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Effective: December 1, 2006 |
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03.50.05ar1 - GAMC With Full Benefits (Archive) |
Archived: May 1, 2007 |
People who do not have a basis of eligibility for MA are eligible for GAMC if they meet all of the eligibility requirements. This includes people who:
l Are adults between age 21 and age 65 who do not live with children who meet the definition of a dependent child . This includes parents whose only children are ages 18, 19, or 20, as well as adults with no children in the home and stepparents with no biological or adoptive children in the home.
l Receive General Assistance (GA) benefits and do not have an MA basis of eligibility.
Example:
Donald, age 19, receives GA. He has an MA basis as a child under 21 and meets all other MA eligibility factors.
Action:
Approve MA instead of GAMC for Donald.
l Receive Group Residential Housing (GRH) benefits and do not have an MA basis of eligibility.
People who are waiting for a disability determination for MA may receive GAMC while the determination is pending.
Note: Effective September 1, 2006, some GAMC applicants and enrollees who do not meet specific qualification criteria will be required to transition to MinnesotaCare. If they meet all other eligibility requirements for GAMC with full benefits but do not have a GAMC qualifier, they are eligible for Transitional MinnesotaCare instead of GAMC. For more information, see bulletin #06-21-12, ”r;New Eligibility Requirements for the GAMC Program and Introduction of a New Transitional MinnesotaCare Program.”
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)
GAMC applicants must complete the form Required Questions for GAMC (DHS-3423) at the time of application. See Legal Factors for more information about this requirement.
The earliest possible begin date for GAMC with full benefits is the date of application or the date all eligibility factors are met, whichever is later. Retroactive coverage is not available for GAMC.
Note: People do not have to be eligible in the month of application. Eligibility may begin at a later date if the applicant meets all eligibility factors by the end of the processing period.
Renewals (standard guidelines)
People who receive GAMC automatically due to being eligible for General Assistance (GA) or Group Residential Housing (GRH) benefits are not required to complete six-month renewals.
Follow MA Method A asset verification procedures.
Exception: Do not verify assets at the six-month renewal.
Follow standard GAMC guidelines.
People who meet the citizenship and immigration status requirements for MA (program MA or program NM) but do not have an MA basis of eligibility may be eligible for GAMC. Undocumented and non-immigrant people are not eligible.
Residency (standard guidelines)
To establish state residency for GAMC, a person must have lived in Minnesota for at least 30 days with the intent of establishing a home. A stay in a battered woman’s shelter counts toward the 30 days if the person intends to establish a home in Minnesota after leaving the shelter. Do not apply the 30-day residency requirement if:
l A household member has a medical emergency meeting the definition in Emergency Medical Assistance (EMA).
l The county waives the 30-day residency requirement for GA.
l A household member is a migrant worker who verifies that the household worked and earned at least $1000 in Minnesota within 12 months preceding the month of application.
Insurance and Benefit Recovery (standard guidelines)
Follow standard GAMC guidelines.
Follow standard GAMC guidelines.
Follow MA Method B to determine asset and income exclusions.
The asset limit is $1000 per household regardless of the number of people in the household or the number requesting GAMC.
Exception: Do not apply the asset limit to people applying for or receiving GAMC automatically with GA or GRH.
Asset transfers without adequate compensation are considered improper and may result in a period of ineligibility for GAMC.
Income Guidelines (standard guidelines)
Income limit is 75% FPG.
Exception: Do not apply the income limit to people applying for or receiving GAMC automatically with GA or GRH.
Note: For people with incomes greater than 75% FPG but less than or equal to 175% FPG, see GAMC Hospital Only (GHO).
No deductions or disregards are allowed for GAMC. Income eligibility is determined using gross countable income.
There are no spenddown provisions for GAMC.
Full GAMC benefits.
Exclude GAMC clients from managed care enrollment if they meet either of the following:
l Are eligible for Medicare benefits.
l Live in a nursing facility.
People who meet all other eligibility requirements but do not have a GAMC qualifier are eligible for Transitional MinnesotaCare instead of GAMC. To remain eligible for GAMC rather than transitioning to MinnesotaCare, applicants and enrollees must have one of the following GAMC qualifiers:
l Receive General Assistance (GA).
l Have a payment made under Group Residential Housing (GRH).
l Have applied for and be awaiting a determination of eligibility from the Social Security Administration (SSA) for Supplemental Security Income (SSI) or Retirement, Survivors, or Disability Insurance (RSDI) income based on disability.
l Be appealing a determination of disability from SSA.
l Have applied for and be awaiting a determination of blindness of disability by the State Medical Review Team (SMRT).
l Be entitled to Medicare due to end-stage renal disease.
l Are currently enrolled in other health care coverage.
l Be incarcerated and meet criteria for continued GAMC.
l Receive treatment through the Consolidated Chemical Dependency Treatment Fund (CCDTF).
l Are homeless or live in a shelter, hotel, or other place of public accommodation.
l Have lived in Minnesota for less than 180 days.
For people whose GAMC eligibility ends because they become eligible for MA due to being certified disabled, see Change in Basis of Eligibility.
GA recipients with no MA basis do not have to accept automatic GAMC. They may decline health care coverage. They may apply for MinnesotaCare although they are not required to do so.