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Effective: May 1, 2007 |
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03.20.25ar2 - MinnesotaCare for Adults Without Children (Archive) |
Archived: October 1, 2007 |
MinnesotaCare (MCRE) adults without children include people age 21 and over who meet the following:
l Are not pregnant.
l Are not parents of children under 21 in the household.
l Are relative caretakers, legal guardians, or foster parents of children under 21 in the household, but are not applying for coverage for these children.
Eligibility factors are listed below with any information that is unique for this group. Links to standard program guidelines are included as well.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
Relationship to Other Groups/Bases.
Other Groups/Bases to Consider.
Application Process (standard guidelines)
Follow standard MinnesotaCare guidelines.
Follow standard MinnesotaCare guidelines.
Renewals (standard guidelines)
Follow standard MinnesotaCare guidelines.
Follow standard MinnesotaCare guidelines.
Social Security Number (standard guidelines)
Follow standard MinnesotaCare guidelines.
Adults without children who are U.S. citizens are not required to document their citizenship and identity.
Note: Applicants and enrollees who are otherwise eligible for MA or federally funded MinnesotaCare but fail to document their citizenship and identity are not eligible for state-funded MinnesotaCare as an adult without children.
Do not use the Systematic Alien Verification for Entitlements (SAVE) system for MinnesotaCare noncitizen applicants and enrollees who are adults without children.
Residency (standard guidelines)
To meet state residence requirements, adults without children must meet all of the following:
l Maintain a fixed address at a place other than a place of public accommodation, such as a shelter.
l Live continuously in the state for at least 180 days immediately before becoming eligible.
l Intend to live in Minnesota permanently.
l Not have moved to Minnesota for the primary purpose of obtaining medical care.
Follow standard MinnesotaCare guidelines.
Household Composition (standard guidelines)
Follow standard MinnesotaCare guidelines.
Adults without children do not qualify for Federal Financial Participation (FFP) regardless of group status. They are coded as:
l Group One if income is <75% FPG. This group status identifies the correct benefit set for these adults. However, unlike children with this status, they are not exempt from any insurance barrier requirements.
l Group Three if income is > 75% FPG but <175% FPG. This identifies people who are eligible for a different benefit set.
Asset Guidelines (standard guidelines)
The asset limit for non-pregnant adults is:
l $10,000 for a household of one.
l $20,000 for a household of two or more.
The income limit is 175% FPG.
Note: Adults with income <75% FPG may be eligible for a more complete benefit set. See eligibility group above and covered services below.
Deductions/Disregards (standard guidelines)
Follow standard MinnesotaCare guidelines.
Follow standard MinnesotaCare guidelines.
Covered Services (standard guidelines)
MinnesotaCare adults without children have some benefit limitations, deductibles, and co-payments which vary depending on household income. They may have one of two benefit sets:
l Basic Plus One – This includes people whose total household income is less than or equal to 75% FPG. This group has a $10,000 annual limit on inpatient hospital benefits, and a 10% inpatient co-payment (up to $1,000 per year).
l Limited - This include people whose total household income is greater than 75% FPG but less than or equal to 175% FPG. This group also has a $10,000 annual limit on inpatient hospital benefits, and a 10% inpatient co-payment (up to $1,000 per year).
Note: There are a number of services that are not available in this benefit set; see the MHCP Provider Manual for more information.
Adults without children have co-payments for other services, including emergency room visits, prescriptions and eyeglasses. These co-payments may vary depending on the benefit set.
Service Delivery (standard guidelines)
Follow standard MinnesotaCare guidelines.
Certain disabled adults without children must apply for MA. See that section for more information.
When adults gain parent or caretaker status, change eligibility to the appropriate major program and group status effective the month after the change. See Change in MinnesotaCare Eligibility Group.
MinnesotaCare and General Assistance Medical Care (GAMC), or MinnesotaCare and GAMC Hospital Only (GHO) may not be open at the same time.
Exception: In some cases, both programs may have to be open for one month if changes occur after capitation or 10-day notice cutoff. See Programs Overlap for further information.
Some GAMC applicants and enrollees who are adults without children are required to transition to MinnesotaCare. For more information, see Bulletin #06-21-12, "New Eligibility Requirements for the GAMC Program and Introduction of a New Transitional MinnesotaCare Program."
At initial application:
l If income <75% FPG, consider GAMC.
l If income > 75% FPG but <175% FPG, and client is hospitalized, consider GHO.
See relationship to other groups/bases above for information on possible overlaps between MinnesotaCare and GAMC eligibility.