determination by the end of the 60 day period. Continue MinnesotaCare eligibility if the client is cooperating with the process, but the MA determination takes longer than 60 days, or if the client is determined ineligible for MA.
Follow the instructions below to approve MinnesotaCare eligibility for children who are applying on a new or inactive case with household income greater than 275% FPG:
1. Update all applicable MMIS person and case-based screens.
2. For each eligible child, enter the Major Program LL or KK, an Eligibility Type of I2 or C2 and a P43 span on RELG.
3. Enter appropriate denial spans for any children applying who do not meet all other eligibility requirements.
4. Enter appropriate denial spans for all adults who are applying.
5. On RINC, enter the maximum allowable income minus $1 for the household size (275% FPG minus $1). See 275% FPG to determine the maximum allowable income.
6. Enter approval case notes in MMIS with the following header. *** MCRE Waiver Workaround: Children Over 275% FPG ***.
7. Complete MinnesotaCare Approval and Premium Information (DHS-3739) and mail it to the household.
DHS creates two data reports each month to identify all cases for which the workaround was applied that have become active. The first report runs at the beginning of the month, and the second report runs after billing occurs each month. After each report is run, DHS provides MinnesotaCare Operations and county MinnesotaCare enrollment sites a list of identified cases they are administering. Before billing occurs, review cases identified in the report issued at the beginning of the month. Process by the last working day of the month cases identified in the report issued after billing occurs.
Review and update cases identified in the DHS reports as follows:
1. Verify the case is active and only the children are enrolled.
2. Review case notes to ensure the workaround was used on the case. The case should have a case note with the following header: *** MCRE Waiver Workaround: Children Over 275% FPG ***.
3. Review case notes to determine if any income changes have been reported by the household since coverage was approved. If an income change was reported and the household income is now equal to or less than 275% FPG, enter a case note with the header: *** MCRE Waiver Workaround Review: Children Now Under 275% FPG ***. Indicate in the case note that a review was completed, but an update was not required. Your review of the case is now complete.
4. If an income change was reported, but the household income remains greater than 275% FPG, or no income change was reported, update RINC to reflect the household's correct household income. Confirm that the monthly premium on RSLT reflects the maximum MinnesotaCare Premium for the household size and number of children enrolled. See MinnesotaCare Premium Amounts for the maximum MinnesotaCare premium amounts. Enter a case note with the header: *** MCRE Waiver Workaround Review: Children Over 275% FPG ***, and indicate that the case was reviewed and updated.